Practice Ayurveda daily for a healthy life.

Practice Ayurveda daily for a healthy life. The following guidelines must be followed by all individuals if they want to maintain an active and healthy lifestyle. Ayurvedic teachings state that harmony between the mind and the body is the key to a happy existence. A great and thriving nation can only be built by healthy people. Consequently, we place a premium on health. Major health crises are happening all across the globe right now, and unfortunately, contemporary medicine has not yet found a solution. 

Consequently, spreading awareness about Ayurveda is critical if people are to improve their quality of life. 

Dhatukshaya stands for the illness Kashta Sadhya, and Sandhis are part of Madhyama Roga Marga. Consequently, one's physical strength is affected and they become unable to conduct everyday activities due to Janu-Sandhigata Vata being Shoola and Shotha pradhana Vatavyadhi. Physical harm can make it difficult to go about daily life, which can lead to stress. So, kashta sadhya illness can be caused by Vata Dosha, Dhatukshaya, and Madhyama Roga Marga.

 

"Sneha Saroayam Purusha" is how Shusruta eloquently defined Snehana, which indicates that Sneha is the essence of a human being. Based on the information provided in the aforementioned texts, Sneha has been appointed as the manager of Janu Sandhigata Vata. This will not only aid in the current healing process but also lead to the development of new treatments that will help people overcome this disease. Another benefit is the potential reduction in hospital waste and hospitalizations because treatment can be done at home.

Janu-Sandhigata Vata illness is characterized by Sandhi, or joint, pain, and has symptoms such as Sandhishoola, Sandhishotha, Prasaranakuncananayoh Savedana, and Hanti Sandhigatah, which mean restriction of joint mobility and chronic discomfort during joint movement, respectively.

This illness was not listed among the eighty varieties of Vata Vyadhi, although it is referenced in the Samhita as "SandhigattaaAnila," as per Acharya Charaka.   Vata Vyadhi Maharoga is how it is characterized in Astanga sangraha. Even in modern industrialized nations, the complicated condition of Sandhigata Vata can lead to disability. It seems like Sandhigata vata shares many of the same symptoms, indications, and characteristics as osteoarthritis. 23% to 40% of the population suffers from this illness. In India,     It could be 20 to 30 years before you have any symptoms at all. Inflammation and discomfort are symptoms that often manifest in middle age. Forty percent of women over the age of 65 report symptoms, and seventy percent show radiographic evidence. . 

NEED OF STUDY: -

Treatment for arthritis reveals persistent discomfort. Both the short- and long-term effects of commonly used anti-inflammatory and analgesic medications are limited. 

When treating osteoarthritis, particularly of the knee joint, intraarticular steroids are commonly employed. This disease's symptoms can be alleviated for a few weeks or months after treatment. Check more frequently than every four to six months. There is no long-term solution, not even with surgery. So, everyone is hoping that Ayurveda will be the answer to JanuSandhigata Vata's safe and successful therapy. Although modern medicine offers numerous antibiotics, PT, and surgery as final treatments, none of these options are permanent, and the condition will recur. Nonetheless, Ayurvedic approaches can alleviate Sandhigata vata symptoms and even prevent surgical procedures in some cases. 

Muscle relaxants, non-steroidal anti-inflammatory medications, exercise, knee traction, surgery, and analgesia (pain alleviation) are the modern medical definitions of the therapy of knee osteoarthritis.

Pitfalls in the above experience:

• There are many problems with medications such as non-steroidal anti-inflammatory drugs. 

• Bed rest may reduce the patient's activities and lifestyle. 

• Patients refuse surgery due to fear and other reasons. 

So, Ayurveda is the way to go for treatment. Knee osteoarthritis treatment includes Vataghna measures (oral medication), as well as Panchakarma treatments including Swedana Upanaha, Agnikarma, and Basti. Across all subjects and objectives, surprising outcomes were obtained. These treatments have many limitations:

• Patients administered by Basti, Upanaha Sweda , and Patra PindaSwedana Karma need to stay in the hospital or go to the OPD every day. .

• Patients refuse to receive this type of treatment due to fear. 

• The patient suffered multiple burns in the affected area of ​​the kneejoint due to excessive heat resulting from the Swedana karma. 

• Snehadhara and Patra Pinda Swedana Karma is very expensive and need daily panchakarma aids. 

In this trial, Snehapana, an oil that is taken orally, was administered with all of this consideration. Using Snehapana mix at home or in an outpatient setting does not necessitate a doctor's visit. Patients self-administer Snehapanat without making an office visit. 

When used to the therapy of Janu Sandhigata vata, Snehapana karma offers the aforementioned benefits and more, becoming a novel approach to medicine that helps alleviate suffering and cut down on hospitalizations. There will be less need for hospital trash if the therapy can be done at home. 

A randomized clinical trial was carried out to assess the efficacy of Snehana karma in Janu Sandhigata vata in light of the high incidence and disability during effective and effective meditation, as well as the classical literature on the subject.

Aim : 

1. To evaluate the effectiveness of Ksheera Bala Taila Snehapana (oral method) and Matra Basti (rectal method) with Ksheera Bala Taila in the treatment of Janu Sandhigata Vata. 

Purpose:

1. To evaluate the effectiveness of Snehapana (oral method) compared to Ksheera Bala Taila and to compare the improvement of WOMAC scale in the treatment of Janusandhigata vata. 

2. To evaluate the effectiveness of Matra Basti (rectal method) with sheer Bala Tail in the treatment of Janu Sandhigata Vata based on the modified WOMAC scale. 

3. To compare the effect of Snehapana combined with Ksheera Bala Taila(oral method) with Matra Basti combined with Ksheera Bala Taila (rectal method) in improving Janu Sandhigata Vata control of WOMAC scale.

1. To asses prakriti of   patients suffering from JanuSandhigata vata (knee osteoarthritis)

DISEASE REVIEW

HISTORICAL REVIEW         AYURVEDIC REVIEW              MODERN REVIEW

All Acharyas recite Sandhigata Vata in Vatavyadhi. A study of Indian scriptures shows that Sandhigata Vata has been harming people since ancient times. Vedas are the source of all kinds of knowledge that are very important for the short life of the world. 

A) Vaidika Kala 

Rigveda - - Describes the work of Ashvini Kumars who cured Rishi Shrona's joint injury. Atharvaveda – The five Vata doshas mentioned in Atharvaveda are Prana, Udana, Samana, Vyana and Apana 

Atharvaveda says that Sandhivikriti arises from Shlesma Vikriti and can be cured by prayer

B) Purana Kala:-

Agnipurana- Agnipurana- In this Purana, Chapter 279 contains some references to Asthigatavata, Majjagatavata and Sarvangavata Sandhigata Samavata. 

Garuda Purana- In this treatise, there is a separate section called Vatavyadhi Nidana, but there is no Sangavata Jinjini Vata definition of this disease, and the name which is not found in Samhitas is also explained. 

C) Samhita Kala: -

1. Charaka Samhita: -

Acharya Charaka explains Vatvyadhi in Vatavyadhi Chikitsa Adhyaya. However, no specific treatment for this disease is mentioned in Vata Vyadhi. 

Charak defines Vatvyadhi as "Sandhigata anila" in Chapter 28 of Chikitsa Sthan and here he mentions the main symptoms of Vatvyadhi, namely Vatapurnadritisparsa Shotha, Prasarana Akunchanayaho Pravrutishcho Vedana. 

1. Sushruta Samhita: -

Acharya Sushruta described Vataja vyadhi in Nidanasthana with main symptoms like Sandhi hanti, Sandhisula, and Shopha .

Sushruta also describes healing methods like Sneha, Upanaha, Agnikarma, Bandhana, and Mardana in Chapter 4 of Vatavyadhi Chikitsa Sthana .

Sushruta also considered this Sandhigata Vata as a separate disease condition and described it in Nidana Stathana.

1. Astanga Sangraha and Hridaya (6-7th century AD): -

Astanga Sangraha and Hridaya described the same symptoms as given by Acharya Charaka and the line of treatment given by Acharya Sushruta .

1. Bhela Samhita: -

Acharya Bhela does not explain this disease in detail. However, while explaining Asthi-Majjagata vatavyadhi , he has mentioned  Sandhi  Vichyuti . 

1. Harita Samhita: -

Acharya Harita explains the treatment of Sandhigata Vata but does not mention the diagnosis of Sandhigata Vata. 

1. Madhava Nidana: - Madhavakara explains another symptom and that is Hantisandhi .
2. Sharangdhara Samhita: - 

According to Sharangdhara - the terms Kroshtuka Shirsha and Vatakantaka are defined in Pratham Khanda

1. Bhaisajya Ratnavali: -

The treatment of Sandhi Vata is discussed in vatavyadhi prakaraṇa. 

1. Chakradatta: -

Chakrapani first described the treatment in detail under the title Vatavyadhi Chikitsa using only some herbal preparations, Snehana Chikitsa, Basti Chikitsa, and Shastra Chikitsa .

1. Bhava-Prakash Nighantu (16thcentury): -

Bhava mishra mentions the word Sandhigata Vata in his Vatavyadhi chapter and explains the treatment of Sandhigata Vata .

11. Vrindamadhava -He explains this disease only from the treatment point of view .

12. Vangasena, Gadanigraha

They mentioned the diagnosis and treatment of this disease but did not add any specific information. 

13. Yogaratnakara mentions Sandhigata Vata in the Vata vyadhi Nidanam chapter and also mentions Hanti Sandhigata .

PREVIOUS RESEARCH WORK: -

NIA, Jaipur: -

S. N. Year Name of Scholar Title of Thesis

1. 2000 Mohit Kiran Clinical evaluation of Tikta Ksheer Basti in the management of Sandhigata Vata with special reference to Osteoarthritis.

2. 2002 Dinesh Kumar Clinical Study of Snehana, Svedana & Rasnadi Guggulu in the management of Sandhigata Vata (Osteoarthritis).

3. 2003 Lal ji Clinical Study on the effect of Sinhanad Guggulu and Murivenna Tail in the management of Osteoarthritis of Knee joint.

4. 2003 Rakesh Kumar

Sharma Efficacy of Sandhi Shulahara Yoga and Traction in the management of Janu Sandhigata Vata (Osteoarthritis of Knee joint).

