A 52 years old man Known alcoholic and smokers arrived in screening on 200405 with

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HISTORY
A 52 years old man Known alcoholic and smokers
arrived in screening on 20/04/05 with c/o Pain
in left leg. It got twisted due to mis-step while
walking 20 days ago. Since then pain in whole
left leg. Gets Lightening like Pain lt Bearing
weight on it left leg associated with
Cramps. Took treatment with local G.P without
much relief. All pains are worse while walking
and better rest. 10 DAYS AGO- Developed
swelling of the left leg, ignored the swelling
and gave a massage with oil which worsened the
swelling in left leg.
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Examination findings T 98.2 F, P 80/min, B.P
124/80 mmHg, Wt 78 kg. RS/CVS NAD. Left Knee
No redness, swelling, or increase in local
temperature. Movements restricted. Left Leg
Swollen from knee to ankle with sparring of ankle
joint pitting oedema. Skin over it shiny,
tense, warm and perifollicular erythema.
Sensation over the area were well
preserved. Dorsalis Pedis and Posterior tibial
pulsations were well felt. Left calf had a tense
feel.
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Moses sign- Positive. Homan's sign
Positive. There was no diffuse redness / dilated
vessels over the limb.
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• CLINICAL QUESTIONS ARISED.
• Why Pain mostly in the calf now rather than in
  the knee?
• Why isnt there a complaint of stiffness?
• Why did the pain and swelling first start in the
  knee
• then traveling downwards?
• Why is it acute onset rather than chronic one?
• Why is there unilateral involvement?

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• CLINICAL DIAGNOSIS
• CRITERIA
• Left Leg unilateral oedema tense and tender.
• Mosess sign positive.
• Homans sign positive.
• Peripheral pulses well felt
• PROVISIONAL DIAGNOSIS DEEP VEIN THROMBOSIS.
• SEAT OF DISEASE AS PER CLINICAL ASSESSMENT
• (Colour Doppler could not be done because
  sonologist had already left for the day.
• Patient was posted for Venous colour doppler
  next day).
• Venous Thrombosis
• Sluggish Venous circulation.

S Y M P T O M S
Pain lt3 least movement, jar, walking.
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REMEDY SELECTION HAMMAMELIS 200 4
hourly. FOLLOW UP He reported next day for
follow up and investigation.
?
SQ
BOTH SYMPTOMATICALLY AND ON EXAMINATION
FINDINGS.
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VENOUS COLOUR DOPPLER STUDIES WAS DONE. Common
femoral Vein, Deep Femoral vein superficial
Femoral Vein, Popliteal, and Leg veins were
Normal. No evidence of Thrombosis. Evidence of
fluid collection in the leg muscles upper
medial aspect 7 x 3 cms. Source of fluid
collection probably due to Ruptured bakers cyst.
(Morrant Bakers cyst). ORTHOPAEDIC OPINION
SUGGESTIVE OF THE SAME DIAGNOSIS.
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THANKS TO TIMELY INVESTIGATION
MODALITYINTERVENTION WHICH LEADUS TO EXACT SEAT
OF DISEASE.
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TOTALITY REFORMULATION.
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• 21/4/05
• FINAL PRESCRIPTION BRYONIA 200 4 hourly given.
• ANCILLARY MEASURE
• CREPE BANDAGE APPLICATION TAUGHT.
• FOLLOW UPS
• 1ST WEEK.
• 1st follow up 40 Improvement.
• 2nd follow up 70 Improvement.
• 2ND WEEK.
• No further improvement potency of BRYONIA was
  raised to 1M.
• 3RD WEEK.
• ALL SYMPTOMS DISAPPEARED. Examination finding
  Knee and ankle better
• completely, ROM better and unrestricted. MOSSES
  and HOMANS Sign negative.

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A RAY OF LIGHT CAN HELP US TO CHANGE THE
DIRECTION WHEN WE GROPE IN DARK. PROVIDED! WE
ARE WISE ENOUGH TO PICK UP THE HINTS GIVEN BY
NATURE.. THIS CASE IS ONE SUCH EXAMPLE. WHAT
IS TO BE CURED IN DISEASE? HELPS us to apply
WHAT IS A CURATIVE MEDICINE?