A Case of Frozen Shoulder

Mrs. Smd, aged 57 yrs, housewife

Presenting complaints:

1. FROZEN SHOULDER SINCE 7-8 YRS: on and off on both sides. No amel. from warm applications, rather it agg. Suffers for 2 days at a stretch; releases slowly. Pain appears slowly⁺⁺.
   • Feels internal heat, desires fan, open air, >fanning.
   • Thirstless, less than 1ltr. per day.
   • Lumbago – can’t bend forward.
   • Numbness after sitting for long time.
   • Perspiration on scalp more < summer, warmth.
   • Doesn’t feel cold in winters – HOT patient.

2. SLEEPLESSNESS SINCE 1-2YRS: weight increased while taking medicine (allopathic Rx. – probably steroids).
   • Doesn’t work fast.
   • Doesn’t feel fresh after sleep in noon (siesta).
   • Gets good sleep while sitting on chair.

Past History

• Hypertension after exertion since 2-3 yrs. Started after marriage – LSCS, 2 abortions.
• H/o accident, twice fell in bathroom, hit on lumbar region causing lumbago. She was affected more on right side.
• Feels retrosternal burning < after eating. > Normal water.
• Headache from anxiety.
• Fever appeared for 1day, 2-3 months back.
• Cold, hoarseness of voice, twice a year, every year.

Family History

Personal History:

1. Appetite: Generally reduced. Only after exertion⁺⁺. Prefers warm food. Caries in most teeth – pain < cold, hot, sweet.
2. Thirst: Thirstless⁺⁺⁺.
3. Desires: Sweets⁺⁺⁺, Non-veg⁺⁺ (mutton, fish), tea.
4. Aversion: Sour⁺⁺, Eggs agg., Salt, Milk, Fat food agg⁺⁺⁺.
5. Micturition:
6. Bowels: Once daily, satisfactory.
7. Sleep and dreams: Sleepless until 2-3am. Sleeps on back. Doesn’t cover⁺⁺⁺. Fan is must. Excessive dreams – nightmares⁺⁺⁺ – wakes up from sleep. Dreams seem real, ghosts, spectres etc.
8. Perspiration: Odor (Nil). < On exertion. More on nose, upper lips, scalp, all over. Easily tired after more than routine exertion. Staining⁺⁺.

Menstrual History:

Menarche: 14yrs of age.

Dysmenorrhoea with menorrhagia. Menses generally last 7-8days, every 20days. Regular.

Before: pain in lower abdomen.

During: Lumbago, abd. pain.

Menopause at 52yrs of age.

Obstetric history:

1^st child: MALE (30yrs), LSCS.

2^nd child: MALE (28yrs), FTND.

3^rd child: MALE (died at the age of 13yrs of age), FTND.

TUBECTOMY.

THERMALS:

• BATHES with mild warm water.
• Wants FANNING while sleeping, generally all the time.
• A/C is intolerable, felt extremely chilly.
• Good in winters and rainy season. Hates summer, agg. summers.
• Travelling – N.
• Hill-station and sea-shore:
• Generals: HOT⁺⁺⁺.

PHYSICAL:

Black moles all over neck.

Nails – N.

Tongue: Cracks, little in centre. Yellow coating in back.

Physically she is fair and fat with multiple black moles on neck.

Life-space development:

• Easily angered. Soft as well as hard.
• Fastidious about cleanliness, however dinner utensils are washed in morning.
• Active @ night⁺⁺.
• Religious⁺⁺⁺
• Thinks negative always. Lack of confidence. Doesn’t make decisions, always⁺⁺⁺ asks others’ opinion.
• Weeps, when someone tells her something or talks about her.
• After getting up from sleep, doesn’t feel fresh immediately.
• Sleepy while sitting, but very lethargic on waking.
• Sciatica < bending, sitting down. > standing, lying down⁺⁺.
• Fell down during pregnancy – profuse haemorrhage at that time.
• Cannot tolerate noise, anxiety starts.
• Palpitations from fright – started after second delivery. Extreme fear of fights⁺⁺⁺⁺⁺.
• Does not let other people finish their sentence, starts talking first (this symptom was narrated spontaneously by her).
• Fear of large bodies of water.
• Pain in heart on waking in night.
• Loves reading, writing.