5. 2004 Nagendra Mani An Indigenous approach to managing the Janu Sandhigata Vata (Osteoarthritis of Knee joint) by Osteocare Rasayana Compound and Knee Traction.

6. 2005 Rakesh Kumar Role of Laksha Guggulu and Haridradi Lepa in the management of Sandhigata Vata with special reference to Osteoarthritis.

7. 2005 Balajit Singh The Clinical Studies on the effect of Ashwagandha Yoga and Nagaradi Lepa in the management of Osteoarthritis.

8. 2006 Rajesh Kumar An Indigenous approach to managing the Janu Sandhigata Vata (Osteoarthrosis of Knee joint) with Knee traction.

9. 2008 Mukesh Kumar A Clinical evaluation of Agnikarma in the management of Sandhigata Vata w.s.r. to Osteoarthritis.

10. 2008 Neha Sharma Clinical evaluation of Janu Basti and Electrotherapy in the management of Janu Sandhigata Vata under the influence of Trayodashanga Guggulu.

11. 2011 Jyoti Clinical study of Punarnava Guggulu, Dashamoolaghrita and Kattamachukadi Taila in the management of Osteoarthritis.

12. 2012 Vinay Bhardwaj Physiological Study of Asthivaha Srotas w.s.r. Efficacy of Vatari Rasa in Sandhigata Vata.

13. 2013 GirdharVaishanav Clinical evaluation of the efficacy of Rasna Guggulu, Rasnapanchak Kwath, and Janu Basti in the management of Sandhigata Vata (Osteoarthritis).

14. 2013 Dattatrya Sampat Nikam

Clinical Study to Evaluate the Role of Adityapaka Guggulu & Tikta Ksheera Basti in the management of Sandhigata Vata with special reference to Osteoarthritis.

15. 2014 Monika Gautam A clinical study to evaluate the efficacy of Rasna Saptak Ghan Vati and Janu Basti in the management of Sandhigata Vata (Osteoarthritis).

16. 2015 Surya prakash saini Epidemiological study and randomized controlled Upashayatmaka trial to evaluate Shulahara (analgesic) effect of certain Ayurvedic drugs on Sandhigata Vata.

17. 2016 Dileep Kumar Vyas A comparative clinical study to evaluate the efficacy of Pancha Tikta Ksheer Basti & Janu Dhara in the management of Janu Sandhigata Vata w.s.r. to Osteoarthritis.

18. 2017 Amit Kumar A comparative clinical study to evaluate the role of Janu Basti and Matra Basti along with Adityapaka Guggulu in the management of Janu-sandhigata Vata w.s.r. to osteoarthritis of knee joint

19. 2018 Champak kumar Pathak  A comparative clinical study to evaluate the Effect of Ksheer Bala Taila in Matra Basti and  Janu Pichu along with Ashwagandha shatavari ksheer pak in the Management of Janu-Sandhigata Vata w.s.r to Osteoarthritis of Knee Joint. 

I.P.G.T. & R.A., Jamnagar: -

S.N Year Name of Scholar Title of Thesis

20. 1963 Karuna Ratna H.W. Vatavyadhi w.s.r to Sandhigata Vata, Dept. of Kayachikitsa.

21. 1966 Vanjak shamma

V.M.  Sandhigata Vikara, Dept. of Kayachikitsa.

22. 1967 Sharma M.B. Shotha and Shula Chikitsa in Sandhigata Roga, Dept. of Kayachikitsa.

23 1976 Ashara K.G. Sandhigata Rogon mein Shuddha Guggulu ka Prayoga, Dept. of Kayachikitsa.

24. 1986 Suryanarayana K. Study on the Sandhigata Vata w.s.r. Its Management, Dept. of Kayachikitsa.

25. 1990 Pradesh Pandya Role of Agnikarma in the management of Sandhigata Vata, ShalyaTantra.

26. 1991 Chandasan D.D. Further Studies on Agnikarma in Sandhigata Vata, Dept. of ShalyaTantra.

27. 1993 Gaur J. A Comparative Study on Mallasindura Prepared by two different methods in relation to its Effect on Sandhivata, 

28. 1995 Ruparelia H.B. A Clinical Study on Role of Shallaki (Kunduru) in the management of Sandhivata (Osteoarthritis), Dept. of Kayachikitsa.

29. 1996 Kunt C.U. Role of Medohara and Rasayana Drugs in the management of Sandhi Vata (Osteoarthritis), Dept. of Kayachikitsa.

30. 1999 Anjukta Sengupta A Clinical Study on Sandhigata Vata w.s.r. its Management by Shamana and Shodhana Therapy, Dept. of Kayachikitsa.

31. 2000 Kalpana Shinde A Clinical Study on the Role of Panchatikta Ghrita Matra Basti and Panchatikta Kshira paka with Suddha Ghruta in the management of Sandhigata Vata, Dept. of Kayachikitsa.

32. 2004 Alpesh Joshi A Clinical Study on the Role of Matra Basti and Shamana Yoga in the management of Sandhi Vata (Osteoarthritis), Dept. of Kayachikitsa.

33. 2005 Mahant Vyasdev Clinical management on Sandhigata Vata w.s.r. to cervical spondylosis by Agnikarma Chikitsa, Dept. of Shalya.

34. 2006 Md. Babul Akhtar Clinical study on Sandhigata Vata w.s.r. to Osteoarthrirtis and its management by Panchtikta ghrita guggulu.

35. 2006 Mayuri Shaha A comparative study of Matra Basti and some indigenous compound drugs in the management of Sandhi gata Vata (Osteoarthritis).

B.H.U. Varanasi: -

S.No. Year Name of Scholar Title of Thesis

36. 1987 Sripathi R Evaluation of Trayodashanga Guggulu in Osteoarthiritis, Dept. of Kayachikitsa.

37. 1988 Neetha Kumari Evaluation of Rasnadi Guggulu in the treatment of Osteoarthiritis, Dept. of Kayachikitsa.

38. 1989 Pathak Bhavana Evaluation of Snehana and Svedana in the management of Sandhi Vata and Amavata (Osteoarthritis and Rheumatoid arthritis), Dept. of Kayachikitsa.

39. 1990 Adarsha Kumar Evaluation of Rasona Compound in the treatment of Amavata And Sandhivata (Rheumatoid arthritis and Osteoarthritis), Dept. of Kayachikitsa.

40. 2002 Arora P.K. A comparative study of therapeutic efficacy of Samsodhana and Samsamana Chikitsa in Sandhigata Vata vis-à-vis Osteoarthritis, Dept. of Kayachikitsa.

41. 2002 Garbyal V.S. A clinical study on Sandhivata vis-à-vis Osteoarthritis and its Ayurvedic management, Dept. of Kayachikitsa.

One of the most prevalent disorders in society is Sandhigata Vata. This is one of the Vatavyadhi types mentioned in the ancient Ayurvedic texts. As we get older, all of our Dhatus go through Kshaya, which results in Vata Prakopa and a plethora of Vata Vyadhis. The Janu-Sandhigata Vata is among the most prevalent of them. 

The name Janu-Sandhigata actually comes from the Sanskrit language. Janu, Sandhi, Gata, and Vata are the four words that make up the word Vata.

Janu: - 

Nirukti- Uru Janghay or Madhya bhaga (Shabda Stoma Mahanidhi)

The word Janu means is the junction that lies between Uru and Jangha.

Sandhi: -

Nirukti – Asthisanyogosthane (Vaidyaka shabdh sindhu)

According to Vachaspatyama:- 

The word Sandhi is derived from the root “Dha” when prefixed by “sam” and suffixed by “ki” gives rise to the word Sandhi which means the union or joint. 

Gata: -

The word “Gata” has two meanings. One is related to Site. Hence in the case of Janu-Sandhigata Vata, it denotes the site in which provoked Vata is situated.

The term Gata is derived from the root “Gam” which means go to, situated in, directed to, arrived at, 

Vata: - 

The term Vata is originated from the root “va – gatigandhanayo”

When suffixed by ‘ktan’ gives rise to the word Vata which means to blow, to go, to move, to smell, to strike, to hurt, to enlighten.

Thus, Sandhigata Vata means aggravated Vata located in Sandhi.

The word Sandhigata Vata mainly has two part -

(1) Sandhi - Anatomical aspect.

(2) Vata - Physiological aspect.

Definition of Sandhi: -

Vachaspatyama collected the various interpretations of Sandhi as they pertain to various domains. Joint, signifying togetherness, is conveyed in all of these meanings.

The name Sandhi, according to Vaidik Shabda Sindhu, means the place where asthies unite and can move actively or passively.

Asthisandhi is a root of Majjavaha Srotasa, as indicated by Acharya Charaka in Vimana sthana, and Shabda Kalpa Drum has elucidated how the word Sandhi is obtained as Sam + dha + Ki. .

Dalhana has described the Sandhi means “Sarirama Asthi Sanyoga Sthana”. “Thus, Sandhi is the meeting places of two or more bones with one other.

Bhaskara govinda ghanekar has explained that where two or more objects articulate with each other in the body it is called the ‘Sandhi’.

Vital structures associated with Sandhi: -

Regarding the structures associated with the Sandhis, there is no mention in Ayurveda, either directly or indirectly. So, we go over a few of the structures that made Sandhi what it is today. 

1) Asthi: - Asthi is the main center of Vata and the main structure of Sandhi. According to Ayurvedic scriptures, Dharana is the main function of Asthi . Therefore, Ashti and Sandhi are the Mulasthana of Majja Vaha Srotasa. This is the seat (stana) of Vayu according to Ashrayashrayi bhava. Asthi Dhatu regulates the body structure and helps in achieving a good body shape. 

2) Mansa: - Actually, many types of muscles cover the joints. Therefore, the relationship between Mansa Dhatu and muscles (Pesi) should be investigated. In Ayurvedic scriptures the function of Mansa Dhatu is said to be Lepana , hence it encompasses Sandhi and its Kshaya gives rise to Sandhivedana []. 

3) Snayu and Kandara: - Acharya Sushruta mentions about four types of Snayu . This is Prithu, Pratanavati, Vritta, and Sushira. Being close to Sandhi and Snayu makes it easier to work successfully together. The holy books contain information of how Snayu and Kandara came to be.

4) Majja:-.Asthi and Sandhi are Mulasthana of Majjavaha Srotasa . According to Ayurvedic Scriptures, Purana is the main function of Majja .

