Sequential Meridian Based Acupuncture Combined With Standard Rehabilitation After Surgery for Severe Cubital Tunnel Syndrome: A Randomized Controlled Trial

Objective: – To evaluate the efficacy of sequential meridian-based acupuncture combined with standard rehabilitation in patients after surgery for severe cubital tunnel syndrome (CuTS). Methods: – In this prospective randomized controlled trial, 40 patients with severe CuTS who underwent ulnar nerve decompression with subfascial anterior transposition combined with supercharged end-to-side nerve transfers (the pronator quadratus branch and the abductor digiti minimi branch to the deep branch of the ulnar nerve) were randomly assigned to a sequential acupuncture group and a standard rehabilitation group (n=20). The standard rehabilitation group received neurotrophic medication and progressive rehabilitation training; the sequential acupuncture group additionally received staged meridian-based acupuncture (the Small Intestine Meridian and the Triple Energizer Meridian were primarily selected during postoperative months 0 to 3, supplemented by the Large Intestine Meridian thereafter, combining filiform-needle acupuncture and electroacupuncture). Motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV), lateral pinch strength ratio, ring-finger grip strength ratio, 2-point discrimination (2PD), DASH score, EQ-5D-5L score, and VAS score were assessed preoperatively and at 1, 3, and 6 months postoperatively. Results: – Thirty-seven patients completed follow-up (18 in the sequential acupuncture group and 19 in the standard rehabilitation group; overall dropout rate 7.5%), with no acupuncture-related adverse events. Baseline characteristics were balanced between the 2 groups (P>0.05). Beginning at 3 months postoperatively, improvements in MCV, lateral pinch strength ratio, ring-finger grip strength ratio, DASH score, and EQ-5D-5L score were greater in the sequential acupuncture group than in the standard rehabilitation group (P<0.05), with between-group differences widening at 6 months (P<0.01). Group×time interactions were significant for these 6 indicators (P<0.001), and between-group differences in improvement magnitude reached large effect sizes (MCV: MD=5.80 m/s, 95% CI: 4.70-6.90; SCV: MD=4.65 m/s, 95% CI: 3.30-6.01; lateral pinch strength ratio: d=2.165; ring-finger grip strength ratio: d=2.321). No significant between-group differences were observed in ring-finger or little-finger 2PD or in VAS score at any time point (P>0.05). Conclusion: – Sequential meridian-based acupuncture combined with standard rehabilitation accelerates postoperative electrophysiological and intrinsic hand muscle recovery and improves upper-limb function and quality of life in patients with severe CuTS. The therapeutic advantage emerges during postoperative months 3 to 6, the critical window of nerve regeneration, with a favorable safety profile.