Management of De-Quervain's tenosynovitis by Agnikarma with Suvarana Shalaka: A case report

Abstract

De-Quervain's tenosynovitis is a painful condition characterized by wrist pain and swelling at the radial styloid process due to inflammation and thickening of the tendon sheath of the abductor pollicis longus and extensor pollicis brevis. Conventional treatment includes rest, analgesics, corticosteroid injections, and surgical release. In Ayurveda, this condition is correlated with Snayugata Vata, where Agnikarma (therapeutic heat) is recommended. A 55-year-old female presented with severe left wrist pain, swelling and difficulty in performing household work for 20 days. Finkelstein's test result was positive, with tenderness of grade-3 (withdrawal sign) and visible swelling. She underwent three sessions of Agnikarma using Suvarana Shalaka (gold rod) in a linear Bindu (point) pattern at weekly intervals. Outcomes were assessed using the visual analogue scale (VAS), Quick disability of the Arm, Shoulder and Hand (Quick DASH) score, and soft tissue tenderness scale. Complete pain relief and functional recovery of the wrist were achieved and sustained over an eight-month follow up period. Agnikarma alleviates Sroto-Avrodha(obstruction) enhancing Rasa-Raktadi Dhatu Samvahana (nutrient flow) and tissue extensibility. Suvarana Shalaka delivers continuous therapeutic heat through the conduction method without causing Dagdha Vrana (burn or blisters). This case report serves as a lead for future researches on the efficacy of Agnikarma with Suvarana Shalaka on Snayugata Vikara. It also suggests Agnikarma is a safe, cost-effective, day-care, drug-less treatment that obviates reliance on long-term use of analgesics and anti-inflammatory drugs.