Radiofrequency Ablation and Herbal Treatment for Frozen Shoulder

Abstract

A frozen shoulder is a painful condition involving the shoulder becoming stiff and inflamed, limiting the shoulder’s movement. Mainly the shoulder is made up of three bones- The clavicle (collarbone), the Scapula (the shoulder blade) and the humerus (upper arm). There is the articulation between the shoulder bones, making the shoulder joint commonly known as the glenohumeral joint. The ball socket joint allows the arm to rotate in a circular movement. The acromioclavicular and sternoclavicular joint plays an important role in the movement of the shoulder joint, with the hyaline cartilage which is present at the end of balance which surrounds the synovial membrane. It is the mobile joint of the body which allows the shoulder to adduct, abduct and rotate which move in 360 degrees. It is one of the largest and most complex joints in the body, there is a bursa which is a synovial fluid-filled sac which acts as a cushion with other structures of joints. In this topic, we are going to discuss the frozen shoulder and how radiofrequency helps in the frozen shoulder with its ayurvedic aspect in detail.

Introduction

Frozen Shoulder is known as Adhesive Capsulitis which is usually associated with shoulder pain and stiffness, it becomes difficult to move the shoulder. The capsule of the shoulder becomes thickened and the thick bands are known as adhesions, which lessens the synovial fluid which becomes difficult to move and freezes in one position and is accompanied by gradual stiffness and restriction. It mostly affects people of age group between the age group of 30-60 years of age and women are more affected than men. People with diabetes have an increased risk of a frozen shoulder.

Facts About Frozen Shoulder

1. It is the progressive restriction of the shoulder movement which is difficult to do any activities and is a disturbing situation at night.
2. It is usually caused by the encapsulating connective tissue which becomes tight and inflamed.
3. The actual mechanism and trigger of a frozen shoulder is unknown.
4. Frozen shoulder is mainly seen in a patient who has a history of systemic diseases such as diabetes, cardiovascular disease and hypothyroidism.
5. The average duration of a frozen shoulder is 1-3 years, but sometimes it varies.

Types

1. PRIMARY- It is idiopathic.
2. SECONDARY- It is caused by various predisposing factors such as stroke, post-injury and post-stroke. It changes the control shoulder and reduces the range of motion and stiffens the joints.

Three Subcategories of the secondary frozen shoulder include

1.  Systemic- It includes metabolic conditions such as diabetes mellitus.
2. Extrinsic Factors- These include cardiopulmonary disease and Parkinson’s disease.
3. Intrinsic Factors- These include Calcific tendinopathy, rotator cuff pathology and arthritis.

Pathophysiology

1. It is the inflammatory and fibrotic component which causes the hardening of joint capsules which further leads to adhesion and causes scar tissue around the joint tissue.
2. Further causes a reduction in synovial fluid. In the first stage, there are inflammatory cytokines in the joint fluid and further in the late stages, it causes dense collagenous tissue in the joint capsules.
3. Under the microscope, the appearance of the shoulder joint appears like a restricted finger movement as seen in Dupuytren’s contracture.

Causes

The cause of adhesive capsulitis is not understood however, there are many factors which are associated with higher risk.

1. Diabetes- as it tends to have a greater degree of stiffness
2. Immobilisation- Frozen shoulder can develop as it gets immobilised for a long period of time due to various diseases, fractures or surgery.
3. Other diseases such as Hypothyroidism, hyperthyroidism and cardiac diseases.
4. Autoimmune disease

Symptoms

Symptoms of frozen shoulder are divided into three stages

1.  The Freezing Stage- In this stage the shoulder becomes stiff and painful to move, this pain going on increases with time. It Gets worse at night and the inability to move the shoulder lasts for 6 weeks to 9 months.
2. The Frozen Stage-  The pain decreases and the shoulder remains stiff, very difficult to complete their daily activities. This stage lasts for 2-6 months.
3. The Thawing Stage (recovery) – In this, the pain gets lessened and there is the ability of the shoulder to move slowly and improve. The recovery phase is seen and the motion comes to the normal phase,  which lasts for 6 months to 2 years.

Risk Factors

1. Age- between 40-60 years of age.
2. Gender- Women are more prone than Men.
3. Recent surgery on the shoulder which includes the rotator cuff tear and fractures of the collarbone and upper arm.

