Direct electrical stimulation on the injured ulnar nerve using acupuncture needles combined with rehabilitation accelerates nerve regeneration and functional recovery-A case report

Objective: This study illustrates that direct electrical stimulation (ES) improve functional recovery and time of return to work evaluated by prognostic scoring system after ulnar nerve injury. Design: The Rosén and Lundborg (R&L) protocol, Disabilities of the Arm, Shoulder and Hand (DASH) scores, and electromyography were applied for measuring improvements after direct ES intervention. Setting: A 32-year-old male with deep cutting wound and total rupture of right proximal forearm ulnar nerve was treated using direct ES and daily rehabilitation activities. Intervention: Direct ES, transmitted using 2 acupuncture needles inserted in the cubital tunnel, was applied along the site of the injured ulnar nerve. Other needles were placed according to muscle origins and insertions. All needles were connected to electrical stimulators. We executed these procedures once per week and conducted rehabilitating activities daily. Main outcome measures: The R&L protocol, DASH scores, and electromyography were used to measure the intervention outcomes. Results: The total score in the R&L protocol was 0.703 of the initial state; the sensory domain contributed the least amount. Among the improved numerical factors, pain/discomfort domain was the first to reach a stable ameliorative state in the first month. The sensory and motor domains reached stable growth in fourth and third months, respectively. The patient returned to the previous job in third month; his time off work was 75 days. Conclusions: Directly applying ES to the proximal site of an injured nerve can augment nerve regeneration through three suspected mechanisms. Although direct ES on the injured nerve contributed to an effective recovery of this patient with minimal adverse effects, additional investigation of treatment protocols is warranted and the actual mechanism must be identified.