Wrist foreign bodies - charm needles (susuk)

Case contributed by Amanda Er

Presentation

Fall sustained with wrist pain and tenderness.

Patient Data

Age: 40 years
Gender: Female

An intra-articular comminuted fracture of the left distal radius with mild dorsal displacement is demonstrated with stable alignment. There is little callus formation across the fracture site. Multiple charm needles are seen in the dorsal aspect of the forearm.

Case Discussion

Charm needles are metallic talismans inserted subcutaneously, most commonly seen in Southeast Asian countries. They are inserted by a shaman (termed bomoh), and can often only be removed by the same shaman. The term 'susuk' is also used to describe these needles, and are thought to preserve the individual's charisma, youth, or beauty. The revelation of its presence may remove the charm's potency, and is hence kept a secret. As these charms may also have been inserted at a young age, the individual themselves may be unaware of their presence and are hence hard to diagnose.

These needles are pin-like in shape, with chemical analysis revealing more than 90% gold and other metals (aluminum, iron, copper). They are non-ferrous and safe for patients undergoing MRI scans.

Although its efficacy remains unknown, it is often thought that after a period of preserving an individual's beauty, youth, or charisma, these needles may start to have a negative effect on the individual, resulting in ailments or illnesses affecting the region of insertion.

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