E-ISSN:2456-3110

Case Report

Frozen shoulder

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 5 May
Publisherwww.maharshicharaka.in

An Ayurvedic approach in the management of Avabahuka (frozen shoulder) - A Case Study

S Kolar S1*, Karthik KV2, S Hiremath S3
DOI:10.21760/jaims.9.5.43

1* Shubhangini S Kolar, Assistant Professor, Department of Kayachikitsa, Shri Siddhivinayaka Rural Ayurvedic Medical College Hospital Research Centre Harugeri, Belgaum, Karnataka, India.

2 Karthik KV, Assistant Professor, Department of Shalya tantra, Shri Siddhivinayaka Rural Ayurvedic Medical College Hospital Research centre Harugeri, Belgaum, Karnataka, India.

3 Shakti S Hiremath, Assistant Professor, Department of Rasashastra Bhaisajya Kalpana, Shri Siddhivinayaka Rural Ayurvedic Medical College Hospital Research centre Harugeri, Belgaum, Karnataka, India.

Shoulder joint (Amsa Sandhi) has its clinical importance because of wide range of motion. Frozen shoulder is a musculoskeletal disorder characterized by stiffness and pain in the shoulder joint. This typically occurs in cycle of 3 stages, painful phase, stiff phase, and thawing phase. This entity is resembling with Avabahuka, in Ayurveda. Avabahuka is a disorder of Amsa sandhi, and it has been mentioned by Acharya Sushruta under 80 types of Vatavyadhis. It is commonest condition in orthopaedic hospital. Frozen shoulder causes pain and restricted movements, which hampers daily activity of the patient. Modern medicine has NSAIDs, steroids for such condition but it is costly, have much side effects and gives temporary relief. hence a case study was carried out using Ayurvedic approach, which got effect on the range of movements. A 62 years female arrived at OPD, SSVRAMC with main complaints of left shoulder pain, stiffness, restricted movements, associated with disturbed sleep due to the pain since 1 month.

Keywords: Avabahuka, Frozen shoulder, Nasya, Patra Pottali Sweda, Rasnadi Guggulu

Corresponding Author How to Cite this Article To Browse
Shubhangini S Kolar, Assistant Professor, Department of Kayachikitsa, Shri Siddhivinayaka Rural Ayurvedic Medical College Hospital Research Centre Harugeri, Belgaum, Karnataka, India.
Email: 		S Kolar S, Karthik KV, S Hiremath S, An Ayurvedic approach in the management of Avabahuka (frozen shoulder) - A Case Study. J Ayu Int Med Sci. 2024;9(5):254-257.
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https://jaims.in/jaims/article/view/3359

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-03-15 2024-03-25 2024-04-05 2024-04-13 2024-04-19
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© 2024by S Kolar S, Karthik KV, S Hiremath Sand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Avabahuka is one among the Vataja Nanatmaja Vyadhi[1] which affects the normal functioning of the upper limbs there by hampering the normal routine lifestyle of an individual. It is mainly caused by vitiation of Vyana Vata vitiation and gets Sthana Samsraya in the Amsa Sandhi (shoulder joint). There it does the

Shoshana of Shleshaka Kapha, Mamsa, Sira, Snayu, leading to Bahupraspandita Haratwa (restricted movements of affected shoulder), Shoola (pain), Sthambha (stiffness).[2] These clinical features closely resemble with Frozen shoulder as described in modern system of medicine.

Frozen shoulder is an idiopathic condition which manifests clinically as shoulder pain with progressive restricted movement, both active and passive along with normal radiographic scans of gleno-humeral joint.[3] It can affect activities like eating, dressing, personal hygiene and works, so life of the patient becomes miserable.

In general population prevalence rate is about 3%-5% and up to 20% in those with diabetes. It is peak in between the ages of 40-60 years and is more common in women.[4]

Temporary relief can be achieved by Analgesics, Local intra articular injections of cortico-steroids in glenohumeral joint followed by physiotherapy. Hence patients approach for alternative treatments with lesser side effects. Ayurveda (the science of life) has described effective remedies for such illness such as Nasya, Uttarabhakthika Snehapana, Swedana, Shamanoushadies.[5] In this case study Nasya with Mahamasha Taila, Sthanika Patra Pottali Sweda, Rasnadi Guggulu were selected.

