Sudan Cupping test is a diagnostic test uses for the primary evaluation of the patients complaining for cervical and lumbosacral radiculopathy. It is a newly applied test, based on the use of different sizes cups of the Sudan Cupping test over certain areas of the cervical, thoracic and lumbosacral spine as dry Sudan Cupping technique. Using the effect of the Sudan Cupping in reducing the pain and relief the patients complains for diagnostic purposes. We used to apply the cups in certain areas over the human body specially the neck, shoulders and back and detect their effect over of the patients complains. If the these complains decreased or disappear when we applied the cups at that area ,this means that these complains are most probably coming from that area. The test is firstly used to differentiate between adductor strain pain and the pain coming from the bladder and genetalia in football players which is really difficult to be differentiated. The test is then started to be a part of the examination of the patient suffering from cervical and lumbosacral radiculopathy and always been written in the patients file as (Sudan Cupping test positive or negative) as well as the other tests (sensation, straight rise test, pressure pain test and others).We noticed that positive Sudan Cupping test always means positive MRI report. Any patient who has positive Sudan Cupping test and not able to do MRI or CT is then diagnosed and treated as a case of radiculopathy and always become better. The test is newly applied as diagnostic test. It is routinely applied in our clinic since 2009.Not registered.
What is the importance of the Sudan Cupping test?
The low economical status of the patients in Sudan leads us to try to find maneuvers to diagnose this widely spreading disease Sudan. Not all the patient have the capability to pay 60$ for MRI or 25$ for the X-ray which has also low diagnostic value. The test uses different sizes cups of the cupping set applied over areas over the cervical and lumbosacral vertebral column.
The test is uses to differentiate muscular from neurological pain, headache, vertigo, acute or chronic groin pain and between knee pains due to osteoarthritis or disc prolepses. It's difficult to differentiate between these diseases unless we use expensive investigations such as MRI. The Sudan Cupping test helps in the differentiation and the primary diagnosis of these diseases.
What is the study result of the Sudan Cupping test?
Since 2008 a number of about 2000 patients between the ages of 18-74, were found to visit our clinic. 343 patients were male and 157 female.
The test is regularly applied for all patients visiting our clinic which is specialized in lumbosacral and cervical radiculopathy .Those patients usually suffer from symptoms of disc prolepses (neck and lower back pain, sciatica, needles, numbness, tingling, straight leg raise, different sensation test). The clinic is also is specialized in doing HIJAMA as well.
We started since that time to apply the Sudan Cupping test regularly and as routine test after the patient is asked for proper history and sufficient physical examination. Each patient has his own file in which always this information is recorded. After the patient is found to have suggestive history and examination of radiculopathy then the Sudan Cupping test is done, if its positive the patient is requested to do X-ray or MRI to confirm the diagnosis. If the patient agreed to do the investigation then we wait for the results. If not then we start the treatment as follow: Hijamah, vitamins B1, B6, B12, NSAIDs, recommendations.
Only five hundred of the patients were able to do X-ray, MRI or CT scan or already present with ready investigations whether done in Sudan or outside the country. These patient usually visit our clinic after they see different doctors or after they did surgical operation and physiotherapy with no improvement .small group seek our help because we are specialized also in sport injuries and presents with knee pain after visiting different orthopedic surgeons and after they did intra-articular steroid with short relief or after they did X-ray and told to do total knee replacement. We apply the Sudan Cupping test and usually find in these patients that the pain is coming from the lumbosacral or cervical area and then send them for MRI of these areas.
The study shows that 440 of the tested patients with positive Sudan Cupping test have positive MRI reports which show the presence of disc prolapse.
38 patients have positive Sudan Cupping and negative MRI reports.
22 patients have negative Sudan Cupping and negative MRI reports.
Extra revision is done again to check the X-ray or MRI reports and the films. We found 2 cases with negative report and positive films and positive Sudan Cupping test. The reports are then recorded in the patients file.
Sometimes we send the patient who presents with MRI show lumbosacral disc prolapse to do other for the cervical spine because the test shows that there is positive Sudan Cupping test at C.
We are sure that the rest 1500 patient who didn’t do investigations has cervical or lumbosacral pathology at 90% at least.
1 - Validity:
Sensitivity: 400/440 = 0.91
Specificity: 22/38 = 0.57
2 - Reliability:
Positive predictive value: 400/438 = 0.91
Negative predictive value = 22/62 = 0.35
What is Sudan Cupping test uses for?
The test is indicated to differentiate:
- Muscular from neurological pain (compression pain).
- Lower limbs complains due to cervical or lumbosacral pathology.
- Headache, due to muscular spasm or headache from cervical disc.
- Vertigo caused by ear disease or vertigo due to cervical pathology.
- Acute & chronic groin pain due to adductor pathology or urological problems.
- Knee, hip & ankle joint pain due to joint diseases such as osteoarthritis or due to cervical or lumbosacral radiculopathy.
- Wrist, elbow and shoulder joint pain due to joint disease or due to cervical or lumbosacral radiculopathy.
- Deferential diagnosis of sport injuries
Advantages of the test:
- Easy for the examiner.
- Easy for the patient to detect.
Disadvantage of the test:
- The test can show that there is cervical disc but cannot accurately detect the area of the disc in the cervical spine.
- The Sudan Cupping test is not applicable if the patient has no complains, in silent cases of radiculopathy.
- The test may induce some local pain or increases the patient’s complains if applied with very high pressure and if applied for long time at one area. Hat Sudan Cupping test
- The test is not able to determine the size and the number of discs and the need for surgical treatment.