Sclerosis of Unilateral Sacroiliac Joint in a Woman of 27

This is a case of chronic back pain in a female of 27 years, living in Faridabad. The patient was seen for the first time on 3rd March 2018.  At that time she presented with the following complaints:

Excruciating pain over the right sacroiliac joint the last three weeks. Shesaid that she may have developed it because of prolonged sitting, as she had been preparing for some examination. She had a constant sensation that something would break if she moved. The predominant modalities were:

<<lying on painful side

<<night

<< rising from seat

<<beginning to move

<<standing

>>lying on painless side

>>stretching the limbs.

The X-ray of lumbosacral spine revealed the following details:

1. Congenital sacralisation of L5(transverse process of L5 fused to sacrum).
2. Reduced disc space at level of L4-L5 (spondylolisthesis as a result of congenital sacralisation).
3. Mild sclerosis of Right sacroiliac joint.

PHYSICAL GENERALS

Thermal reaction – hot

Thirst- poor

Desires- sweets, sour, chocolate, milk.

Aversion- strong odors especially of perfumes and tobacco.

Appetite- increased; cannot tolerate hunger.

Sweat- not much; axillae, face, upper lip.

Stool- once daily; nad

Urine- D5-6,N0-1

Sleep – Takes a long time to fall asleep; disturbed by thoughts; sleeps with arms over forehead; has to sleep with a pillow and feels insecure at night if she wakes up and is not able to find a pillow; hypnic jerk present; can only sleep on left side as sleeping on painful side is impossible.

Dreams- falling, snakes.

GYNAECOLOGICAL AND OBSTETRIC DETAILS

Menstrual cycle 28+-2 days; last three days; PMS- low back pain and weakness; Gets profuse sweating during menstruation; Menarche-13 years; G0P0A0.

PAST HISTORY

*Chickenpox

*Typhoid

*Fall on the back 4 years back.

FAMILY HISTORY

*Hypertension

*Diabetes mellitus

*Hypothyroidism

*Asthma

PATIENT AS A PERSON

1. Weepy; cries about small things and also on watching an emotional scene on television. Cried while narrating her symptoms. Says she feels lighter after crying.
2. Aversion to being alone. Wants someone around her always.
3. Irresolute
4. Loves being caressed and pampered.
5. Fear of animals and thunderstorms.
6. Introverted, does not socialise much.
7. Easily startled.
8. Irritable
9. Anxious personality.

ON OBSERVATION

*Dry skin.

*Tongue coated at back.

*Involuntary sighing.

*After giving every answer she used to look at her husband for affirmation.

PRESCRIPTION

The patient was prescribed PULSATILLA in ascending LM potencies from March to October 2018.

Latest scans reveal neither the sclerosis of right sacroiliac joint, nor the reduced disc space at L4-L5 level.