Case Study

A 62 years female patient approached to Kayachikitsa OPD of Shri Siddhivinayaka Rural Ayurvedic Medical College, Hospital & Research Centre, Harugeri, Belagavi, Karnataka with complaints of left shoulder pain, stiffness, restricted movements, associated with disturbed sleep due to pain since 1 month.

Patient was apparently normal before 1 month, gradually she developed pain in the left shoulder joint, restricted movements,

associated with disturbed sleep due to pain. She was unable to do movements of same joint which caused her to limit the daily performance. For these complaints she took allopathic medicine which has given her relief for few days. Later on, complaints of pain, restricted movements reoccurred which made her to visit the hospital. Treatment started on 16/4/24 to 22/4/2024. (OPD No-240421382, IPD No-IP2400521) There was no any past history of Diabetes mellitus, Hypertension, thyroid disorders.

Clinical findings

Blood pressure - 120/70mm of Hg,

Pulse rate - 72 bpm

Respiratory rate - 14cpm

Systemic Examination

Central Nervous System : Conscious and well oriented

Cardiovascular System : S1 and S2 heard and no murmurs

Respiratory System : Air entry bilaterally equal, NVBS, no added sounds

Astasthana Pareeksha

1. Nadi : Vata-Kaphaja

2. Mutra : Prakruta

3. Mala : Prakruta

4. Jivha : Alipta

5. Shabda : Prakruta

6. Sparsha : Anushnasheeta

7. Drik : Prakruta

8. Aakriti : Madhyama

Dashavidha Pareeksha

Prakruti: Vata-Kaphaja

Vikruti: Vyana Vayu, Shleshaka Kapha,

Sara: Madhyam

Samhanan: Madhyam

Vaya: Madhyam

Satmya: Vyamishra

Satva: Madhyam


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Abhyavaran Shakti: Madhyam

Jarana Shakti: Madhyam

Vyayama Shakti: Avara

Local examination

  • Muscle tone : Normal
  • Deformity Left shoulder joint : Absent
  • Muscular atrophy : slight wasting
  • Tenderness : Mild tender
  • Local temperature : Normal

Range of Movements

  • Abduction - 60°
  • Flexion - 45°
  • Extension - 50°
  • Internal rotation - Severe pain with Dorsum of hand touching to L2 only (15°)

Diagnosis

Diagnosis was made based on classical signs and symptoms of Avabahuka i.e., Shoola (Pain the shoulder joint), Sthambha (stiffness), Bahupraspandita Haratwa (restricted range of movements).

Treatment

Nasya with Mahamasha Taila, Sthanika Patra Pottali Sweda along with oral medicine Rasnadi Guggulu was given as per the following;

Table 1: Therapeutic intervention

AushadaMatraSevana KalaAnupanaKala
Mahamasha Taila8 drops each nostrilMorning-1-7 days
Sthanika Patra Pottali Sweda-Morning-1-7 days
Rasnadi Guggulu500mg BDAfter foodSukoshna Jala1-30 days

Observation & Outcome

After completion of treatment that was of 1 month patient got significant relief. Nasya gave effects in terms of pain and stiffness. The pain during movement and that was getting worse at night got diminished after 15 days of treatment. The range of motion of the shoulder joint also got improved.

Table 2: Assessment

CriteriaBefore treatmentAfter treatment
Pain (VAS)82
StiffnessSevereMild
Flexion45°120°
Extension50°60°
Internal rotation15°60°
Abduction60°120°