5) Sira: - The branches of Siras work like Upasnehana (expulsion of nutrients), Akunchana (twisting), and Prasarana (stretching) . Siras provides nutrients to the body's connective tissues. 

6) Shleshmadhara Kala:- - The shlesma within the bag acts as a lubricant, allowing the joints to move freely and smoothly, much like a wheel that spins effortlessly on a well-greased axle. . It permeates every joint and is the fourth Kala.

There are three distinct Doshas that, according to Ayurveda, govern every bodily function. Sandhi gives weight to the following doshas. 

Vata dosha is related to: - As mentioned” in "Samhitas Vyana vata", “controls all the functions of the body as unmesha, nimesha Gati Aksheepana Utkshepana. These functions are directly related to the joints, so disturbing Vyana Vayu affects the functions of the joints. So we know that Vyana vayu is related to sandhi. 

Kapha dosha Contribution: - Shleshaka kapha, smoothness of Sandhi joints etc. It is responsible for lubrication. It holds the bones together tightly, protects their joints, and protects them from separation and union .

Synovial fluid, such as Shleshaka Kapha, appears to serve the following two main purposes:

• Lubricate joints

• Support joint functions. 

Kapha is responsible for Snigdhatva (lubrication), Sthiratva (stability) and Sandhibandhana (joints). 

Classification:-

Acharya Sushruta explains the classification of joints as follows

A) Sthira Sandhi (Fixed Joints)

B) Chestavaha Sandhi (Mobile Joints)

In order to keep the joints stable and lubricated, Shleshaka Kapha and Snayu keep sandhi functioning. Movement is made possible by the existence of joints in the body. The Samrapti of Janu-Sandhigata Vata revolves around Sandhi's impairement. 

Chestavaha Sandhi is divided into two types. 

i) Bahu Chesta (Synovial Joint)

ii) Alpa Chesta (Cartilage Joint)

Dalhana divides Sandhies into eight categories in the Sushruta Samhita according to their Akriti, or structure. Parts of the Sushruta Samhita and Sharira Sthana that pertain to sandhies explain their construction and function in detail.

Dr. B.G. Ghanekar has also described in detail about the joints in his commentary on the same topic. According to Akriti, Sandhies are classified into 8 types .

1) Kora: This type of joint is more active and is related to the joints of Uattana Asthi. 

2) Ulukhala: This ball and socket-shaped joint can be divided in the following two types.

a) Sthira: Taruna Sandhi

b) Chestavaha: Kaksaka and Vanksana Sandhi. 

3) Samudga: This is partially movable Sandhi. These Samputa-shaped Sandhis are present in Ansapitha Guda Bhaga and Nitamba.

4) Pratara: These types of Sandhi have less action and Pratara sila in nature. They are made up of horizontal symmetrical bones.

5) Tunna Sevani: These are connected with each other by teeth-like structures in the Sira Kapala (skull bone joints) and the Kati Kapala (pelvic bone) Asthi. It can be seen in the skull during adult age, whereas in Kati Kapala Sandhi.

6) Vayasatunda: Where Hanvasthi and Sankhasthi meet with each other that are called as a Vayasatunda Sandhi. 

7) Mandala: These are circular-shaped joints, made up of Tarunasthi and found in the trachea, Hrdya, and Netra.

8) Shankhavarta: This type of Sandhi is in the shape of Sankha, which is seen in Karnasaskuli.

Anatomy of Sandhi’s: -

According to Acharya Sushruta Sandhi is one of the five types of Marma . In Sandhi Marma, the Janu, Kurpara, Gulpha, and Manibandha are all included. The Vaikalyakara group of Marma includes Janu and Kurpara. Gulpha and Manibandha are Marma members of the Rujakara caste. It is Prana's natural and designated seat to be located above Marma. .According to Acharya Sushruta Sandhi is one of the five types of Marma .

According to Chakrapani, this Rogamarga split is useful for evaluating the Sadhya-Asadhyata of illness. When illness strikes, one of three Rogamarga come into play. In Madhyama Roga Marga, you'll find Asthi-Sandhi. .

It is Yapya that is to be considered the sickness in Marma and Sandhi specific reference is given for the structures that are accountable for Sandhi's creation and function. Here, therefore, we've made an effort to characterize some likely structures and factors that contributed to Sandhi's genesis and function. Given this background, it should come as no surprise that the joints, namely Asthi and Shlesakakapha, are vulnerable to Vata vitiation. It could start a vicious cycle where the reduction of Asthi and Kapha makes Vata even more vitiated.

Since Vyana Vayu's seat is in Sandhi, it is possible that it has a close relationship with Shlesaka Kapha as well. . Janu-Sandhigata Vata can develop either initially or later on as a result of a pathological state of Vyana Vayu in conjunction with Sthana Vikriti or Khavaigunya at Sandhi.

i) Definition of Vata: Vayu is often thought of as indicating wind or air. Of the five Mahabhutas, Vayu is the second most important and powerful of the three fundamental elements—Dosha, Dhatu, and Mala—that make up a human body. Tantrayantradhara, Pravartakachestanam, Sarveindriyarthanabhivodha, Sarvasarirdhatuvyuhakara, Sandhanakarah, Agni-Sandipana, Niyanta Praneta Cha Manasa, and many other Vata attributes are mentioned by Acharya Charaka in Vatakalakaliya Adhayaya. . Creating motion or force is Vata's primary purpose. Vata or Vayu is what moves.

ii) Physical Properties of Vata: -All the Acharyas have mentioned that Vata has Ruksha, Sheeta, Laghu, Khara properties.

Table -1:- Physical properties of Vata

S.No Physical properties Ch. Su  Ch. Su  Ch.Vi. Su.  Ni  As. Hr. 

1. Ruksha + + + + +

2. Sheeta + + + + +

3. Laghu + + + + +

4. Khara + + - + +

5. Vishada + + + - -

6. Chala - + + - +

7. Sukshma - + - - +

8. Daruna + - - - -

9. Parusha - - + - -

10. Shigra - - + - -

11. Bahu - - + - -

Total 6 7 8 4 6

iii) Physiology of Vata: -

Vayu regulates the movement of the skeletal system. Additionally, it causes Sandhi to go into a pathological growth condition, similar to Janu-Sandhigata Vata. Prana, Udana, Vyana, Samana, and Apana are the five variations of Vayu that are categorized according to the nature of function. Vyana The movements of Sandhi, such as Akunchana Prasarana, Utkseepana, Avakseepana, etc., are controlled by Vayu, which is located in Hridaya and circulates throughout the body. As a result, Vayu controls much of the motor function. .

Relation between Sandhi and Vata (Ashrayashrayi Bhava):-

The Bhautika composition of the Dosha and Dushya is related to the properties, activities, and significance of the Tridoshas, as described in Ashtanga Hridaya. When the Dosha and Dushya are interdependent, it's known as Ashrayashrayi Bhava. Asthi is supposed to be the location of Vata, Sveda, and Rakta to be of Pitta, and Rasa, Mamsa, Meda, Majja, and Shukra to be of Kapha. Drugs or dietary regimens that enhance one Dosha also impact their dependent Dhatu due to this connection. They will experience changes to their Dhatus as a result of Dosha enhancement. However, the inverse is also true: an increase in Vata (Ashrayi) will cause an increase (Kshaya) in Asthi (Ashraya). It has a similar relationship to Kapha. The quantity of Vata will grow when Kapha's Akshaya is increased, and vice versa. .

Asthi is the seat of Vata:-

The body's framework is made up of asthi, the hard tissue. The paternal element is known as pitrij bhava. Tendons and aponeurosis connect muscles to bones. A locomotor system is formed by bones, muscles, and ligaments that surround each joint. Muscles may be flexed and extended to make the body move, a process known as mobility. Large intestine (Pakvashaya), pelvis (Kati), sakthi bones, padas, strotas, and sparshana 

(Skin) are the seat of Vata. Asthi has also been mentioned as the seat of vata in Kashyap samhita, Portion below the umbilical region, asthi and majja are the seat of vata. Here is what Charaka has to say about the chikitsa of asthigata rogas:Asthigata rogas are treated using panchkarma.Use basti, dugdha, and ghrita that are made with tiktavarga dravyas. The best treatment, or Vata-vikara, is believed to be ardhachikitsa, and Basti is a part of it. Based on the variations described earlier, it can be inferred that Asthi is Vata's seat.. All bodily functions rely on the harmonious interplay of vata, pitta, and kapha. The hridaya and nabhi were revered as significant anatomical sites. Since the human body is composed of seven dhatus, the area immediately below the navel is thought of as the seat of vata. Additionally, this area is thought of as the seat of the somatic humors. In dhatu, Vata sits. Ashrayashrayi bhava is present between Asthi and Vata. Akasha and vayu are the main bhuta in vata. Kapha manifests as aapya and prithvi, while Pitta is Agni. A minor amount of prithvi coexists with the akasha and vayu mahabhuta in asthi. Because of its gunashraya, asthi might be thought of as vata's seat. The body's vata and asthi are chalanatmaka and chalana karana, respectively. Therefore, karma ashraya (vata) may be thought of as sitting in asthi.

Janu-Sandhigata Vata: -

While the exact meaning of Sandhigata Vata is unclear, it can be inferred from the available literature that it occurs when vitiated Vata becomes lodged at one or more Sandhi after Nidana Sevana, causing symptoms such as joint pain, swelling upon palpation, crepitus, and stiffness in the joint.

Nidana Panchaka: -

The knowledge of disease is obtained by the study of Nidana, Purvarupa, Rupa, Upashaya, and Samprapti which are termed Nidana Panchaka. 

Acharyas have not mentioned a particular Nidana for Janu-Sandhigata Vata, so we can take the common Nidana given for Vata Vyadhi along with Asthi and Majjavaha Srotodusti Karana[ as the Nidana of Janu-Sandhigata Vata. Janu-Sandhigata Vata is considered as a part of Vata vyadhi. The function of Vata particularly of VyanaVayu has a close resemblance with the function of Sandhi, as Vyana Vayu controls all the functions of the body like Gati, Aksheepana, Utksepana, Nimesa and Unmesa. These functions are directly connected with joints, so the disturbed Vyana Vayu can disturb the functions of joints .

