Clinico-comparative Study of Trayodasanga Guggulu with and without Nasya Karma in the Management of Avabahuka (Frozen Shoulder Syndrome)
Authors: Solanki Vishal, Vaidya Tapankumar, Gupta S N, Patel Manish and Patel Kalapi
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Frozen shoulder (adhesive capsulitis - capsule thickens and tightens around the shoulder joint,
restricting its movement) is a condition characterized by stiffness and pain in the shoulder joint.
non-steroidal anti-inflammatory drugs and local corticosteroid injection given as a therapy in
frozen shoulder syndrome.
Frozen shoulder typically develops slowly, and in three stages. Each stage can last a number of
Freezing stage: Any movement of shoulder causes pain, and shoulder's range of motion starts
to become limited.
Frozen stage: Pain may begin to diminish during this stage. However, shoulder becomes
stiffer, and using it becomes more difficult.
Thawing stage: The range of motion in shoulder begins to improve with proper treatment.
People having more than 40 years of age, particularly women, are more likely to have frozen
shoulder. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the
joint capsule so that it can move more freely. People who have certain diseases i.e., diabetes,
hyperthyroidism, hypothyroidism, cardiovascular disease, tuberculosis and Parkinson’s disease
appear more likely to develop frozen shoulder.
The prevalence of frozen shoulder is estimated to be 2 to 5 percent of the general population. It is
more common in mid-50s. In 6 to 17 percent of patient, the other shoulder affected within 5
years. Frozen shoulder occurs predominantly and it is usually, lasting over 2 to 3 years sometime
40 percent of patient have persistence and have mild symptom beyond 3 years and 15 percent
have long term debility. The condition affects diabetic(type 1) patients more often than healthy
ones, with a prevalence of almost 11% in this population group.
According to modern treatment non steroidal anti inflammatory drugs (NSAIDs) and steroidal
injection at local site are given for reliving the symptoms of frozen shoulder syndrome, patient
may keep continue these drugs. Long term use of these drugs causes side effects.
Most common side effects of NSAIDs are on cardio vascular system (hypertension), Gastro
intestinal peptic ulcer, liver toxicity, kidney toxicity, ringing in ear. Also local application of
corticosteroid injection causes side effects such as osteonecrosis, osteoporosis and nerve damage,
tendon rupture, thinning of skin and soft tissues, joint infection.
According to āyurveda, here symptom of the ceṣṭahani is including in vatavṛddhi. Nasya karma
is indicated in bahugatavata.
MATERIALS AND METHODS
Total 31 patients were enrolled for the treatment. 16 patients were enrolled in group A. One
patient left the treatment due to non-medicinal cause. Hence, 15 patients completed the treatment
course in group A with trayodaśāṅga guggulu and nasya karma (māṣataiala). In group B, total
15 patients were enrolled and all the patients completed the treatment with nasya karma
(māṣataiala).Result was assesed by the relief in symptom index of avabāhuka (frozen shoulder
syndrome), with the help of scoring pattern.
Group A: 66.67% patients belonged to group of marked improvement, 33.33 % patients had
moderate improvement. There were no any patients found in group A in mild and unchanged
Group B: 53.33% patients belonged to group of moderate improvement, 40 % patients had mild
improvement and 6.66% patient was found in unchanged group.
Both the treatment had significant effect when assessed individually with paired ‘t’ test.
However, more percentile results were obtained in group A. During the testing of hypothesis
(comparing the effectiveness of both the therapy) p value is less than 0.001 in all the parameter.
Means, null hypothesis was rejected and alternate hypothesis accepted. It suggests that nasya
karma along with oral medicaments is more effective than only oral medicaments in the patients