Efficacy of Multi modal approach in the management of Chronic Rotator Cuff injury A Randomized controlled trial

Rotator cuff injuries (RCI) are common orthopaedic problem, prevalence of 20% in the general population which increases with age. While 50% of injuries are degenerative and occur in patients over 80, a large subset of injuries occurs in the athletic population. Athletes at particular risk for RCI include throwing athletes, overhead athletes, and those in contact sports. The best available evidence is specific to baseball throwers; however, clinicians should keep in mind the forced overhead mechanism required in tennis, golf, basketball, volleyball, track & field (throwers), lacrosse, and swimming athletes who experience significant and prolonged stress on the shoulder over the course of their athletic careers. Though a younger, athletic cohort in tennis and baseball are primarily covered in this review, recreational and master overhead athletes may present with rotator cuff pathology as well.These injuries can significantly impair shoulder function, leading to pain, weakness, and restricted range of motion (ROM). Most rotator cuff injuries may be treated conservatively by using regimens of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and functional rehabilitation therapy. For patients who cannot tolerate NSAIDs, acetaminophen serves as a viable alternative. The choice between surgical and non-surgical management is influenced by several factors, such as location of injury, the patient’s age, activity level, and comorbidities. Despite its benefits, arthroscopic repair has some risks. Common complications include re-tear, infection, stiffness, and nerve injuy. In Ayurveda, it can be correlated with Amsa sandhi marmaghata. Amsa marma is a snayu gata marma, measuring half angula and injury leads to loss of function in arms. Bhagna chikitsa and vatvyadhi chikitsa principles should be incorporated during the treatment of Marmaghata.Agnikarma is indicated for pain management in the diseases of Sira Snayuagata vata.Research have showed that usage of oral medications is effective in the pain management of marmaghata, among them Trayodashanga gugguluand Murivenna tailaare proved to have efficacy in the musculoskeletal pain management. Multi Modal approach is the need of the hour and it provides improvements in pain and function in patients with chronic pain compared with usual care.Yoga (Asana) is a non-invasive modality commonly used in the rehabilitation of shoulder injuries which improves muscle flexibility by improving the natural alignment of joints. A special Multi Modal treatment plan is planned by incorporating Ayurveda (Agnikarma, oral medicine like Trayodashanga guggulu and local application of Murivenna taila) and yoga (Asana) to manage the rotator cuff injury. Hence with this objective the study will be undertaken to evaluate the efficacy of Multi Modal approach in the management of rotator cuff injury.