Ayurvedic management of unilateral thenar atrophy mimicking Hirayama disease: a case report

Abstract

Thenar atrophy is the atrophy of the muscles on the radial aspect of palm, flexor pollicis brevis, abductor pollicis brevis and opponens pollicis which have the function of precision pinching and grip strength.  Thenar atrophy can be correlated to Viswachi in Ayurveda in which there is deficit in function of hand. Viswachi is a disease said in vatavyadhi nidana in which vata affected Kandara which supplies the bahu cause diminished functioning of the hand. The article assesses the effect of Ayurveda treatment as a supportive measure in motor neuron disease.  Here is an Ayurvedic management and supportive rehabilitation of 24 years old male who was presented with weakness and atrophy of thumb of right hand since 2 years. The clinical presentations are very much similar to Hirayama disease and on detailed clinical examination there is motor deficit of recurrent branch of median nerve. Upon investigations the MRI findings are suggestive of cervical myelopathy rather than Hirayama disease. The patient was admitted and manged with the protocol of vatavyadhi chikitsa. The treatment protocol included shodhana, samana and brimhana chikitsa adopted in this case and mode of action is described in this article. Considering the thenar atrophy treatment local brimhana therapy was also administered. Follow up medicines were prescribed along with upanaha and continued for one month. The case was assessed using the MRC scale of muscle strength, and Quick DASH questionnaire for quality of life. Muscle strength improved and QOL with DASH questionnaire improved from 61.36 before treatment to 40.90 after treatment. The present case of viswachi was rehabilitated and got improvement in quality of life related to the function of the hand by conservative ayurvedic treatment protocol.