Efficacy of Dry Cupping Therapy in Avabahuka: A Randomised Control Trial

Shoulder joint is the most mobile joint of human body with wide range of movements facilitating day to day work ranging from simple jobs like wearing clothes to complex ones like lifting objects. Imagine cessation of movement of our shoulder joint, attributed further by pain and stiffness. Routine life will be partially handicapped in this scenario. The clinical vignette described above goes by the name of Frozen Shoulder or Adhesive Capsulitis. It is most commonly associated with patients with Diabetes Mellitus. The prevalence of frozen shoulder is estimated to be 2 to 5 percent of the general population. Such patients have a lifetime risk of 10-20 percent of developing frozen shoulder.  Alternatively Supraspinatus Tendinitis also brings similar picture in front of us.Treatment of the above disease in early stage is with analgesics, intraextra capsular corticosteroid injections, which are hepatotoxic, nephrotoxic; produce gastric irritation. It also requires regular ‘pendulum’ exercises of the arm to prevent the capsule from over tightening. So, the patient has to go to physiotherapist for regular follow ups, which is too costly and time consuming. Acharya Sushruta has mentioned the symptom complex analogous to frozen shoulder/supraspinatus tendinitis in Avabahuka.  He opines the use of Raktamokshana in the management of Avabahuka. Raktamokshana has been described as “Ardha Chikitisa” by Acharya Sushruta. It provides quick relief in conditions of shoola (pain) and Shoth (Inflammation). There are various techniques of performing Raktamokshana out of which the technique of choice for the management of Avabahuka is Cupping Therapy. Shringa Therapy can be considered analogous to cupping therapy since vacuum created by suction to draw out blood is mainstay of the modus operandi of both the techniques. This is similar to Wet Cupping therapy. Similarly, Dry cupping can also be performed on the grounds that the ecchymosis thus created by negative pressure can be compared to Raktamokshana. Cupping Therapy has now 4 4 become a mainstay of Sports medicine and being utilized by even top Athletes like Michael Phelps. Chronic conditions like Avabahuka usually do not respond positively to standard protocol of management. Physiotherapy requires additional resources viz. time, money and patience. Raktamokshana is unchartered territory in the arena of Avabahuka management which require to be tapped in and researched upon to give low cost, safe and time bound remedy to its hold on our society. Study plan: Two groups, interventional involves dry cupping and control involves wet cupping therapy. 45 patients sample size per group. Follow up on day 15 and day 30. objective criteria involves range of motion and VAS.