Diagnosis

1. X-Ray
2. MRI (Magnetic resonance imaging)
3. Ultrasound

Treatment

1. Hot and cold compresses help to reduce pain and swelling.
2. Nonsteroidal anti-inflammatory drugs are managed with steroid injections and corticosteroids.
3. Physical therapy
4. Joint distension which improves the range of motion.
5. Surgery
6. Shoulder manipulation helps to loosen the shoulder tissue.
7. Hydrodilatation

Use of Radiofrequency Ablation

1. As we know the shoulder is one of the most easily movable joints in the body which is more prone to injury so it can be injured due to repetitive movements, injuries and due to degenerative diseases.
2.  But Radiofrequency Ablations can be helpful in this condition. Radiofrequency Ablation is a procedure which is used to reduce pain, in which an Electrical current is radiated by a radio wave.
3. This current heats the area of nerve tissue where there is pain. The radio wave heat is blocking the signal which is caused by nerve tissue and therefore diminishes the pain.
4.  In this procedure, the electrode is applied directly through the skin which mainly targets the skin and heat is given up to 42 degrees and causes no damage.
5. There is no risk of paralysis and weakness, radiofrequency energy is transmitted at the tip of the needle which is converted into energy which is applied directly to the fibers of nerves.
6. In this treatment, the results will be seen within a week so there will be changes in pain and help to restore the range of motion hence improving the quality of life.
7. In this radio waves destroy the area of the nerve impulse which stops sending the signals to the brain.
8. It takes 15 minutes to 2 hours to complete the procedure.

Goals of Radiofrequency Ablation

1. Reduces the pain
2. Improves the function
3. Reduces the number of medications related to pain
4. Delays the pain  

Ayurvedic Aspect for Radiofrequency Ablation In Frozen Shoulder

1. In ayurveda, a frozen shoulder is correlated with Apabahuka. It is a disease which usually affects the Amsa Sandhi (shoulder joint), which is due to an imbalance of Vata dosha.
2. There is vitiation of Kapha doshas thus stiffness of the joint is seen.
3. In joints imbalance of Vata doshas begins in the digestive tract, which is the natural home of Vata dosha along with joints and bones and the excess begins to accumulate which causes many symptoms of Vata doshas.
4. Due to excess Vata doshas, there are compromises of Agni which forms the Ama dosha in the GI Tract.
5. When the Vata dosha accumulates in the joints and bones there is dryness and popping upon movement without causing any swelling.
6. Sheleshaka Kapha gets dried up due to the presence of toxins which further affects the lubrication of joints thus causing pain in the joints and bones.

Causes Are Divided Into Two Groups

1. Bahya Hetu- It is a vital part of the body (marma) which is surrounding the shoulder joint
2. Abhyantra Hetu- It is due to etiological factors which further aggravate the Vata dosha which leads to karmahani of bahu.  

Nidana

1. Aaharja-
2. Ras= Katu, Tikta and Kashaya
3. Guna= Laghu, Sheeta Guna
4. Matra= Alpashanam Vishamasha due to vitiation of Vata

Samprapti

1. Samanya Samprapti– It is due to vitiation of Vata (due to vitiation of Ruksha and laghu causes which increase the Vata dosha), Kapha (due to vitiation of Atiguru, Atisheet which further increases the Vikruta Kapha and further causes Kaphavrita Vata condition). This dosha gets accumulated in the micro-channels which further causes the symptoms of Avabahuka.
2. Vishistha Samprapti- In Avabahuka due to ativyayama and abhighata there is dushti of Vata Doshas. Vyana Vayu circulates in the entire body and causes shotha which causes Sira to become thin. Due to the aggravation of Vata and Kapha doshas, there is heaviness in the body, pain in all joints and there is loss of mobility.

Samprapti Ghataka

1. Dosha- Vyana Vayu, shleshaka Kapha
2. Dushya- Sira, Snayu, Mamsa, Asthi
3. Srotas- Mamsavaha, Asthivaha
4. Adhisthana- Amsa Pradesh
5. Udbhava Sthana- Pakwashya

Chikitsa

1. Snehanam
2. Swedanam
3. Abhyangam
4. Avagahana
5. Lepa
6. Upanaha
7. Parisheka

This panchkarma treatment is helpful in pacifying the Vata dosha and treats the gati of Vata.

Yoga for Frozen Shoulder

1. Surya Namaskara
2. Gomukha Svanasana
3. Trikonasana
4. Ushtrasana  

Herbs Useful In Frozen Shoulder

1. GUGGUL

Guggul (Commiphora Mukul) is an oleo gum resin which is used as a binding agent which is helpful in decreasing the level of cholesterol and relieving the inflammation of joints. It is useful in the quick healing of fractures and dislocations so it has many enormous effects on the musculoskeletal system. It has a rejuvenative property which is helpful in improving digestion and anti-inflammatory properties.

2. GOKSHURA

Gokshura (Tribulus Terrestris) is helpful in treating the urogenital system and acts as an Aphrodisiac. Improves the strength of muscles and body composition. Gokshura has a diuretic property which cleans the urinary system and has a lithotriptic activity which breaks down the urinary stones. Has anti-obesity properties and is helpful in treating wounds.

3. ASHWAGANDHA

Ashwagandha (Withania Somnifera) is a powerful gift of ayurveda which is used in various treatments such as Anxiety, and leucoderma and in the strengthening muscles and as a sexual stimulant. It is helpful in promoting strength and promotes cardiac health and has antioxidant properties.

