Introduction

There are hundred and seven Marmas, which may be divided into five classes, such as the Mamsa Marma, Sira Marma, Snayu Marma, Asthi Marma and Sandhi Marma. The junction of Mamsa, Sira, Snayu, Asthi and Sandhi (joints) are called Marmas which naturally and specifically form the seats of ‘Pran’ (life) and hence an injury to the Marma always produces severe life threatening symptoms to minor pain. According to Acharya Sushrut, Manibandha Marma is a Rujakar Marma. Rujakar Marmas are having ‘Agneya’ and ‘Vayu’ properties become extremely painful as both of them are pain producing in their properties. An injury to the Manibandha Marma leads to ‘Kunthata’ (dysfunction) of the affected hand. Two fingers breadth should be avoided from its location in making any incision on Manibandha.^[1]

Manibandha Marma injury may cause the loss of function of flexion, extension, adduction and abduction of the hand. It can cause incoordination, dislocation and disfigurement of the hand. It may cause wasting of the hand also.^[2]

The ancient Indian science of Ayurveda describes Marma Sthan as vital energy centres where muscles, veins, ligaments, bones, and joints intersect. Manibandha Marma, located at the wrist joint, plays a crucial role in hand movements, grip strength, and overall upper limb functionality. In sportsperson the wrist joint undergoes significant stress due to repetitive loading, making it susceptible to injuries such as sprains, strains, ligament tears, and joint instability. In Ayurveda, Manibandha Marma is categorized as a Sandhi (joint) Marma, also it is a Rujakar Marma. When any Marma gets injured, all Doshas Vata, Pitta or Kapha are bound to get aggravated. If Vata is aggravated, then there is severe pain not only at the site of Marma but in the whole body. If Pitta gets aggravated, then there are symptoms like inflammations, bleeding etc. When Kapha gets aggravated then there is swelling, accumulation of fluid etc.^[3]

Aim and Objectives

1. To study Manibandha Marma in detail.
2. To assess the relationship between Marmabhighat of Manibandha Marma and wrist injuries in sportsperson.

[Image source-snells clinical anatomy by regions, tenth edition]

Articulation:

Occurs between the distal end of the radius, the articular disc above, and the scaphoid, lunate, and triquetral bones below. The proximal articular surface forms an ellipsoid concave surface, which is adapted to the distal ellipsoid convex surface.

Ligaments:

Anterior and posterior ligaments strengthen the capsule.

The medial ligament is attached to the styloid process of the ulna and to the triquetral bone.

The Lateral ligament is attached to the styloid process of the radius and to the scaphoid bone

Type: Synovial ellipsoid joint.

Capsule: Encloses the joint and is attached above to the distal ends of the radius and ulna and below to the proximal row of carpal bones.

Synovial membrane: This lines the capsule and is attached to the margins of the articular surfaces. The joint cavity does not communicate with that of the distal radioulnar joint or with the joint cavities of the intercarpal joints

Nerve supply: Anterior interosseous nerve and the deep branch of the radial nerve.^[6]

Figure 3: Wrist joint [image source - internet]

Anatomical structures of wrist joint - Anterior view

The following structures pass superficial to the flexor retinaculum (outside the carpal tunnel), in medial to lateral sequence:

Symptoms: Pain when pressing on the area or during strong gripping activities.

Tendon Disorders

de Quervain’s Tenosynovitis

Cause: Repetitive movements involving thumb abduction and extension.

Involved Tendons: Abductor pollicis longus (APL) and extensor pollicis brevis (EPB).

Effect: Thickening and irritation of the tendon sheath.

Oarsman’s Wrist

Cause: Friction where tendons of the first extensor compartment cross over those of the second compartment.

Seen in: Rowers and other athletes performing repetitive wrist extension.

Flexor Carpi Radialis (FCR) Tendonitis

Cause: Repeated wrist flexion or a sudden overstretching injury.

Symptoms: Pain on the palm side near the base of the thumb, worsens with resisted wrist flexion.

Extensor Carpi Ulnaris (ECU) Injury

Cause: Chronic overuse or sudden trauma during wrist flexion, supination, and ulnar deviation.

Symptoms: Pain and possible snapping sensation on the ulnar side during movement.

Cartilage & Joint Issues

Triangular Fibrocartilage Complex (TFCC) Tear

Cause: Common in athletes who perform repeated gripping and wrist rotation (e.g., golfers, racquet sports).

Symptoms: Pain on the ulnar side of the wrist.

Can lead to secondary ECU tendon irritation.

Ulnar Abutment Syndrome (Ulnocarpal Impaction)

Cause: Caused by repeated wrist movements involving pronation, ulnar deviation, and axial loading.

Symptoms: Chronic pain along the ulnar side of the wrist.^[8]

Ayurvedic interventions, such as Marma Chikitsa (Marma therapy), massage, herbal applications, and therapeutic exercises, are believed to aid in injury prevention and recovery.

References