APABAHUKAM

(Clinical Notes on Shoulder Pathologies)


APABAHUKAM



1.FROZEN SHOULDER

Observations:
•Amsa sandhi gata vata
•Chala guna kshaya
•Manda,sthabdha guna vridhi

Vital diagnostic points

•Pain and stiffness.
•Decreased range of  movements.
•Cannot raise arm beyond certain point due to stiffness and pain.
•Physical evaluation of joint and scapula(~winging) helps in primary diagnosis.
•Usually non-edematous.
•Usually presenting age group will be young adults/mostly male.

Underlying causes:-

1.Cervical disc diseases of neck.(directs =>to cervical pathologies)
2.Shoulder injury.
3.Diabetes mellitus.

Suggestive investigations
Blood RE
X-Ray
MRI (not essential in preliminary evaluation)

Line of Rx

Consider jadaragni,ama at dhatu level and other kaphanubandha lakshana.
Snigdha/Ushna chikitsa.

Rx Choices:-

Internal medicines:
1.Vaishwanara ch./Hingu vachadi tab(bipha)
2.Ashtavarga ksm
3.Mustharishtam
4.Dhanwantharam ksm/tab.
5.Snehana.
6.Prasaranyadi ksm


(Guggulu/Sallaki preperations not a must and can be safely avoided.Panion tab/Painoff not a good choice here.)
Stifain tab may be reserved for a later suggestion.

External treatment.

1.Exercise suggestions is a must.[Physio suggestions]Stretching over a wall,step wise raising on window rods.Abduction.Try to improve the comfort zone movement rather than trying for increasing range of movement.

2.Nasyam Karpasasthadi.(5-8drops max.)
3.Rooksha sweda followed by Abhyangam+Ushma Swedam.(Prasaranyadi thaila/ Karpasasthyadi thaila)
4.Jambeerapinda sweda/Patrapotala sweda.

A moderately build young male/29y presented with rt shoulder stiffness was managed in this treatment line.With 7days E/Rx. symptoms subsided with 90% improvement in r.o.m.
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2.GLENOHUMERAL ARTHRITIS

Observations:
•Vata vridhi in kapha sthana(sandhi)

Vital diagnostic points:

•Progressive shoulder pain.
•Stiffness and loss of motion.
•night pain,mostly postural.

Underlying causes
•O.A ; R.A
•Post trauma.

Suggested investigations:
•Blood routine
•X-Ray
•MRI

Line of treatment:
Vatakapha hara.
Ushna pradhana.
Abhayanthara Snehana.

Rx suggestions

Consider agni/dhatu gata ama before Rx

Internal medicines
1.Rasna saptakam ksm
2.Maharasnadi ksm
3.Aaba guggulu.
4.Gandha tailam Cap.
5.Ksheerabala.
6.Rasonadi ksm.

Ext Rx.
1.Nasyam -Karpasathyadi.
2.Dhanyamla dhara local.
3.Abhyanga with vathahara thailas like Dhanwantharam/Ksheerabala etc.