HTML Full Text

Introduction

The term Amsa denotes to a part or a portion of Amsaphalaka (Scapula). It is the synonymous of the shoulder also. Amsa marma is situated at the junction of shoulder & neck. Amsa marma is located on the midpoint of imaginary line drawn from tip of shoulder to root of spine of scapula. Depending upon the injury effect(Parinama), it is vaikalyakara type & According to structure (Rachana), it is snayu marma, Amsa marma consist of shoulder & scapular region. Acharya sushruta mentioned pratanavati type of snayu present in shakha (All extremities) & sandhi (joints). The shoulder joint (glenohumeral joint) is a ball and socket joint between the scapula and the humerus. It is the major joint which connecting the upper limb to the trunk. Pratanavati4 snayu is close to structure of  ligaments. Ligaments of  Amsa sandhi, which bind the joints, bones together for maintaining the  movements & stability. Any injury to this structure causes loss of movement of upper limb (stabdhabahuta5). Hence, from both the clinical and surgical perspective, the detail knowledge of trauma site, structures involving and identification of deformity is essential. So this paper is an attempt to find out the exact anatomical structures lies at the region of Amsa marma.

Aim:

Anatomical study of prushthagata marma w.s.r. to Amsa marma

Objectives:

1. To compile the literature about Amsa Marma from Ayurvedic and classical texts.

2. To critically analyze the anatomical structures at the region of Amsa marma.

Materials & Methodology:

Literary study-

The References and data about Amsa marma is collected from various Ayurvedic and modern texts like Brihatrayis and Laghutrayis and other classical books.

Review of literature:

Classification of Amsa marma:

According to shadanga: Prushthagata(Upper back) marma - Number-02                        

Site:- Bahumurdhagreevamadhye Amsapeethaskandha nibandhauvanso naam ||   -Su.Sha.6/35

It is situated between Bahushira (Head of the shoulder) & greeva (neck), on the trapezius muscle. This connects the Shoulder & Amsapeetha together. Dalhanacharya commented Amsapeetha as Bahushira & Acharya sushruta described Amsapeetha as a sandhi.

Pariman (Dimensions): half angula (finger unit).

Type: According to Rachana(structure)-Snayu marma

According to Parinama(Effect)-Vaikalyakar marma  Viddhalakshana( Effect of trauma):-

Tatra stabdhabahuta ||   -Su.Sha.6/35

According to Acharya sushruta-Stabdhabahuta(stiffness of the upper limb with loss of function);

According to Acharya vagbhata- Bahukriyahara (Loss of function of upper limb).

 

Skandha(Shoulder)-

Ashtangulau skandhau, Shadangulauvanso ||   -  Ch.Vi.8/117

According to Acharya Charak- Skandha-Acromioclavicular joint to midpoint of arm (Deltoid region):-8 Angula(6inch). This region is responsible for lifting of heavy items.

Amsa:-Line joining from tip of shoulder to the root of spine of scapula-6 Angula (4.5inch).

BONES:

The shoulder is made up of three bones: the scapula, clavicle  and humerus. To maintain stability, the bones of the shoulder are held in place by muscles, tendons and ligaments. The Amsa marma is connected to Amsapeetha (Acromioclavicular joint) & skandha (shoulder/Glenohumeral joint).

JOINTS:

The shoulder is made up of two separate joints, the Acromioclavicular joint and the Glenohumeral joint. 

i) Acromioclavicular joint:

The acromioclavicular joint (tip of shoulder) is formed by an articulation between the lateral end of the clavicle and the acromion process of the scapula. It is a plane type of synovial joint & is composed of Acromioclavicular & Coracoclavicular ligaments,. These ligaments provide stability to joint. When one of these ligaments tears it can lead to shoulder separation or dislocation.

ii) Glenohumeral joint:

It is the major joint connecting upper limb to trunk. It is the most mobile & less stable  joint in the body. In the Glenohumeral joint, the ligaments play a important role in stabilising the bony structures.

The group of muscles and tendons in the shoulder is known as the rotator or musculotendinous cuff. The rotator cuff made up of the tendons of four muscles, the supraspinatus, infraspinatus, teres minor and the subscapularis. The muscles & tendons of the rotator cuff keep the humerus tightly in the socket.

Trapezius Muscle.

The trapezius is wide, flat, triangular muscle, which covers most of the upper back & posterior of the neck. This muscle arises from Spines of cervical & thoracic vertebrae & It is attached distally onto the lateral 1/3 of clavicle, acromion & spine of scapula.

The trapezius muscle is innervated by the spinal root of accessory nerve. Injury to this nerve causes paralysis of trapezius muscle.

tables

Discussion

Snayu6:-Based on many textual references. It is close to ligaments, tendon, Aponeurosis, fascia & somewhere it is consider as nerve. Snayus are rope or jute like structures. Their main function is binding &They bind together the mamsa (Tendons bind muscle to bone), asthi (Ligaments attach one bone to another) and medas (fat).

Vaikalyakara7(causing deformity):

Vaikalyakara means which deforms or cripples. The nature of vaikalyakara marma is saumya i.e.having qualities of moon; The soma guna supports or nurtures the prana8 by its Sthira(stable) & sheeta(cold) attributes. Therefore, when injured, these marma produce deformity & dysfunction but rarely causes death.

Amsa marma is vaikalyakara marma & injury to this marma leads to Bahustabdhata. which can be correlated with the symptoms of frozen shoulder, trapezius palsy, rotator cuff injuries, shoulder dislocation etc.

By the above discussion, Predominantly the structures falling under the Amsa marma ( shoulder and scapular region ) are mostly affected due to traumatic injury.

Conclusion

It can be concluded that, Amsa Marma is located in between the Head of upper limb and Neck. Structurally, it is snayu marma & the main structures found at this region are- Coracohumeral ligament, Glenohumoral ligament, Trapezius muscle. Acromio-clavicular ligament, Coraco clavicular ligaments, Conoid ligament, Trapezoid ligament, Coraco-acromial ligament, Musculotendinous cuff & spine of scapula.