How to Manage Pain in Apabahuka (Frozen Shoulder)

Abstract

Avbahuka is one of the vata vyadhi and the main cause of avbahuka is dhatu kshaya. In this disease the main characteristic feature is that it hampers the whole functioning of the hand. As per modern the correlation of avbahuka is frozen shoulder. In this article we are going to discuss how to manage the pain in avbahuka patients. So if you or nearones are facing this type of problem then you must study this article carefully and get the solution for this condition. As per classical texts pain is not considered as the characteristic feature of avbahuka but clinically it is seen in all patients so yes there is immediate need to cure pain in avbahuka. Here we will discuss all the causes, symptoms of avbahuka or how to treat pain as per ayurveda along with one example of case study.

Frozen Shoulder, Pain management, Apabahuka, Causes, Signs, Symptoms, Nidaan, Lakshan, Risk Factors, Treatment Of Frozen Shoulder In Ayurveda, Shodhan Chikitsa, Shaman Chikitsa, Pathya, Apathya, Diet, Foods, Avbahuka Roga

Introduction

Avbahuka is one among the vata vyadhi (neurological disorders) that affect the functioning of the hand. According to acharya charak, after the dhatu depletion vata dosha gets aggravated and causes vata vyadhi. Causes of vata vyadhi are- ruksha ahaara, ati-alpa ahaara, sheeta ahaara, asatamaya ahaara, katu ahaara, tikta ahaara, kshaya ahaara, vishma ahaara, excessive fasting, excessive intercourse, food intake on indigestion, natural urge suppression, depression, stress, fear, excessive swimming, excessive travelling, depleted sleep, day sleeping, anger, day sleeping. All these dietary and lifestyle regimen cause vata vyadhi.

Avbahuka Samanya Nidaan And Lakshan

According to acharya vagbhata (as. Hri. 15/43) aggravated vata dosha shrink the veins and arteries of the shoulder (ansa mool stitha) and cause avbahuka roga. As it comes under Due to this condition all the movements of shoulder and arm get restricted.

Samanya Lakshan (Symptoms Of Avbahuka)

  • Ansa sandhi shoola (pain in shoulder joint)
  • Shotha (inflammation)
  • Stabdhhata (stiffness)
  • Sakashta kriya of bahu (restricted movement of hand)

Nidaan (Causes Of Avbahuka)

  • Dietary and lifestyle regimen that affects vata dosha already mentioned earlier
  • Trauma of neck
  • Shoulder dislocation
  • Akshaka asthi fracture (fracture of clavicle bone)
  • Tumour
  • Trauma of brachial plexus that leads to paralysis.

Modern Aspect Of Avbahuka

Frozen shoulder is a condition characterised by pain and stiffness in the shoulder joint. Symptoms  begin gradually and worsen with time passing away. The main Risk of developing a frozen shoulder is if you’re recovering from some condition that restricted your arm movement. Also there is a risk of developing a frozen shoulder in the same hand.

Symptoms Of Frozen Shoulder

It typically develops slowly and is divided into three stages and  each stage lasts for a few months. Following stages are there in case of frozen shoulder.

  • Freezing Stage – This is the first stage of frozen shoulder. In this stage  movement of the shoulder causes pain and range of motion  becomes limited.
  • Frozen Stage – This is the second stage of this condition. In this stage pain begins to diminish. But the affected  shoulder becomes stiffer and the range of motion also gets difficult.
  • Thawing Stage – In this stage the range of motion of the shoulder begins to improve. Sometimes pain worsens at night and disrupts sleep.

Causes Of Frozen Shoulder

The main reason for a frozen shoulder is when the capsules of the shoulder joint tightens and thickens and causes restriction in the range of movement of the shoulder joint. The exact cause behind this thickening and tightening of the capsule is not known but here are some risk factors that are responsible for this condition. Let’s take a look at those risk factors.

Risk Factors For Frozen Shoulder

  • People older than 40 years, usually women are more prone to the risk of occurring this condition.
  • People with prolonged or reduced shoulder mobility are at higher risk of suffering with the condition of frozen shoulder.
  • Rotator cuff injury, Broken arm, Stroke, Recovery from surgery
  • Systemic diseases: Diabetes, Overactive thyroid (hyperthyroidism), Underactive thyroid (hypothyroidism), Parkinson’s disease, Cardiovascular disease and Tuberculosis are some of the diseases that may lead to restricted movement of the shoulder joint.
  • All the above mentioned are some of the risk factors that may lead to frozen shoulders.

Treatment Of Frozen Shoulder As Per Ayurveda

Line of treatment for avbahuka must be followed as per line of treatment of vata vyadhi. Let’s take a look at those lines of treatment. Treatment for vata vyadhi is  divided into two basic patterns:

  • Shodhan Chikitsa – In shodhan chikitsa panchakarma procedures have to be followed. Snehan karma, Swedana karma, virechana karma, basti karma, rasayan chikitsa, nasya and dhumpana, all these panchakarma procedures are to be followed in vata vyadhi.   
  • Shaman Chikitsa – Under shamana chikitsa all classical herbal formulations are mentioned.

Let’s have a detailed look on both the treatment options. Before studying the procedures of shodhan chikitsa and shaman chikitsa let’s take a look at what panchkarma is. Panchakarma comes under kayachikitsa that is one among the eight branches of ayurveda. It deals with the purification of vitiated doshas from the nearest paath of the body where the vitiated dosha is situated. Samshodhan chikitsa comes under the poorva and pradhan karma of panchakarma therapy and shamana chikitsa comes under the pashchat karma of panchakarma therapy.