Discussion

Acharya Vagbhata’s quotation Naasa Hi Shirasodwaram[6] states that, nose is the easiest and closest opening for conveying the potency of medicines to the cranial cavity. The Nasya Dravya acts by reaching 'Sringataka Marma’ from where it spreads into various Strotas (vessels and nerves) and brings out vitiated Dosha from the head. Acharya Sushruta considers Shringhataka Marma as a Sira and Sadyo Pranahara Marma[7] and as a composite structure consisting of four Siras in connection with four sense organs - viz, nose, ear, eye and tongue. Further pattern of induced activity depends on chemical and physical properties of the stimulant medication, for which lipid based Balya medication was selected i.e., Mahamasha Taila which mainly contains Masha (black urad pulse), very commonly famous for its properties like Brumhana, nervine tonic, immune modulator and anti-inflammatory. The other main contents Dashamoola, Chaga Mamsa, Atmagupta (Mucuna pruriens) and Jeevaniya drugs and others making it Madhura Vipaki, Snigdha, Ushna Viryatmaka and Vatahara in nature hence effective in treating conditions like Avabahuka.

Patra Pottali Sweda possesses Ushna, Sukshma and Laghu Guna that removes the Avarodh from the Srotas caused by vitiated Vata and Kapha and hence brings Doshas into Samyawastha. Swedana not only proves itself as a boon in pain management but also has anti-inflammatory property too. According to Vant Hoff’s principle the basal metabolism of the body increases by certain percentage for every 1 degree rise in body temperature. Rise in temperature induces relaxation of muscles and hence muscle spasm with inflammation and pain gets reduced. Muscle relaxes most readily when tissues are warm which in turn reduces the spasm, inflammation and pain.[8]

The Rasnadi Guggulu[9] mentioned in Yogaratnakar Vatavyadhi Adhikar


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which contains the drugs like Rasna, Guduchi, Eranda, Devadaru, Shunti and Guggulu these drugs are having Ushna Virya acts as Deepana, Pachana Vatakaphanashaka, Shoolahara, Shothahara and Balya.

Conclusion

This case study demonstrated that Ayurvedic management of Nasya Karma seems very effective for the treatment of Avabahuka i.e., frozen shoulder and this attempt was made to provide safe and effective treatment to the patient within short period. From the above case, it can be said that Avabahuka i.e., frozen shoulder can be successfully managed through Nasya Karma as Shodhana, Patra Pottali Sweda along with Shamanoushadi.

References

1. Acharya K. R. Shrikantha Murthy, Sharangadhara Samhita, Purvardha, Chapter-7, Shloka no-108 Choukambha Publication, Edition 5, 2003, Pp-40

2. Acharya K. R. Shrikantha Murthy, Astanga Sangraha, Nidana Sthana, Chapter-15, Shloka-45, Choukambha Publication, Edition 5, 2005, Pp-247

3. Manjunath Akki, Suresh N Hakkandi, Mohammed Lulu. To evaluate the Comparative efficacy of Svalpamasha Taila Nasya and Parinata Keriksheeradi Nasya in Avabahuka (Frozen shoulder). AYUSHDHARA, 2019;6[1]: 2005-2010

4. Case Study of Frequent Leech application in Diabetes mellitus with special reference to Frozen Shoulder. Chetan Agrawal, Rashmi Kale Ayurlog: National Journal of Research in Ayurved Science-2018; 6(2): 1-5

5. Sharma S, Bhagat PJ, Reddy RG. Management of Avabahuka (frozen shoulder) with Ayurveda Therapeutic Regimen: A Case Study. J Res Ayurvedic Sci 2020;4(4):158-163

6. Vagbhata, Astanga Sangraha translated by K R Srikanthamurthy volume 2 sutrasthana 3rd 29/2. Edition. Chaukhambha Orientalia, Varanasi. 1998

7. Acharya Agnivesha, Charaka samhita chikitsasthan, Vidyotini Hindi Commentary by Sri Satyanarayana Sastri edited by pt. Rajeswaradatta Shastri, Chaukambha Bharati Academy, Varanasi.

8. G Shrinivas Acharya, Panchakarma Illustrated

Textbook, Published by Chaukambha Sanskrit Prathisthan, Varanasi. Edition 2015, P.40.

9. Vaidya Lakhsmipati Shastri, Yogaratnakara, Vidyotani Hindi Commentary, Vatavyadi Chikitsa, Shloka no-2, Choukambha Publication, Edition Reprinted, 2013, Pp-531


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