Nidanas can be classified into various types like -

• Aharaja
• Viharaja
• Agantuja
• Manasika
• Kalaja
• Anya Hetu
• Aharaja Nidana: -

Intake of Ahara having Katu, Tikta, Kashaya Rasa, Sheeta, Ruksha, Laghu Guna and indulgence in Alpasana, Vishamasana, Adhyasana, Pramitasana lead to aggravation of Vata dravya like Shushkashaka, Vallura, Varaka Nivara, Koradusha, Kalaya, Tumba, Kalinga etc. causes Vata vitiation.

Some of the important Nidanas: -

Abhighata: Abhighata is an important Nidana for Janu-sandhigata Vata. Nowadays, falls from vehicle may lead to vitiation of Vata Dosha. Abhighata leads to structural deformity in the joints. Joint is an organ rather than a single structure. It is stabilized by different structures like Asthi, Snayu, Peshi, and Kala etc. Hence any trauma to these structures will alter the structural integrity of the joint. 

Marmabhighata: Janu Sandhi is one of the Vaikalyakara Sandhi Marma, which is Saumya and Shitayukta so it is not Pranahara.Janu Sandhi is a Marma (vital point), which is formed by Asthi, Snayu, Sira and Mamsa49.

Pain in the joints is not necessarily only associated with bony changes, but the involvement of other joint structures may also give rise to symptoms pertaining to the joint. Between the Jangha and Uru in Sandhi Sthala Janu Marma is seen. Any injury to that may lead to Khanjata .

Ativyayama: If physical exercise is done excessively act as one of the important Nidana for Janu-sandhigata vata. It will affect the structures of Sandhi. They mainly affect the Joint stability by over-exertion. But if done properly they stabilize the Joint.

Bharavahana: Carrying excessive load causes excessive pressure and stretching effect over the structures of the joint. As the knee is a weight-bearing joint, carrying excessive load will have direct affection the joint. The constant compression will lead to wear and tear effect loading to degenerative changes in the joint.

Atisankshobha: It is the Nidana for Asthivahasrotodusti. Since there is the involvement of Asthivahasrotasa in Janu-sandhigataVata, this can be considered as Nidana for the same .violent activities like Atyadhva Plavana Langhana Balavat Vigraha Pradhavana, etc. will have its effect on joint. As told earlier knee is the weight- bearing joint, the violent exercises or activities will alter the structural integrity of the joint.

Sthaulya: Sthaulya is another causative factor for Vataprakopa. The Meda Avarana of Vata is the mechanism causing the inter-relationship between Sthaulya and Vatavyadhis []. All types of Avarana are also important vitiating factors of Vata. In Sthaulya more burdens occur in the weight-bearing joints especially the knee joint leading to Janu-sandhigata Vata. Avyayama and Manda chesta are noticed in Sthaulya leading to decreased blood supply in joints resulting in osteoarthritis.

PURVARUPA: - 

According to Acharya Charaka Avyakta Laksana of Vatavyadhi are to be taken as its Purvarupa . Commentator Vijayarakshita explains the term Avyakta as the symptoms which are not manifested clearly . Hence mild of occasional Sandhishoola or Sandhishotha prior to the manifestation of the disease Janu-Sandhigata Vata may be taken as Purvarupa.

Purvarupa indicates the disease, which is going to occur in the future. It occurs in the Sthanasamsraya stage of Satkriya Kala. Like Hetus, no clear Purvarupa of the disease Janu-Sandhigata Vata is mentioned in the classics. Hence Purvarupa of Vata Vyadhi can be aPurvarupa of Janu-Sandhigata Vata.

RUPA: -

The symptom which specifies a manifested disease are included under Rupa. A clear understanding of Rupa is inevitable for accurate diagnosis. It occurs in the Vyakta Avastha of Shatakriya Kala after Sthanasansraya.

Table 2:- Lakshanas of sandhigatavata

S.No Lakshna’s Ch.Sa Su. Sa. As.Sa As.Hr. Bh.Pr.

1. Sandhishoola + + + + +

2. Sandhishotha

/Shopha + + + + +

3. Vatapurna-drati-Sparsah + - + + -

4. Prasarana

kuncanayoh

savedana + - + + -

5. Hanti Sandhi-gatah - + - - +

6. Atopa (Crepitus) - - - - -

Acharya Charak has first described Janu-Sandhigata Vata as Sandhigata anila and defined as Shotha of joint which on palpation revealed as air filled bag (Vatapurnadrati sparsha) and pain during movement of the joint on flexion and extension (Prasaran akuncanayoh savedana)[.

Janu-Sandhigata Vata is defined according to Acharya Sushruta as vitiated Vata accumulate in Sandhi and impairing the function of a joint (Hanti Sandhigatah) with pain (Shoola) and swelling (Shopha).

In Madhava Nidana the description of Janu-Sandhigata Vata is given in Vata vyadhi Nidana and defined as loss of functions of a joint (Hanti Sandhigatah), Pain (Shula) and Swelling (Atopa) due to the vitiation of Vata in Sandhi.

Symptoms of Janu-Sandhigata Vata:

1. Sandhishula: -

       In case of Vata situated in Sandhi gives rise to Sandhishoola. It is stated that without Vata Shoola does not occur. Shoola is the main symptom of Prakupita Vata. It is obvious to experience Shoola in the diseases which are dominated by Vata. 

1. Sandhishotha: -

In Janu-Sandhigata Vata, Prakupita Vata gets lodged in Sandhi where Srotoriktata already exists. So there is wide scope of Vata panchayat in specific sites to get accumulated there resulting in Shotha. Here Vatapurnadrati Sparsha type of Shotha has been explained by Acharya Charaka. As Shotha is Vatika type, on palpation the swelling is felt like a bag filled with air.

1. Hanti Sandhigataha: -

Acharya Sushruta and Madhavkara both explain this symptom and commenting on this word, Dalhana and Gayadasa explain it as inability to flexion and extension. However, this symptom may not be seen in early phases. When the disease is aggravated the vitiated Vata may produce Stambha and they not be able of movements.

In Madhukosha commentary, commentator Vijayarakshita has given two meanings of Hanti Sandhi Gata. One is Sandhivishlesha and another is Stambha []. Here, Sandhivishlesha occurs due to Prakupita Vata located in Sandhi.

Stambha means immobility as defined by Dalhana. Arunadatta explained Stambha as less or absence of flexion and other movements. Gati is a unique feature of Vata and in Janu-Sandhigata Vata; this Gati is obstructed because of Sanga type of Strotodushti. This gives rise to Stambha. Vata also increased the Sheetaguna of Vata is responsible for Sthambha.

Prasarana Akuncanayoh Savedana: -

Acharya Charaka has shown this symptom. Sandhi is made to perform the function of Akunhchana and Prasarana. When Prakupita Vata gets located in Sandhi, it hampers the normal function of Sandhi which results in Vedana during Akunchana and Prasarana.

Sandhisphutana: -

This symptom is not mentioned in our classics directly. Acharya Madhavakara has been given a new named i.e. Atopa .

Janu-Sandhigata Vata is localized Vata Vyadhi in which Prakupita Vayu affects Sandhi. This Sthanasansraya is result of Srotoriktata present at Sandhi. That means Akash Mahabhuta is increased at the site of Sandhi and Shabda is a Guna of Akasha. Hence, in the process of extension and flexion, Shabda is heard or palpated. In allopathic texts, it is mentioned clearly as crepitation.

Upshaya: -

All drugs, diet and regimens that give long lasting relief in disease are taken Upashaya. Janu-sandhigata Vata being a Vata Vyadhi, the general Upasaya and Anupasaya of Vata Vyadhi are applicable. Following Ahara-Vihara and Karma are Upasaya for Vata Vyadhi.

Ahara:Madhura, Amla and Lavana Rasa, Usna Virya, Guru, Snigdha Gunas, Ghrita, Taila, Vasa Majja, Dugdha, Mamsarasa, Madira, Vrisya, Balya,Ahara Godhuma, Masa, Purana Sali, Rasona etc.

Vihara: Atapa, Sevana, Nirvaata Sthana, Ushna Pravarana etc.

Karma: Abhyanga, Svedana, Pariseka, Upanaha, Udvartanam, Nasya, Basti etc.

Anupshaya: -

All drugs, diet and regimens which exaggerate the disease are taken Anupasaya for that disease. Also Hetus of that disease can also be taken as Anupasaya.

Ahara: Katu Tikta Kasaya Rasa in Atimatra, Laghu, Ruksha, Sheeta Gunas, Mudga Canaka Kalaya, etc.

Vihara: Vegavidharana, Atichankramana, Anasana, Chinta, Shoka, Ativyayama etc.

Karma: Ruksha Udvartana Ruksha Svedana etc.

Samprapti: -

Samprapti is a series of change taking place during the production of disease from nidana sevana upto rogotpatti. Through Sanghivata vata has no direct classical reference to the samprapti it can be inferred that the samprapti of sandhigata vata is the same as that of samanya samprapti of vata vyadhi. When we see the samanya samprapti of vata vyadhi we can analyze the process of samprapti of Dhatukshaya Sandhigata vata. 

देहे स्रोतांसि रिक्तानि पूरयित्वा अनिलो बली |

करोति विविधान व्याधि, सर्वांग एकांग संश्रितान ||”

Vayu gets aggravated and fills up the rikta srotas in the Shareera producing various disorders about the entire or one part of the shareera. Chakrapani while commenting on the word Riktani stated. “snehadi guna shoonyani ityaethah” i.e. lack of snehadi gunas.The dhatus are enable to get proper nutrition and thus degeneration (dhatukshaya) begins. 

“The way in which the Dosha gets Vitiated and the course it follows for the manifestation of the disease is called Samprapti. A proper understanding of Samprapti is vital for the treatment since Chikitsa illustrated in the Ayurvedic text depends upon ‘Samprapti Vighatana .

No specific Samprapti has been explained for Janu-Sandhigata Vata. So it can be said that Samprapti of Janu-Sandhigata Vata is the same as that of general Samprapti of Vata Vyadhi .

Acharya Charaka has mentioned that Nidana Sevana vitiates Vata and this vitiated Vata gets accumulated in Rikta Srotas and gives rise to various generalized and localized diseases. 

Hence Commentator Chakrapani has explained that, as said earlier, Samprapti of Janu-sandhigata Vata follows either of two ways according to the Nidana of Vata Prakopa .