Shodhan Chikitsa In Avbahuka Roga

  • Snehan Karma – Snehan is referred to as oleation therapy. Snehan karma causes unctuousness, softness, liquidity and stickiness in the body and is considered as one of the important karma in the line of treatment of vata vyadhi. It is mentioned under the purvakarma (procedure performed before  and is to be done before the pradhan karma. In case of avbahuka sthanik abhyanga is to be done with ghrit, taila, vasa and majja.
  • Swedana Karma – Swedana karma is referred to as fomentation therapy. In this procedure perspiration of the body occurs and it removes heaviness, stiffness and coldness in the body. It is to be followed after snehana karma to maintain the blood circulation. In case of avbahuka sthanika swedana is to be performed, that is ekanga sweda (for one part only that is the affected part).

Shaman Chikitsa In Avbahuka Roga

Herbal formulations come under the shaman chikitsa. Here are some of the formulations that help in getting rid of avbahuka roga.

  • Agnitundi Vati
  • Rasraj Ras
  • Mal Sindoor
  • Shunthi Churna
  • Ashwagandha Churna
  • Ashwagandharishta

Pathya And Apathya

Pathya

  • Whole wheat
  • Brown rice
  • Cherries
  • Dates
  • Grapes
  • Mango
  • Papaya
  • Apricots
  • Banana
  • Plums
  • Apples
  • Peaches
  • Cooked onion
  • Carrots
  • Mustard
  • Peas
  • Moong dal
  • Red lentil
  • Buttermilk
  • Butter
  • Tofu
  • Garlic
  • Cloves
  • Mint
  • Sea salt
  • Ajwain
  • Herbal tea
  • Fruit juices

Apathya

  • Rye
  • White rice
  • White refined flour
  • Melon
  • Dried fruits
  • Cauliflower
  • Sprouts
  • Cabbage
  • Potato
  • Ice cream
  • Powdered milk
  • Coriander seeds
  • Beer
  • Wine
  • Coffee
  • Hard alcohol
  • Mutton
  • Beef
  • Dry and roasted nuts
  • White sugar
  • Brown sugar

Case Study On Pain Management In Avbahuka Roga

Here we are sharing with you a case study on pain management in avbahuka by respected Dr. Jabeen Shaikh Gani and Dr. Amol M. Badarkhe. They both did the treatment of an 18 year old male patient. Let’s take a look at a detailed case study of the patient.

Case Study

Patient came to the hospital along with symptoms- vam ansa sandhi shoola (pain in left shoulder joint), vam hasta shoola (pain in left hand), alpa shopha (mild inflammation), vam hasta kriya alpata (left hand restricted movements) since 1 month. Nidan of the patient is done with ashtavidha pariksha and dashvidha pariksha.

Patient’s Details

  • Name of Patient: X
  • Age and Sex: 18/M
  • Religion: Hindu
  • Occupation: Student

Chief Complaints

  • Vam hasta shoola
  • Alpa shopha
  • Vam ans sandhi shoola
  • Vam hast kriya alpata
  • Alpa hast kriya

Ashtavidha Pariksha

  • Nadi: 80/min
  • Mala: Samyak
  • Mutra: Samyak
  • Jihva: Alpa saam
  • Shabda: Spashta
  • Sparsha: Anushna
  • Drika: Prakrit
  • Akriti: Madhyam

General Examination

  • PR: 80/min 
  • BP: 110/70mm of Hg
  • RS: Clear
  • CVS: S1 S2 N
  • CNS: Conscious and oriented
  • P/A: Soft, no tenderness

Past History

H/O- Trauma at left hand 1 month back. MRI Brachial plexus findings- in left brachial plexus mild diffuse thickening of nerve roots is there along with mild inflammation but the continuity of structures is maintained. There is a history of allopathic medications but with that patient got no relief. And symptoms got worse with shoulder joint movement.

Treatment

Shodhan Chikitsa

  • Sthanika Snehana – This procedure is done with ksheerabala taila for 20 minutes and continues till 15 days.
  • Sthanika Swedana – This procedure is done with dashamoola and nirgundi for 15 minutes and continues till 15 days.

Shaman Chikitsa

  • Ekangveer Ras – This ayurvedic formulation is given in a dose of 250 mgm with lukewarm water twice a day after meals.
  • Mahavat Vidhwansan Ras – It is given in the dose of 250 mgm with lukewarm water twice a day after meals.

Pathya

  • Ahara – Ghrit, vasa, taila, majja, masha, patola, godhum, draksha and other vata shamak dravyas.
  • Vihara – Vyayam is followed by the patient.

Observations

Effect of treatment on symptoms is observed as under:

VAS Scale – Before treatment was 10 and after treatment was 5 in vam ans sandhi shoola and in vam hast shoola, before treatment was 8 and after treatment was 5. Skastha vam hasta kriya- before treatment was +++ and after treatment was ++.

Conclusion

In this article we discuss what avbahuka is and what are its causes, risk factors and symptoms. We studied avbahuka roga which is one of the vata vyadhi that occurred mainly due to depletion of dhatus. And in this condition the movement of shoulder, arm and hand is restricted along with pain, stiffness and inflammation. As per modern it is correlated to frozen shoulder. We studied the ayurvedic pain management of avbahuka roga along with the example of case study. In case study we saw that stahnika snehan and sthanika swedana are effective along with shaman chikitsa and pathya diet and lifestyle. So if you are facing the same problem you must follow ayurvedic treatment and have great relief.