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.