A. Dhatukshayajanya Sandhigata vata

B. Avaranjanya Sandhigata vata

C. Abhighatajanya Sandhigata vata 

As Janu-Sandhigata Vata is a degenerative disease and mainly occurs in old age, Dhatu Kshaya due to Vriddhavastha is the most common factor. In Vatika disorders, Acharya Charaka mentions that the Khavaigunya is mainly due to empty Srotas

1. Dhatukshaya Janya Janu-Sandhigata Vata: -

All dhatus undergo Kshaya in the body in Vriddhavastha (Old age) thus leading to Vata Prakopa.Vata Vardhaka Ahara Vihara leads to Vatasanchaya and Agni Vaishamya. Further, Agni Vaishamya causes Anuloma Dhatukshaya which ultimately results in Vataprakopa and vice-versa. Because of Anuloma Dhatukshaya the vitiated Vata moves in the body and settles down in joints. Ashrayashrayi Sambandha also leads Asthi Dhatu Kshayas. Vatavriddhi leads to Asthi Dhatu Kshaya. Asthi being the main tissue of the joint its Kshaya leads Khavaigunya in the joints. In this condition if Nidana Sevana, further provokes Vata. If Vata Prakopa is not corrected by appropriate means and simultaneously if the person indulges in Asthivaha and Majjavaha Srotodusti Nidana, the Prakupita Vata spreads all over the body through these Srotas and produces symptoms of asthi and Janu-sandhigata Vata. Hence it can be said that as this entity itself is a degenerative joint disease, age factor plays an important role in the precipitation of disease.

The chief properties of Parthiva Dravya are Guru Sthula Sthira Gandha Guna in excess. These are the properties, which are necessary for Sthairya and Upachaya of the body. Excessive intake of Dravyas having Laghu Ruksha Sukshma Khara properties leads to Guru and Sneha Guna Abhava due to their opposite quality. Thus it leads to Dhatu kshaya in the body. 

Intake of Ruksha: -Sheeta Ahara and Vihara like Ativyayama, Abhighata etc Reduction of Sneha bhava in the body Dhatukshaya where by Sushirata in the channels results in Vatapurana of these channels Manifestation of symptoms. In the meantime, Sthana Sansraya of Prakupita Vata takes place in the Khavaigunya Sandhi. This localized Vayu due to its Laghu Ruksha; Kharadi Guna decreases the properties of Shlesaka Kapha producing the disease Janu-Sandhigata Vata.

1. Avarana Janya Janu-Sandhigata Vata: -

In sthulas usually Janu-Sandhigata Vata occurs in weight bearing joints. In them due to the Kapha, Medas the Margavarana occurs and the Vata gets vitiated and causes many Vata Vyadhi, and one among them is Janu-sandigata Vata. If Kapha, Medavardhaka Nidana Sevana is present, it leads Medasagni Mandhya due to Amamedovridhi occurring. Meda is Poshya Dhatu of its later Dhatus i.e. Asthi and Majja which are Poshaka Dhatus for Meda. 

If Ama Medovriddhi takes place then obviously its Poshaka Dhatus Kshaya takes place. That means Ashti Dhatu and Majja Dhatu Kshaya occur. Now due to Asthi Dhatu and Majja Dhatu Kshaya, Khavaigunya takes place in Asthi and Majjavaha Srotas. 

The excessive fat deposited all over the body will produce Margavarana of Vata. Prakupita Vata due to Margavarana starts to circulate in the body. While traveling it settles in the joint where Khavaigunya is already exists. Now at the same time, due to Amameda Vriddhi Medasavarit Vata occurs. This Avarana leads Vataprakopa. Avaranajanit Prakupita Vata gets situated in Khavaigunya (RiktaSrotas), which is present in Asthi and Majjavaha Srotas (Purayitva Anilobali). This is Sthana Sanshraya Avastha of Sada Kriyakala in which Dosha-Dushya Sammurcchana occurs. Further in Samprapti Vyakti Avastha takes place where Rupa of Disease.

Three main factors involved in the production of Janu-sandhigata Vata, in any form of Samprapti are-

1. Kopa of Vyanavata, which normally controls all the movements of the body.

2. Kshaya of Shleshaka Kapha, which normally aligns the joints and maintains its Compactness.

3. Deterioration of Shlesmadhara Kala, which lubricates the joint. 

(C) Abhighatajanya Sandhigata vata –

Trauma is a secondary cause of Osteoarthritis. By the Abhighata the integrity of the joint is disturbed. Due to Abhighata to the Asthi involved in Sandhi leads to the provocation of Sthanika Vata that is. Vyana Vata (Ashrayashrayi Sambandha). Ruksha Guna of Vata and Ushanata produced by Abhighata will do the Shoshana of Shleshmaka Kapha in the joint. This produces a degenerative change in joint cartilage (lack of nutrition). In another way Vata is vitiated in the joint by the Siramarga Avarana of Vata due to Abhighata This vitiated Sthanika Vata will produce a series of changes in the joint after Dosha Dooshya Sammurchhana and produces Sandhi Vata Lakshana.

To understand the disease properly, Samprapti plays an important role. Acharya Caraka has explained Samprapti in detail by classifying it into six types.

1. Sankhya Samprapti: Sandhigata vata is only one in number mentioned in our classics.
2. Vikalpa Samprapti: As sandhigata vata is a vata Vyadhi, the predominance of vata guna is there like Ruksha, laghu, khara. Due to the intake of ruksha, sheeta, laghu Ahara, vata gets aggravated and causes riktata of srotas and takes Sthanasamshraya in sandhi, where in it affects the Majja, Asthi, and Mamsa Dhatus leading to sandhigata vata. Person who indulges guru, Snigdha, madhura Ahara leads to kapha prakopa causing the Dushti of Mamsa and meda dhatu. Due to this amarupi Dhatus, there will be no proper formation of subsequent Dhatus like asthi, majja and shukra, it also causes Avarana of vata which takes Sthanasamshraya in sandhi leading to sandhigata vata.

If there is an Abhighata to sandhi, Asthi is affected which causes prakopa of Vyana vata which in turn leads to the shoshana of sthanika kapha leading to sandhigata vata.

1. Pradhanya Samprapti: In sandhigata vata, vata dosha is predominant from all the doshas. Especially Vyana vata plays an important role in the manifestation of sandhigata vata.
2. Vidhi Samprapti: Vidhi Samprapti is classified into two types,
   • Nija – vata dosha is predominant in the manifestation of sandhigata vata.
   • Agantuja – due to Abhighata.
3. Kala Samprapti: According to vaya – in Vruddha avastha vata predominant is seen.According to kala – In Varsha kala, vata prakopa is seen.
4. Bala Samprapti: As sandhigata vata occurs in Vruddha avastha, it is kastasadhya. In sandhigata vata pain increases on movement after prolonged rest and usually decreases after movement is continued.

Stages of Shadakriyakala: -

To have a clear understanding of the etiopathogenesis of the disease Janu-sandhigata Vata an attempt has been made to understand the Samprapti of Janu-Sandhigata Vata in the light of Shadkriya Kala.

1. Sanchaya avastha (Stage of accumulation): In the case of the patient, who is going to develop Janu-sandhigataVata, Vatavyadhi may show the signs and symptoms of Asthiruksata, Asthikharata, and Asthivishadata due to Vatasanhaya in Asthi itself. In this stage, provocative factors result in the accumulation of the Doshas which in turn affects the equilibrium of Doshas. The effect can be observed as symptoms appear in the body like Stabdha, Purna Koshthata, Pittavabhasata, Mandoshmata, etc .
2. Prakopa avastha (Stage of vitiation): Prakopavastha starts due to failure to take corrective measures during the Sanchaya Avastha and In this stage already accumulated Dosha get strengthened at their own place and tends to become excited. In this stage, due to provocation of Vata, Kosthatoda and Kosthasancharana may be manifested . In a patient who is developing Janu-sandhigata Vata, we may see the Asthibheda Laksana in this stage. 
3. Prasara Avastha (Stage of spread): If the aggrevating factor are not checked followed by the failure of physician to treat or to have a proper diagnosis . In this stage, excited Dosha spreads to other organs, structures and part of the body.
4. Sthana Sanshraya Avastha (Stage of localization): This stage represents the Purvarupa phase of disease and the interaction between the Dosha and Dushya, named as Dosha Dushya Sammurchhana.As a continuation of previous stages and conditions in this stage the spreading Doshas become localized wherever there is Khavaigunya or reduced immunity, and it marks the beginning of specific disease pertaining to that structure . If vitiated Vayu localized in a joint they may cause Janu-sandhigata Vata. In this stage, the Purvarupa of the disease occurs. Vatavyadhies do not have any type of Purvarupas .
5. Vyakta Avastha (Stage of onset): In the case of Janu-sandhigataVata, patient feels Vedana during Akunchana and Prasarana of Sandhi. On examination clinician can easily elicit Shotha which on palpation revealed air filled bag . This stage may be stated as the manifestation of the fully developed disease i.e. results of Doshadushya Sammurcchana and it is represented by its characteristic clinical features i.e. Rupa.
6. Bheda Avastha: The Janu-sandhigata Vata is a Vatavyadhi but types of Janu-sandhigataVata are not described in Samhita granthas. Sandhigata Vata can be classified in the following ways.

On the basis of Doshas

• Nija - Due to the vitiation of Vata by Vatavardhaka Ahara-Vihar Dhatukshaya and Avarana etc.
• Agantuja - Due to traumatic injury.

On the basis of Curability

• Sadhya
• Asadhya

3. On the basis of Samprapti

a) Avaranajanya Janu-Sandhigata Vata.

b) Dhatukshayajanya Janu-Sandhigata Vata.

Diagnosis of Janu Sandhigata vata : -

Examination of Patients: No specific Pariksha vidhi for Sandhivata is given in Ayurvedic classics. From the Lakshana given by ancient and modern scientist, we can get clue for the examination of the sufferers; the main three types of examination are as under.

1) Darsana Pariksha (Inspection): In this examination, the physician should observe Shotha or Atopa (swelling) over the affected joint, gait, attitude, muscular wasting etc.

2) Sparsana Pariksha (Palpation): Acharya Charak has clearly explained the special symptom – Vatapurnadrati Sparsah Shotha which can be palpable on the joint, local temperature with the back of palm, tenderness, crepitus during passive movements, wasting of muscles, fixed flexion of hip, lymph nodes.