summary:

We have a 58 yr old fair and fat women with moles on neck and frozen shoulders on both joints. The pains appear slowly and agg. from warmth. There is internal heat also and hence she requires fanning all the time. She is sleepless with dullness on waking, both in morning and after siesta. Past h/o hypertension, spinal injury, headaches, acidity and annual coryza with hoarseness. Family history is minimal but sycotic miasm seems prominent. Appetite increases on exercise only, with preference for warm food. Dental caries < both hot and cold and sweet. Thirstless, agg. from fat, eggs and a strong desire for sweets. Sleeplessness with nightmares of ghost which wake her up and dreams seems real. There are pains before and during menses, menopause uneventful. Hot patient at a general level with great desire for fanning. Tongue has a crack in centre. On mental and emotional level we have lack of confidence, easy weeping, unrefreshed on waking, sleeps mostly while sitting, palpitations from fright, loquacity, fear of water and sensitivity to noise.

Analysis:

If I were to prescribe without repertorising this case, I would just prescribe Pulsatilla. The reasons are easy to understand, hot and thirstless patient with agg. from fat along with easy weeping, lack of confidence and fears….a perfect picture. I would have done that if there were no other symptoms in this case. But because of the detailed case taking, I was able to come up with a few peculiarities in the case. I am a great fan of PQRS symptoms and most cases I post are generally solved based on it. Hence, in this analysis, I shall only discuss the peculiarities of the case. You can also look at the rep. sheet to get an idea of the peculiar symptoms as well as the symptoms covered by different remedies:

1. Active at night: only one remedy comes up prominently.
2. Multiple fears: fear of quarrels, water, palpitations, anxiety/fear of noise. However no single remedy covers all to give us a clear image.
3. Sleep and dreams are peculiar: she sleeps well while sitting and nightmares wake her up. Dreams seem real and consist mostly of ghosts. Also, always unrefreshed sleep is peculiar.
4. Loquacity: The peculiarity is that she wouldn’t listen to another person but rather keeps saying her mind. Hepar-sulph is the only remedy in this rubric but it is an extremely chilly remedy. However, from materia medica we know of other remedies which have this.
5. Mouth: we have two peculiarities here. Crack in the middle of the tongue. As she has not taken any hom. treatment in the past, this becomes a pure symptom. Also, her toothache is agg. from both hot and cold; which contains only 2 remedies.
6. Pain in heart on waking in night. At a general level she is not well on waking.
7. warmth agg. in any form, from food or otherwise. Great desire for sweets and agg. from fat ( I believe it’s because it increases the internal heat).
8. Mental-emotional: Cannot tolerate least criticism. She weeps easily.

Follow-ups:

1^st Prescription: Lachesis 200/ 1 dose was prescribed with placebo. She was advised to follow-up after 2weeks.

1^st follow-up: She came after 6 months and straight away asked me to repeat the medicine that I had given her the last time. I knew that the face was similar but I couldn’t remember the case. Hence confirmed from her case sheet. When I looked at the case-sheet I was shocked. I realised that she was the same lady who had come 6 months earlier with both sides having frozen shoulder and now she is back. On enquiring I found out that immediately after the 1^st dose, all her complaints were better. Even her sleep and appetite improved. I could see that her weight was the same though most moles on her neck had disappeared. On enquiring why she did not come all these days, she said nothing (probably financial stress). The reason for her coming now was that since the last 2 weeks, her left should pain had gradually come back. Right side was totally normal and her sleep was also disturbed since 2 weeks ago.

I prescribed the same as last time and asked her to see me in 2 weeks if her complaints did not improve. It has been some time and she has not yet come back, but I know that she will again come back after 5-6 months when the action of the remedy will be over.

Also, as you can see that I only talked to this lady twice (follow-up was just 5 mins.). There is not much personal opinion that I can give here, but if she follows up regularly I shall share more information.

In homoeopathy, when a remedy acts at such a constitutional level, taking hold of the whole organism and curing it, such a case must be shared. I know that there are possibilities for other remedies too in this case (at least repertorially) but LACHESIS is the remedy that cured and that’s all that matters.

Kindly post your comments on the case, repertorisation or the D/D or discuss the remedy Lachesis itself.