Abstract
OBJECTIVE: To investigate whether combining neurophysiological assessments with high-resolution ultrasound (HRUS) enhances the prediction of functional recovery and prognosis in patients undergoing surgical repair for median or ulnar nerve injury. METHODS: This retrospective study included 315 patients who underwent surgical repair for median or ulnar nerve injuries between February 2013 and February 2023. Six months post-surgery, all patients underwent neurophysiological and ultrasound evaluations. Based on British Medical Research Council (BMRC) criteria, patients were categorized into good prognosis (n = 177) and poor (n = 138) prognosis groups. Key factors like distal motor latency (DML), sensory conduction velocity (SCV), and neural cross-sectional area were analyzed. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess their predictive values for functional recovery. RESULTS: Compared to the poor prognosis group, the good prognosis group showed significantly better neurophysiological measurements, including shorter DML (median nerve: 4.66 ± 0.62 vs. 4.89 ± 0.85 ms; ulnar nerve: 3.29 ± 0.35 vs. 3.42 ± 0.38 ms), higher SCV (median: 44.03 ± 4.22 vs. 42.27 ± 5.13 m/s; ulnar: 44.25 ± 6.24 vs. 42.51 ± 7.18 m/s), and faster motor conduction velocity (P < 0.05). HRUS revealed smaller cross-sectional areas and lower nerve swelling rates in the good prognosis group (both P < 0.05). Logistic regression identified DML, SCV, and nerve swelling rate as independent predictors of functional recovery. The combined model demonstrated high predictive accuracy with an AUC of 0.967. CONCLUSION: Combining neurophysiological testing and HRUS offers a comprehensive and accurate approach for assessing postoperative recovery in median and ulnar nerve injuries, thereby improving prognostic accuracy and facilitating personalized treatment strategies.