3) Prashna Pariksha (History taking):- History of common symptoms of like pain, onset, chronicity, joint involvement, stiffness, and mechanical disorders e.g. locking, giving way, click, etc. and lymph should be collected.

                                     

Table 3:- Samprapti Ghataka

Nidana (etiology) Vata Prakopaka Nidana

Dosha

Vata  particularly

Vyana Vayu and Shleshaka Kapha

Dushya Asthi, Majja, Rasa and Meda

Srotasa Asthivaha, Majjavaha, Rasavaha and Medovaha

Srotodushti Sanga

Adhisthana Asthi Sandhi

Doshamarga Marmasthi Sandhi gata

Rogamarga Madhyama 

Udbhava Sthana Pakvashaya (Ch. Chi. 28/37)

Vyavicchdaka Nidana (Differential Diagnosis): 

Vyavicchdaka Nidana or differential diagnosis has a vital role in making an exact decision between diseases presenting a similar clinical feature. While making the diagnosis of Janu-Sandhigata Vata the following disorders that have similar features have to be excluded.

                 

Table 4:- Vyavicchdaka Nidana (Differential Diagnosis): 

Factor Sandhigata Vata Amavata Vatarakta Krostraka Sirsa

Dosha Vata Vata- Kapha Vata Vata

Dushya Sandhi Rasa Rakta Rasa- Rakta

Ama Absent Present Absent Absent

Jwara Absent Present Absent Absent

Hridya Gaurava Absent Present Absent Absent

Prone age Old age Any age Any age Any age

Pain Normally with movement Vrishchika

Danshavata Toda &

Bhedavata Tivra

Anya

Laksana Not Significant Gaurava,

Apaka,

Aruchi Not Significant Not Significant 

Shotha Vatapurnadriti

sparsha

Stony hard   Raktimayukta Krostraka

Siravata

Adhisthana Weight Bearing

Joint All Major

Joints Small Joints Only knee

Joint

Uapashaya Snehana Svedana Ruksha

Svedana Rakta

Mokshana Rakta

Mokshaṇa

Stabdhata Present Present Present Absent

Tvaka Vikara May Present Absent Present Absent

Svabhava Chronic Chronic Acute   Acute  

Sadhya- Asadhya: -.

According to Charaka Samhita, Asthigata Vikara can be cured if patients are healthy, the disease is not chronic,is without any complications and is superficial.

According to Astanga Hridaya, it is yapya when deep seated, in Marmasthana and Sandhi.Acharya Vagbhata and Sushruta have designated Vatavyadhi as Mahagada . It is so as the treatment is time-consuming and the prognosis is uncertain. Further, Dhatukshaya is the main cause of Vata Vyadhi. Dhatukshaya is difficult to treat as Acharya Vagbhata has elaborated since the body is accustomed to Mala. Dhatukshaya is more problematic than Dhatu Vriddhi. 

Janu-Sandhigata Vata is the disease of Sandhi which forms Madhyama Roga Marga. The disease present in Marma and Madhyama Rogamarga is Krichchha Sadhya. Vatavyadhi occurring due to vitiation of Asthi and Majja are difficult to cure.

Chikitsa Siddhanta: -

Withdrawal of the primary causative factor is considered the basic approach in the management of the disease. By the Nidana Parivarjana Pravriddha Dosha's may not increase and by Prakrti itself, Vikara will subside, secondly, the intensity of the Doshaprakopa should be considered before deciding the line of treatment.

Prevention is better than cure as emphasized by Ayurveda. So, the first and utmost principle adopted in the treatment of every disease is to avoid the Nidana of the disease, i.e. Nidana-Parivarjana. 

Samanya Chikitsa for Janu-Sandhigata Vata: -

Acharya Charaka quotes the general treatment for Vatavyadhi in a clear way. If the disease is caused by Vata exclusively, and if no occlusion (Avarana) is involved, then in the beginning the patient should be managed with Snehana karma for which Ghrita, Taila, Vasa and Majja should be administered followed by Svedanakarma Viz. Nadisveda, Prastarasveda, Sankarasveda etc

Janu-Sandhigata Vata is a Vatavyadhi, hence the (general treatment) Samanya Chikitsa of Vatavyadhi is applicable to Janu-Sandhigata Vata also. Acharya Charaka has not given specific treatment of Janu-Sandhigata Vata, but he has explained that Kriya Vaishishtaya can be varied according to Sthana and Dushya of Vatavyadhi .

Acharya Vagbhata, in the sutra of Vatopakrama, has advised Madhura, Amla, and Lavana Rasa Pradhana and Ushna Ahara. Taila and Ghrita with Guda, Kanji, Abhyanga, Parisheka, Mardana and Basti have been advised.

Chikitsa for Janu-Sandhigata Vata: -

Acharya Sushruta mentioned the line of treatment for Janu-Sandhigata Vata, i.e. when Vata affects Snayu , Sandhi and Asthi, then therapies such as Snehana (oleation); Upanaha(Poultice); Agnikarma (Thermal cautery); Bandhana (Bandaging); Unmardana (Trampling of the body) has to be done without any laxity.

Benefits of Snehana & Svedana: -

The curved and stiffed part of the body becomes soft and easily movable after Snehana and Svedana like dry wood after processing . Snehana therapy provides nourishment for dry Dhatus and increases the strength of the body, digestive powers, and immunity. The fomentation causes Harsha, relief in pain, increases the flexibility of the body decreases Shotha and stiffness of the body and makes the body part Mardava (soft)

If Snehana and Svedana is administered frequently the Koshtha softens then Vata Roga’s is removed from the body .

              

Table 5:- Chikitsa modalities in different classics: -

Treatment Cha Su.Su A.S. A.H. B.R.

Snehana + + - + +

Svedana + - + - -

Basti + - - - -

Virechana + - - - -

Mardna - + + - +

Upnaha - + + + +

Bandhana - + + - +

Agnikarma - + + + +

PATHYA – APATHYA: -

Specific Pathya and Apathya of Sandhigata Vata are not mentioned in the classical texts. But as being a Vatavyadhi, we should adopt the same principle of general Vatavyadhi. The list of some Pathya-Apathya is as follows:

Pathya Ahara: -

Table 6:- Pathya apathya described in ayurveda classics 

Varga Dravya

1. Annavarga Godhuma, Masha ,Raktashali , Kulattha 

2. Dugdhavarga  Gaudugdha, Aja dugdha,Ghrita, Kilatam etc.

3. Phalavarga Draksha, Badara, Amra, Madhuk etc.

4. Jalavarga   Ushna Jala, Shritashita Jala

5. Madyavarga Sura, Madira, Surasava, Amlakanjika

6. Mamsavarga Kukkuta,Mayura,Chataka,Tittir,Nakra,Matsya,Varah,Jalachara Mamsa.  

7. Mutravarga Go(Cow), Avika , Ashva,Hasti Mutra

8. Rasavarga Madhura, Amla, Lavana

9. Shakavarga Patola,Shigru,Rason, Jivanti

10. Snehavarga Taila, Vasa, Majja, Ghrita  

Pathya Vihara:-

• Atapa Sevana, Mridushayya, Ushnodaka Snana etc.  

Pathya Aushadha:-

• Rasna, Sunthi, Bilva, Gokshura, Agnimantha, Rasona, Palandu etc.  
• Brimhana, Samshamana, Abhyanga, Mardana, Avagahana, Upanaha, Nasya, Basti, Agni karma etc. 

Apathya Ahara: -

Varga  Dravya

1.Annavarga  Yava , Kodrava , Shyamaka (Common millet), Nirava, Chanaka , Kalaya etc

2.Dugdhavarga Gadarbha Dugdha 

3.Ikshuvarga Madhu(Honey)

4.Jalavarga Nadi(River)-samudra(Sea wáter), Tadagasyajalam(Pond wáter), Shita Jala (Cold wáter), Dushita Jala (Impure wáter) etc

5.Madyavarga Navamadya(Fresh wine), Atimadyapana (Excess alcohol intake) 

6.Mamsavarga Kapota, Paravat (Pigeon), Kulinga (Green parakeet), Shuka (Window bird), Shushka Mamsa (Dry flesh) etc

7.Mutravarga Ajamutram (Goat’s urine) 

8.Phalavarga Jambu, Kramuka, Kasheruka (Rush nut), Lavali (Star gooseberry fruit), Parpataki Phala (Physalis berry fruit) etc.

9.Rasavarga Katu , Tikta, Kasaya Rasa (Astringent) 

10.Shakavarga Kumuda , Kamalanala, Palakya, Udumbara (Gular) etc.

.

Apathya Vihara:-

• Chinta, Jagarana, Vega Sandharana, Shrama, Anashana, Vyavaya, Pravata, Chankramana, Kathin Shayya, Yana Gamana etc.

Apathya Aushadha:-

• Vamana and Raktamokshana

Sandhigata Vata can be correlated with osteoarthritis in modern medical science. Because it also produces the features such as, pain, inflammation, stiffness, limited movements and deformity in severe cases.  

Etymology 

The word osteoarthritis made by two words- 

a)   Osteo- The word 'Osteo' comes from the Greek word 'Osteon' means bone. 

b) Arthritis - The prefix 'Artho' means joint. The suffix 'itis' is defined as inflammation. 

So osteoarthritis can be defined as inflammation of the bony part of the joints.

Definition: -

1. Osteoarthritis (OA) is the most common form of arthritis. It is strongly associated with ageing and is a major cause of pain and disability in older people. Osteoarthritis is characterized by focal loss of articular cartilage, subchondral osteosclerosis, osteophyte formation at the joint margin, and remodeling of joint contour with enlargement of affected joints .

2. In Osteoarthritis degenerative changes take place in joints with similar changes in all other systems. They begin in the third decade of life. Where they occur at a physiological rate of development symptoms do not arise and the changes hardly qualify as pathological . 

3. It is a clinical syndrome in which low-grade inflammation causes; Pain, progressive disintegration of articular cartilage, and formation of new bone in the floor of the cartilage lesions and at the joint margins (osteophtyes), it is the most common form of arthritis leading to chronic disability

4. The pathologic sign of osteoarthritis is loss of hyaline articular cartilage, present in a focal and initially, non-uniform manner. This is accompanied by increasing thickness and sclerosis of the subchondral bony plate, outgrowth of osteophytes at the joint margin, stretching of the articular capsule, by mild synovitis in many affected joints, and weakness of muscles bridging the joint. In knees, meniscal degeneration is part of the disease. There are numerous pathways that lead to joint failure, but the initial step is often joint injury in the setting of a failure of protective mechanisms .

