Acute Radial Compressive Neuropathy: The Most Common Injury Induced by Japanese Rope Bondage

Japanese rope bondage (RB), or Shibari, is an art form involving the voluntary and aesthetic binding of a person with a rope, which may result in compression injuries to peripheral nerves. To investigate the nature and extent of nerve injuries associated with this practice, we conducted a survey of four experienced RB practitioners (riggers) and participants who were willing to share their experiences of injury. Injuries presented acutely and immediately following full-body suspensions, with a total of 10 individuals (16 injuries) identified with damage to the radial, axillary, or femoral nerves. Notably, the radial nerve was the most commonly affected structure in our patient cohort, with 90.0% of individuals experiencing an injury at this level. We present a rare case of acute repeated compression of the radial nerve during full-body suspension RB. A 29-year-old female was suspended for 25 minutes using a 6-mm jute rope, resulting in wrist and finger drop, as well as reduced sensation in the left hand. Analysis revealed a 77.3% conduction block in the upper arm segment. Improvement was observed after three months, fully achieved after five months. Seventeen months later, re-compression of both radial nerves occurred during a similar suspension lasting 8-10 minutes. Improvement occurred after one week, fully achieved after four weeks. The third compression episode occurred three years later, lasting five minutes, with full recovery within two minutes. This study focuses on the injury of peripheral nerves, including the radial, axillary, and femoral nerves, namely, acute compression neuropathy induced by Japanese RB. Because the radial nerve is the most frequently injured structure, the findings underscore the significance of recognizing the anatomical course of the radial nerve, particularly its position posteriorly at the distal deltoid tuberosity level, as a means of preventing nerve injury in this region. This knowledge is particularly crucial for individuals engaged in the practice of RB, emphasizing the importance of taking precautions to avoid potential nerve damage.