CASE STUDY- 3

Presentator Dr. Ranjith

Abeysinghe

Personal details

Patient name
Age
Sex
Address
Civil status
Occupation
Religion

: Mr. A. K. Ariyasena
: 50yrs
: Male
: Neluwa, Galle
: Married
: Mason
: Buddhist

Present complain & duration

Main complain:
Pain and swelling in the right forearm
for 1 month
Other complaints:
Reduce normal movements of r/forearm
for 1 month
Slight deformity and stiffness in right
forearm since 1 month
Loss of appetite since 3 weeks

History of present
complaint
Had trauma in April 2015.
Then after that, felt severe pain and
swelling in right forearm. Pain aggravated
when moving the arm and at night. In
addition to that, difficult to moved r/arm
and he got fever after that. Also Slight
deformity seen in right forearm.
After seeking for medical advices, but the
present complaint still exists.(but pain is
now reduced).

Medical history
First he admitted to the Nagoda hospital
to get western medicine.
POP was applied.
Got anti-biotics and pain killers.
Pain was reduced but swelling, deformity
and immovability still persists.
Then after 2 weeks, he admitted to the
Ayurvedic hospital to get Ayurveda
treatments.

Family history

No family history
Have three children

Occupational history
Has worked as a mason in a private
building. Had fought with another
mason and then this trauma occurred.

Dietary habits
Rice and vegetables for all the three
meals
Eat meat or fish once a week
Has eaten lot of spicy foods
Less water intake

Sleeping pattern
less sleep from the childhood. Now it is
more decreased due to this disease.

Habits
Heavy alcoholic and cigarette smoker
Eat betals at least 6-7 times
Bowel habits
1 times per 2 days. Mild pain occur and
lasts
from 10-15
minutes after
defecation. Hard stools.
Urination
D/N = 4-5/1-2 times per day
No pain or any abnormal discharge

Constitution
Physically - Vatha-pitta
Mentally - Rajas guna

Body constitution
Height 54
Weight 48 kg
B.M.I. 20.77

Examination of Srothas
Anna waha srotas Agni
Abyavarana sakti Awara
Jarana sakti
- Awara

Rasa vaha srotas

Rakta vaha srotas
Mansa vaha srotas
Asti vaha srotas

- awara
madya
madya
awara

Examination of Sra

Rasa
Raktha
Mansa
Medas
Asti

avara
madya
madya
avara
avara

Local Examination
Trivida pariksha on affected site

Darshana pariksha
Deformity in 1/3 of right fore arm
Swelling in that area
Reduced the movements of r/forearm

Sparshana pariksha
Moderate pain when touching the affected arm
Different movements/unable to perform correct
movements when touching
Heard sounds when touching(chimi chimi)
(crepitus)

Prashna pariksha

Pain present when examination(tenderness)

According to Nidana panchaka

Causes (Nidana)
Has eaten lot of spicy foods before getting
this trauma
Low consumption of water
Worked hard and had less time have a rest
Alcohol, cigarette intake
Less sleep, constipation
Vata prakriti, rajas guna
These factors may help to aggravate the
disease and reduce the healing of fracture.

 Rupa
Moderate pain in affected area
Swelling and stiffness in r/forearm
Difficult to do normal movements

Samprapti
Due to trauma, and the fracture of the
bone, mainly Vata and also Pitta &
Kapha doshas get vitiated & affect on
rasa, raktha, mansa and asti dathus
and produced the deformity, pain,
swelling and loss of normal movements.

Pathogenesis
Aganthuja Nidana(trauma)
Fracture of the right forearm
Vitiated Vata, Pitta & Kapha dosas
Affects on rasa, raktha, mansa, asti dathus
Accumulated in right forearm
Pain, swelling, deformities in right forearm
Unable to perform normal movements of r/forearm

Dosha and Dushya

Dosha
Mainly Vatha
Pitta
Kapha

Dushya

Rasa
Raktha
Mansa
Asti

Roga marga, Srothas and Srotho

dusti
Roga margaya(site of disease)
external(Bahira)

Srothas
Asti waha srothas
Rasa, raktha, mansa waha srothas

Srotho dusti
- Sanga

Investigations
X-ray of R/forearm
A-P View
Lateral view
FBC
Differential Diagnosis
Kanda Bhagna
Sandi Bhagna

Diagnosis
Kanda bhagna
Pain, swelling in 1/3 of r/forearm
Stiffness
Heard sounds when moving the arm
Unable to perform normal movements of
r/forearm