4. HARIDRA

Haridra (Curcuma longa) is a famous ayurvedic herb which is helpful in many diseases and has anti-inflammatory properties. It is helpful in curing diabetes and in urinary tract disorders. Haridra is helpful in removing blocked blood vessels which makes the flow of blood and nutrients easy. Haridra has the property of restoring body functions and establishing immunity.

5. SHALLAKI

Shallaki (Boswellia Serrata) is a very famous herb which is used in osteoarthritis and in much muscular pain. It has cancer properties and acts as a mild painkiller. Shallaki is helpful in balancing the Pitta and Kapha. Helpful in many skin diseases and blood disorders and cleans wounds. It is indicated in many Psychological disorders and in excess sweating.

Herbal Remedies by Planet Ayurveda for Frozen Shoulder

Planet Ayurveda is an emerging US-FDA registered, GMP certified and ISO 9001:2015 certified Ayurvedic Company which manufactures many ayurvedic medications which are given in the ancient textbooks of Ayurveda. These medications are prepared without any use of additives, preservatives or any other synthetic materials which cause any ill effects on the body. The products manufactured are pure and devoid of any adulterations. The frozen Shoulder Pack from planet ayurveda is useful in managing a frozen shoulder.

Products List

1. BOSWELLIA CURCUMIN
2. JOINT AID PLUS
3. AAMVATANTAK CHURNA
4. ORTHOVITA OIL
5. YOGRAJ GUGGUL
6. ANU TAILAM

Products Description

1. Boswellia Curcumin

Boswellia Curcumin is a polyherbal capsule made by planet Ayurveda which is using ingredients such as Shallaki (Boswellia serrata) and Curcumin (Curcuma longa). These capsules have anti-inflammatory properties and are useful in many disorders such as Ankylosing spondylitis and rheumatoid arthritis. Has cardioprotective properties and reduces morning stiffness.

Dosage– 1 capsule twice daily after meals with plain water.    

2. Joint Aid Plus

Joint Aid Plus is a polyherbal capsule from planet ayurveda which is consisting of various herbs such as Nirgundi (Vitex negundo), Sonth (Zingiber officinale), Guggul (Commiphora Mukul) and many more. This capsule is helpful in maintaining overall health and is well-known for arthritis. Maintains joint health which supports healthy bones and acts as an analgesic which supports the immune system.

Dosage– 1-2 capsules twice daily with plain water after meals.

3. Aamvatantak Churna

Aamvatantak Churna is polyherbal churna which is formulated by planet ayurveda using ingredients such as Ashwagandha (Withania somnifera), Suranjaan (Colchicum autumnale), Haridra (Curcuma longa) and many more. It is very well known for its anti-inflammatory and analgesic property which provides nourishment to joints and nourishment to bones and joints. Helpful in decreasing the level of uric acid metabolism.

Dosage– ½ tsp to 1 tsp twice daily with plain water after meals.

4. Orthovita Oil

Orthovita Oil is a herbal oil formulation by planet ayurveda using ingredients such as Camphor, Prasarini Oil, Turpentine Oil and many more. This oil is applied externally used in joint pain, stiffness or on any part of the body. Has anti-inflammatory properties and is helpful in reducing inflammation, is used in reducing the Vata dosha and provides lubrication and increases the proper functioning of joints.

Dosage– apply over the affected area gently once or twice

5. Yograj Guggul

Yograj Guggul is a herbal tablet which is made by planet ayurveda using various ingredients Karavi (Piper chaba), Devadaru (Cedrus deodara), Gokshura (Tribulus terrestris), Yavagraja (Hordeum vulgare) and many more. It is useful in increasing digestion power and provides immunity. Helpful in rheumatoid arthritis and in Gout. Supports the overall health of the body and is helpful in relieving pain.

Dosage– 1-2 tablets twice daily with lukewarm water.

6. Anu Tailam

Anu Tailam is a classical herbal oil formulation by planet ayurveda using Til Tail, Aja-Dugdha, Ushir, Agar, Kantkari and many more. This is used to support and maintain the healthy functioning of the ear, nose and throat. This is helpful in preventing microbial replication and in the treatment of asthma. It has anti-inflammatory properties and modulates the immune system.

Dosage– two drops in each nostril every morning before sunrise.

CONCLUSION

A frozen shoulder is a painful condition involving the shoulder becoming stiff and inflamed, limiting the shoulder’s movement. It is one of the largest and most complex joints in the body, there is a bursa which is a synovial fluid-filled sac which acts as a cushion with other structures of joints. Frozen Shoulder is known as Adhesive Capsulitis which is usually associated with shoulder pain and stiffness. In ayurveda, a frozen shoulder is correlated with Apabahuka. It is a disease which usually affects the Amsa Sandhi (shoulder joint), which is due to an imbalance of Vata dosha. For this planet, ayurveda provides many herbal supplements which are helpful in this disease without causing any side effects.