here. pt. who. is. suffering. mrng. pain. pip. n dip . shoulder joint ... she. is. unable to. shoulder. flexion ... thay. hv. tk. medications. ... but. not. relive . plz. guide. medical. management ..... thank. u


Even after first you have to go for RA factor Quantitative. Anti CCp if you find the report against your patient u can start ARMDs with NSAIDs like Etoricoxib with Rutoside and peptidase. But even after for better functional improvement in your patient condition can go with Physiotherapy. Physiotherapy programs are 1- US Therapy with 1MhZ for about 6-8 mins and 0.8watt/cm2 for both shoulder and PIP. DIP as well. 2. IFT for about 12-15 for shoulder only 3. Contrast bath 8-10mins for PIP DIP and Shoulder 4. Shoulder MWM followed bu PRT 5. PIP and DIP Mobilization Advice for Active ROM Exercises for shoulder and other joints. Capsular stretching for shoulder active and passive as well. Do isometric exercise for shoulder and other joints. M sure this will improve your patient's health. Thanking you
R,A, factor positie uric acid normally IFT warks but temporary For alopathy drugs I have got results but it was temporary but apart from allopathy. I tried for Homeopathic remedy i, e, Sanicula in 200 potency mostly I got good result I have studied im integrated courses i,e, Ayurved + Alopathy but in Homeopathic remedy I had gain knowledge independent and most of time I got results in arthritis cases.

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Why only medical management, why not other. Other alternative medicine can improve better your patient's condition.
Kindly reffer the patient to a rheumatologist specifically. And along witb that continue the physiotherapy treatment. That will definitely improve the general condition of the patient. Physiotherapy part as told by dr. Rahul pandey ji. Is perfect.
First you have to go for RA factor Quantitative.. Physiotherapy programs: 1.Us therapy according to the pain.U can give 1 MhZ for 5-8min with 0.8 watt/cm for both shoulder PIP DIP and Shoulder.. 2.PIP and DIP Mobilization 3.Hot pack 8-10 min. 4.IFT for about 10 -12min.. 5.Active ROM Exercises for shoulder joint? 6.isometric for shoulder joints. 7. Capsular streching 8.Go for shoulder gjoints exercise, finger lader, stick exercise etc.
If patient unable to flexion.go for the passive movements of shoulder joint.
i strongly contradict the statements given by several physios. And a humble request. Kindly don't give heat therapy in any form other than contrast bath to any rheumatoid arthritis patient without any deformity. As the condition itself is inflammatory. Giving heat will worsen the condition. Apply cold or contrast bath if there is no contracture or deformity. Not going according to literature. But sharing my experience.
Along with medication patient require exercise protocol, superficial heat therapy to reduce pain, ultrasound to reduce inflammation in joint, Active ROM exercise along with joint mobilization. Life style counselling will also work with this patient. It is long term therapy. Shoulder joint capsular stretch and passive joint mobilization will work. If he developed any deformity in hand splitting will also work.

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"No Heat packs" . The joints are already inflamed. By heating modalities chances of inflammation will increase and worsen patients problem. Superficial pain relieving modalities with manual mobilization of affected joints will definitely improve patients condition.
Since RA factor is positive you have to get base line liver and renal function test and blood counts. After the test according to the reports start dmards. Repeat blood test monthly.
Along with medications for RA ,she should do ROM exercises for shoulder and finger ,wrist stretches, hot water fomentation also eases the pain and stiffness.
As the ESR is high and Rheumatoid Factor is positive the patient may be diagnosed as a patient of Rheumatoid Arthritis and accordingly treated with DMARDS
plz. prescribe. medical. treatment

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