Safety and efficacy of Meridian sinew tuina (MST) for post-surgical upper limb lymphedema: a systematic review and meta-analysis.

Complex Decongestive Therapy (CDT) is the non-operative standard for breast cancer-related lymphedema (BCRL), but many patients experience persistent subcutaneous stiffness, pain, and restricted mobility. This study systematically reviews the safety and clinical efficacy of Meridian Sinew Tuina (MST) protocols for BCRL. Global and regional databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP) were searched from inception to January 15, 2026, with alerts monitored through April 30, 2026. Randomised controlled trials (RCTs) evaluating MST (deep tissue mobilisation along the six-hand meridian sinew [Jingjin] lines via plucking, kneading, and pressing) were included. Two reviewers independently extracted data, evaluated risk of bias using Cochrane RoB 2, and assessed evidence certainty via GRADE using a random-effects model. Fifteen RCTs were included. For the primary anthropometric outcome, MST significantly reduced upper limb circumference compared to controls (SMD = 1.59; 95% CI: 1.44 to 1.74; Z = 20.81; p < 0.0001; I2=0.0%; N = 924; GRADE: Moderate certainty). The Clinical Response Efficacy Rate (≥ 30% swelling reduction and symptom relief) favoured MST (RR = 1.69; 95% CI: 1.54 to 1.87; Z = 10.62; p < 0.0001; I2=0.0%; N = 1,114; GRADE: Moderate certainty). Trial Sequential Analysis confirmed sample size sufficiency. For secondary outcomes (N = 924; GRADE: Low to Very Low certainty due to performance bias and clinical heterogeneity), MST showed favourable 3-month improvements in DASH functional scores (SMD = -1.81; 95% CI: -2.11 to -1.51; I2=45.1%), pain intensity (SMD = -2.44; 95% CI: -2.93 to -1.95; I2=50.4%), and quality of life (SMD = 1.04; 95% CI: 0.79 to 1.29; I2=0.0%). No serious adverse events occurred. MST protocols are associated with favourable short- and mid-term reductions in upper limb swelling. However, confidence is tempered by unblinded performance bias and control group variations. MST cannot be unconditionally recommended for standalone implementation but represents a promising, optional supportive adjunctive intervention within oncological rehabilitation. Breast cancer surgery and radiation can sometimes damage the lymph nodes, causing fluid to trap in the arm on the treated side. This results in a long-term condition marked by painful swelling, heavy limbs, and stiff shoulders. Standard treatments focus on fluid drainage, but many survivors still struggle with lingering stiffness and discomfort.This study combined and analysed data from 15 medical trials involving over 900 patients to evaluate Meridian Sinew Tuina, a specialised traditional Chinese manual massage. This therapy uses deep kneading, pressing, and plucking on the arm’s muscles and connective tissues to release tension and clear trapped fluid.The combined findings show that patients who received this specialised massage had noticeably less arm swelling and a higher overall recovery success rate than those who received only standard care. These improvements appeared within the first month and lasted through medium-term follow-ups. No severe side effects were reported, suggesting the therapy is safe.However, the public should view these encouraging results with caution. Because a massage is a hands-on physical treatment, patients and therapists knew exactly who was receiving it, which naturally lowers the scientific certainty of the results. Furthermore, while patients reported less pain and a better quality of life, this evidence is less certain because the analysed studies lacked long-term tracking data and used different routine hospital care for comparison. Overall, this specialised massage is a promising, safe option to add to regular rehabilitation to help survivors manage swelling.