Prognosis
Yapya
Body constitution
Dietary habits
Time
Mental state

Cikithsa sutra
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>D; os.afoak mfk fIaghs;ajd h:d
mfgdamr l=Ydka o;ajd h:djoa nkaO udpfr;a
2 W;amsIaGu: Ia,sIagx ikax ffjoHdk >gfha;a
;;# Y;dk mrsfYalx m%foaydxYajpdrfha;a
3 N.ak udfo! mrs{dh lD;sx m%lD;sx kfha;a
;;# Y;dnqkd isxfp;a mQ; mxflak jd ;;#
iqY%e; ixys;dj

Treatment Protocol(ls;aid uQ,Ou&

ieliu
fiaosu
ndysr m%;sldr
wNHka;r m%;sldr
m:Hdm:H

Treatment

Abyanthara(Internal)
Specially Vatha shamaka drugs
Dashamula kasaya + babila mul+sudulunu
Lakshadi guggulu 1 b.d. with warm water
Thalisadi churna 1 tea spoon with warm water b.d.

Bhahira(External)
- Application of Nilyadi oil and correct the position of
bones
- Applied Katakala paste and bandaged with sticks
Sathwawajaya Cikithsa

Pathya apathya
Pattya
Light diet is advised.
Take plenty of fluids and water
Reduced the movements of r/arm until
complete cure
Meditations and yoga to reduce stress and
anxiety

Apathya
Spicy and fermented food
Alcohol, cigarette intake
Swimming in cold water

Anatomy of the forearm

The radius and ulna have an important role in
positioning the hand. The ulna has a stabilising role,
while the radius is articulated in a way which allows
it to roll over the ulna, moving the hand from
supination (external rotation) to pronation (internal
rotation).
The two bones of the forearm are the radius,
laterally, and the ulna, medially. Other components
of the forearm include skin, blood vessels, and soft
tissue.
At its upper end, the radius articulates with the
capitulum of the humerus at the elbow, and with the
ulna (superior radio ulnar joint). At its lower end it
articulates with the scaphoid and lunate bones and
also with the ulna (inferior radio ulnar joint).

 At its upper end, the ulna articulates

with the trochlea of the humerus, and
with the head of the radius (superior
radio ulnar joint). At its lower end it
articulates with the radius (inferior radio
ulnar joint).
The olecranon process at the upper end
of the ulna forms the prominence of the
elbow. The styloid processes of the
radius and the ulna form prominences
at the wrist.

Forearm fractures
Forearm fractures account for most limb
fractures. Wrist fractures are the most
common forearm fracture.
Fracture risk factors include osteoporosis
(more common in women than in men)
and malignancy (pathological fractures).
Fractures of the radius and ulna may
occur in isolation - usually due to a direct
blow - but these are usually associated
with fracture or displacement of the
other bone in that forearm.

Classification
Forearm fractures can be classified as
either proximal, middle or distal.
They can affect one or both forearm
bones.
They are either open or closed.
Proximal forearm fractures may
involve the elbow joint.
Distal forearm fractures may involve
the wrist.

Mechanism of injury:
usually a significant force injury. These
most commonly occur in motor vehicle
accidents, and also occur from a direct
blow, a fall from a height or during sport.
Presentation:
pain and swelling at the site with obvious
deformity.

Assessment:
may
be
nerve
involvement
with
paraesthesiae, paresis or loss of function.
Do not elicit crepitus, as this may cause
further soft tissue injury. Do not probe
open fractures as this may cause deeper
contamination.
Investigation:
X-ray the entire length of the forearm,
wrist and elbow, with AP and lateral
views. Consider compartment syndrome.

Management:
displaced fractures are the usual
situation in adults.
Operative treatment with internal
fixation or intramedullary nailing will
be needed in nearly all cases, so refer
urgently.
Closed reduction may be attempted
(with sufficient sedation/analgesia
muscle relaxants) if there is acute
neurovascular compromise.

Complications of forearm fractures

Non-union and malunion (uncommon).
Compromise of the brachial/radial
artery blood supply.
Median, ulnar or radial nerve injury.
Infection (more likely if the fracture is
secondary to a crush injury).
Compartment syndrome (more common
in both-bone forearm fractures).
Radio ulnar fusion (synostosis).
Re-fracture

Prevention of forearm fractures

Prevention of osteoporosis.
Adequate
treatment
of
existing
osteoporosis.
The use of wrist and elbow guards
whilst taking part in certain sporting
activities, such as mountain biking and
skating.

Thank
You