CLASSIFICATION 

1. Primary Osteoarthritis: -

In primary osteoarthritis, the degenerative wear-and-tear process occurs after the fifth and sixth decades, with no predisposing abnormality apparent. The cumulative effects of decades of use lead to degenerative changes by stressing the integrity of the collagen matrix of the cartilage. Damage to the cartilage results in the release of enzymes that destroy collagen components. With aging, there is a decreased ability to restore and synthesize normal collagen structures.   

1. Primary osteoarthritis

A. Localized 

• Hands – nodal osteoarthritis with more than three joints involved 
• Knee – medial tibiofemoral, lateral tibiofemoral, patellofemoral
• Spine – apophyseal, intervertebral, spondylosis 
• Hip – eccentric, concentric, diffuse 

B. Generalized 

• Small or peripheral joints 
• Large or central  joints 
• Mixed and spine 

C. Erosive osteoarthritis 

2. Secondary osteoarthritis: -

It is associated with some predisposing factors responsible for the degenerative changes. Various predisposing factors in secondary osteoarthritis include congenital abnormalities in joint structure or function (e.g. excessive joint mobility and abnormally shaped joint surfaces), trauma (obesity, fractures along joint surfaces, surgery, etc.), crystal deposition, presence of abnormal cartilage, and previous inflammatory disease of joint {rheumatoid arthritis, gout, septic arthritis, etc.  

1. Congenital and developmental disorders, bone dysplasia’s. 
2. Post-surgery / injury – meniscectomy. 
3. Rheumatologic– rheumatoid arthritis
4. Neurological– Charcot joints
5. Hematological – hemoglobinopathies. 
6. Iatrogenic – intra-articular steroids. ii) Post-surgery / injury – meniscectomy. 
7. Endocrine – Acromegaly, diabetes mellitus, hypothyroidism, hyperthyroidism, hyperparathyroidism, Cushing syndrome. 

Metabolic –Marfan syndrome, Paget disease, gout, pseudo gout, Wilson’s disease, Gaucher’s disease. 

BONE

Bone is highly specialized living tissue, a hard form of connective tissue that forms most of the skeleton and is the chief supporting tissue of the body.

STRUCTURAL COMPOSITION:-

Bone is rigid form of connective tissue in which the extracellular matrix is impregnated with inorganic salts, mainly calcium phosphate and carbonate that provide hardness.

The organic matrix consists of ground substances in which collagen fibers are embedded. Ground substances consist of glycosaminoglycans, proteoglycans and water. Glycoproteins (osteonectin and osteocalcin) bind with to calcium ions and play a role in the mineralisation of bone. Organic matrix forms 30-35% of the dry weight of a bone.

The inorganic matrix is primarily calcium and phosphorous salts. Magnesium, carbonate, hydroxyl, chloride, fluoride, citrate, sodium and potassium are also present in significant amounts. Most of the calcium, phosphate and hydroxyl ions are in the form of needle-shaped crystals that are given the name hydroxyapatite [Ca10 (Po4)6 (OH) 2]. It constituted about 65-70% of the dry weight of a bone.

BONE CELLS[]:-

There are three types of bone cells,

1. Osteoblasts: - Osteoblasts concerned with ossification. These cells are rich in alkaline phosphatase, glycolytic enzymes and phosphorylases.

1. Osteocytes: - These are mature bone cells that vary in activity and may assume the form of an osteoclast or reticulocyte. These cells are rich in glycogen and PAS Positive Granules.

1. Osteoclasts:-These are multi-nucleate mesenchymal cells concerned with bone resorption. This constitutes glycolytic acid hydrolases, collagenase and acid phosphatase enzymes. 

Remodelling of bone:-

Bone can alter its size, shape structure in response to stress. This happens throughout life though not perceptible. According to Wolff`s law of bone remodeling, bone hypertrophy occurs in the plane of stress. 

CLASSIFICATION OF BONE:

Bones are mainly of two types on the relative amount of solid matter and on the number and size of the space they contain.

• Based on histology
• Compact / Cortical bone
• Spongy / Cancellous / Trabecular bone
• Based on maturity
• Mature / lamellar bone
• Immature/woven bone
• Based on the manner of development
• Cartilage bone
• Membrane bone
• Based on their shape
• Long bones: Long bones are tubular e.g. femur in the leg.
• Short bones: These bones are cuboidal and are found only in the ankle and wrist.
• Flat bones: Usually flat bones serve protective functions e.g. skull protects the brain.
• Irregular bones: These types of bones have various shapes other than long, short or flat. 

Bone provides-

• Protection for vital structures.
• Supports the body
• The mechanical basis for movements.
• Storage for salts (e.g. calcium)
• A continuous supply of new blood cells.

CARTILAGE:-

Cartilage is a firm tissue but is softer and much more flexible than bone. It is a connective tissue found in many areas of the body including:

• Joint between bones e.g. the elbow, knee and ankles
• Ends of the ribs 
• Between the vertebrae in the spine
• Ears and nose
• Bronchial tubes or airways

Cartilage is made up of specialized cells called chondrocytes. These chondrocytes produce large amounts of collagenous extracellular matrix composed of collagen fibers, proteoglycan and elastin fibers. There are no blood vessels or nerves in the cartilage. Nutrition is supplied to the chondrocytes by diffusion.

Classification of cartilage:-

1. Elastic cartilage – external ear flaps
2. Hyaline cartilage – nose,trachea,  part of larynx

Fibrocartilage –in spine and menisci 

JOINTS

RELATED TERMS:

• Arthron (G. a joint). Compare with the terms arthrology, synarthrosis, diarthrosis, arthritis, arthrodesis, etc.
• Articulatio (L. a joint); articulation (NA)
• Junctura (L. a joint).
• Syndesmology (G. syndesmos = ligament) is the study of ligaments and related joints. 

DEFINITION: 

Joint comes from the Latin ‘Junctio’ i.e. joining, the point of the juncture between two bones. Joint is a junction between two or more bones or cartilages. It is a device to permits movements. However, immovable joints are primarily meant for growth and may permit molding during childbirth.

There are more joints in a child than in an adult because as growth proceeds some of the bones fuse together – e.g. the ilium, ischium and pubis to from the pelvic bone; the two halves of the infant frontal bone, and of the infant mandible; the five sacral vertebrate and the four coccygeal vertebrae.

• The scientific study of joints is called Arthrology
• Arthro = Joint,  Logos =  study 

ANATOMICAL AND PHYSIOLOGICAL CONSIDERATION OF JOINT:

An articulation (joint) is a point of contact between two bones, between cartilage and bones or bones and teeth. When we say that one articulates with another, we mean that one bone forms a joint with other bone. The scientific study of joints is termed as Arthrology; the study of motion of the human body is called Kinesiology.

CLASSIFICATION OF JOINTS

1.  STRUCTURAL CLASSIFICATION:-

• Fibrous joints:

1. Sutures;
2. Syndesmosis;
3. Gomphosis,

• Cartilaginous Joints:

1. Primary cartilaginous joints or synchondrosis; and
2. Secondary cartilaginous joints or symphysis.

• Synovial Joints:

1. Ball and socket or spheroidal joints;
2. Sellar or saddle joints; 
3. Condylar or bicondylar joints
4. Ellipsoid joints
5. Hinge joints
6. Pivot or trochoid joints 
7. Plane joints
8. FUNCTIONAL CLASSIFICATION:-

 (According to the degree of mobility)

1. Synarthrosis (immovable):-Syn = Together, Arthos = join.

The articular surfaces are joined by tough fibrous tissue.

E.g. Suture of skull.

1. Amphiarthrosis (slightly movable) :- Amphi = On both sides, Arthros = joint

An amphiarthrosis is a slightly movable joint.

A pad of cartilage lies between bone surfaces, and there are fibrous ligaments to hold bones and cartilage in place,like cartilaginous joints.

1. Diarthrosis (freely movable), like synovial joints.
2. Synarthrosis is fixed joints at which there is no movement. The articular surfaces are joined by tough fibrous tissue. Often the edges of the bones are dovetailed into one another as in the sutures of the skull.

1. Amphiarthrosis is jointed at which slight movement is possible. A pad of cartilage lies between the bones surfaces and there is a fibrous capsule to hold the bones and cartilage in place. The cartilages of such joints also act as shock absorbers, e.g. the intervertebral discs between the bodies of the vertebrae, where the cartilage is strengthened by extra collagen fibers.

1. Diarthrosis or synovial joints are known as freely movable joints at some of them the movement is restricted by the shape of the articulating surfaces and by the ligaments that hold the bones together. These ligaments are of elastic connective tissue. A synovial joint has a fluid-filled cavity between articular surfaces which are covered by articular cartilage. The fluid, known as synovial fluid, is a form of lymph produced by the synovial membrane which lines the cavity except for the actual articular surfaces and covers any ligaments or tendons which pass through the joint. Synovial fluids act as a lubricant. The form of the articulating surfaces controls the type of movements that take place at any joint.

The movements possible at synovial joints are:

Angular

• Flexion: Decreasing the angle between two bones.
• Extension: Increasing the angle between two bones.
• Abduction: Moving the part away from the mid line.
• Adduction: Bringing the part towards the mid-line.

Rotatory

• Rotation: Turning upon an axis.
• Circumduction:  Moving the extremity of the part round in a circle so that the whole part inscribes a cone.
• Gliding: one-part slides on another.

1. REGIONAL CLASSIFICATION:

• Skull type: Immovable
• Vertebral type: Slightly movable
• Limb type: Freely movable

The structural classification is most commonly followed so considered in detail in the following paragraphs. 

Fibrous Joints: In fibrous joints the bones are joined by fibrous tissue. These joints are either immovable or permit a slight degree of movement. These can be grouped in the following three subtypes.

Sutures: These are peculiar to the skull and are immovable. According to the shape of bony margins, the sutures can be plane, serrate, denticulate, squamous, limbous and of schindylesis type.

Syndesmosis: The bones are connected by the interosseous ligament, e.g. inferior tibiofibular joints. 

Gomphosis (peg and socket joints), e.g. tooth in its socket. 

Cartilaginous Joints:

In this type of joints the bones are joined by cartilage. These are of the following two types.

Primary cartilaginous joints (synchondrosis, or hyaline cartilage joints): The bones are united by a plate of hyaline cartilage, so that the joint is immovable and strong. These joints are temporary in nature because after a certain age the cartilaginous plate is replaced by bones (synostosis). 

Examples:

1. Joint between epiphylis and diaphysis of a growing long bone.
2. Spheno-occipital joint,
3. First chondrosternal joint and
4. Costochondral joints.

Secondary cartilaginous joints (symphyses or fibrocartilaginous joints): The articular surfaces are covered by a thin layer of hyaline cartilage, and united by a disc of fibrocartilage. These joints are permanent and persist throughout life. In this respect, symphysismenti is a misnomer. Typically the secondary cartilaginous joints occur in the median plane of the body, and permit limited movements due to the compressible pad of fibrocartilage and the occasional fluid-filled cavities, such as in the pubic and manubriosternal joints; the thickness of fibrocartilage is directly related to the range of movement. Secondary cartilaginous joints may represent an intermediate stage in the evolution of synovial joints. Examples:

• Symphysis pubis,
• Manubriosternal joint and
• Intervertebral joints between the vertebral bodies.

Synovial Joints:

Synovial joints are most evolved, and therefore, most mobile type of joints.

The articular surfaces are covered with hyaline (articulator) Cartilage (occasionally fibrocartilage in certain membrane bones). Articular cartilage is avascular, non-nervous, no lymphatics and is elastic in nature. Lubricated with synovial fluid, the cartilage provides slippery surfaces for free movements, like ‘ice on ice’. The surface of the cartilage shows fine undulations filled with synovial fluid.

Between the articular surfaces there is a joint cavity filled with synovial fluid. The cavity may be partially or completely subdivided by an articular disc or meniscus. 

The joint is surrounded by an articular capsule which is made up of a fibrous capsule lined by synovial membrane. Because of its rich nerve supply, the fibrous capsule is sensitive to stretches imposed by movements. This sets up appropriate reflexes to protect the joint from any sprain. This is called the ‘watch – dog’ action the capsule. The fibrous capsule is often reinforced by capsular or true ligaments representing thickenings of the fibrous capsule and the accessory ligaments (distinct from the fibrous capsule) which may be intra or extracapsular.

Synovial Membrane:

The synovial membrane (synovium) attaches directly around the margins of the articular cartilage and lines the monoarticular region of synovial joints, covering the inner surfaces of joint capsules, bone surfaces, and extra-articular ligaments and tendons. This membrane secretes synovial fluid. Fat laying outside the synovial membrane helps the synovium to fill potential spaces in the joint cavity. The synovial lining cells are of two types, viz 

Type A: Those that are like macrophages and have a preliminarily phagocytic function.

Type B:  That which are secretary and similar to fibroblast.

Synovial Fluid: Which fills the synovial cavity has a yellow-tinted or clear viscus fluid.

Content: A) Hyaluronic acid      B) Leukocytes C) Type Ⅱ collagen C proteins.

Functions: 

1. Lubrication and reduces friction in the joint.
2. Supplies nutrients to and removes metabolic wastes.
3. Phagocytosis that kills microbes 
4. Removes debris resulting from bear and tear in the joint. Synovial fluid consists of Hyaluronic acid an interstitial fluid formed and from blood plasma. The amount of synovial fluid varies according to the size of the joint. For example, a large joint, Such as the knee, may contain 3-4 ml of fluid. It forms a thin viscous film over the surface within the articular cartilage.

Hinge Joints (Ginglymi):

Articular surfaces are pulley-shaped. There are strong collateral ligaments. Movements are permitted in one plane around a transverse axis. 

Examples:

• Elbow joint
• Ankle joint
• Interphalangeal joints

Pivot (Trochoid) Joints:

The articular surface comprises a central bony pivit (peg) surrounded by an osteoligamentous ring, Movements are permitted in one plane around a vertical axis.

Examples:

• Superior and inferior radio-ulnar joints and
• Median atlanto-axis joints.

Condylar (Bicondylar) Joints:

Articular surfaces include two distinct condyles (convex male surfaces) fitting into reciprocally concave female surfaces (which are also, sometimes, known as condyles, such as in the tibia). These joints permit movements mainly in one plane around a transverse axis, but partly in another plane (rotation) around a vertical axis.

Example:

• Knee joints 
• Right and left jaw joints

Ellipsoid Joints: 

Articular surface include an oval, convex, male surface fitting into an elliptical, concave female surface. Free movements are permitted around both the axes, flexion and extension around the transverse axis, and abduction and adduction around the anteroposterior axis. A combination of movements produces circumduction. Typical rotation around a third (vertical) axis does not occur.

Example: 

• Wrist joint,
• Metacarpophalangeal joints and
• Atlanto-occipital joints.

Articular surfaces are reciprocally concavoconvex. Movements are similar to those permitted by an ellipsoid joint, with the addition of some rotation (conjunct rotation) around a third axis which, however, cannot occur independently.

Examples:

• First carpometacarpal joint,
• Sternoclavicular joint and
• Calcaneocuboid joint.

Ball and Socket (Spheroidal) Joints:

Articular surfaces include a globular head (male surface) fitting into a cup-shaped socket (female surface). Movements occur around an indefinite number of axes that have One common centre. Flexion, extension, abduction, adduction, medial rotation, lateral rotation, and circumduction, all occur quite freely.

Examples:

• Shoulder joint,
• Hip joint and
• Talo- calcaneonavicular joint.

CLASSIFICATION AND MOVEMENTS SYNOVIAL JOINTS:

Terminology and Definition:

• Human Kinesiology: Study of the geometry of surfaces and their associated movements.
• Male surface: An articulating surface that is larger in surface area and always convex in all directions.
• Female surface: An articulating surface that is smaller and concave in all directions.
• Simple Joints: Joints with only two articulating surfaces, i.e. male and female.
• Compound Joints: Joint possessing more than one pair of articulating surfaces.
• Degrees of Freedom: Number of axes at which the bone in a joint can move.
• Uni-axial: Movement of bone at a joint is limited to one axis, i.e. with one degree of freedom.
• Biaxial: With two degrees of freedom. 
• Multi-axial: Three axes along with intermediate positions.
• Translation: Sliding movements of one articulating surface over the other.

Movements and Mechanism of Joints:

• Angular movement: Movement leading to diminution or increase in the angle between two adjoining bones. They are:
• Flexion and extension: Bending and straightening respectively.
• Abduction and adduction: Movement away and towards the median respectively.
• Circumduction: When a long bone circumscribes a conical space.
• Rotation: Bone moves around a longitudinal axis.
• Adjunct rotation: Independent rotations.
• Conjunct rotation: Rotations which accompany other movements.

Mechanism of lubrication of a synovial Joint:

Synovial fluid, secreted by the synovial membrane, is sticky and viscous due to hyaluronic acid (a mucopolysaccharide). It serves the main function of lubrication of the joint but also nourishes the articular cartilage.

Hyaline cartilage covering the articular surfaces possesses inherent slipperiness, like that of the ice.

Intra- articular fibrocartilage, articular discs on menisci, complete or incomplete, help in spreading the synovial throughout the joint cavity, but particularly between the articular surfaces.

Haversian fatty pads (Haversian glands) occupy extra spaces in the joint cavity between the incongruous bony surfaces. All of them are covered with synovial membrane and perhaps function as swabs to spread the synovial fluid.

Blood supply of synovial Joints:

The articular and epiphyseal branches given off by the neighboring arteries form a periarticular arterial plexus. Numerous vessels from this plexus pierce the fibrous capsule and form a rich vascular plexus in the deeper parts of synovial membrane. The blood vessels of the synovial membrane terminate around the articular margins in a fringe of looped anastomoses termed the circulus casculosus (curculus articularis vasculous).

It supplies capsule, synovial membrane, and epiphysis, The articular cartilage is avascular.

After epiphyseal fusion, communication between the circulusvasculous and the end arteries of metaphysis are established, thus minimizing the chances of osteomyelitis in the metaphysis.

Nerve supply of synovial Joints:

The capsule and ligaments possess a rich nerve supply, which makes them acutely sensitive to pain. The synovial membrane has a poor nerve supply and is relatively insensitive to pain. The articular cartilage is non-nervous and totally insensitive.

Articular nerves contain sensory and autonomic fibers. Some of the sensory fibres are proprioceptive in nature; these are sensitive to position, and movement and are concerned with the reflect control of posture and locomotion. Other sensory fibres are sensitive to pain. Autonomic fibres are vasomotor or vasosensory. The joint pain is often diffuse and may be associated with nausea, vomiting, slowing of pulse, and fall in blood pressure. The pain commonly causes reflex contraction of muscles which fix joints in a position of maximum comfort. Like visceral pain, joint pain is also to uninvolved joints.

The principles of distribution of nerves to joints were first described by Hilton (1891). Hilton’s law states that a motor nerve to the muscle acting on joint tends to give a branch to that joint (capsule) and another to the skin covering the joint.

The concept of innervation of a joint was further elucidated by Gardner (1948) who observed that each nerve innervates a specific region of the capsule and that the part of the capsule which is rendered taut by a given muscle is innervated by the nerve supplying its antagonists. Thus the pattern of innervation is concerned with the maintenance of efficient stability at the joint.

KNEE JOINT:-

Knee joint is synovial joint of the condylar variety.it can be regarded as a modified hinge variety (because it allows some rotator movements beside flexon and extension). It is largest & complex joint in the body which cosists of” 3 joints:-

1. Medial condylar joint: Between the medial condyle “of the femur” & “the medial condyle of the tibia”.
2. Lateral condylar joint: Between the lateral condyle “of the femur” & the lateral condyle of “of the tibia”.
3. Patellofemoral joint:  Between the patella & the patellar surface of the femur.

(Fibula is not directly involved in the joint)

“Articulation:

Above - The rounded condyles of the femur.

Below – the condyles of the tibia and their cartilaginous menisci.

In front – Articulation between the lower end of the femur and the patella. Articular 

surfaces of the femur, tibia and patella are covered with hyaline cartilage.