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Ultrasound for Diagnosing Hand and Digital Nerve Trauma: A Systematic Review and Meta-Analysis
Jonah W Perlmutter1, Adham Elsherbini1, Jacob Wise2
1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Journal of Hand Surgery Global Online
|March 19, 2026
Summary
Ultrasound effectively diagnoses traumatic hand and digital nerve injuries with 93% sensitivity, visualizing structural damage better than electrodiagnostic studies. An "ultrasound-first" approach optimizes diagnosis and surgical planning.
Area of Science:
- Orthopedic Surgery
- Radiology
- Neurology
Background:
- Traumatic hand and digital nerve injuries require accurate diagnosis for effective treatment.
- Conventional methods like electromyography (EMG) and nerve conduction studies (NCS) have limitations in visualizing structural pathology.
- Ultrasound's role in diagnosing these injuries needs comprehensive evaluation.
Purpose of the Study:
- To assess the diagnostic accuracy and clinical utility of ultrasound for traumatic hand and digital nerve injuries.
- To compare ultrasound's performance against established electrodiagnostic modalities (EMG/NCS).
- To determine ultrasound's ability to characterize nerve injury structures and guide surgical planning.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA guidelines.
- Searches of MEDLINE and Embase databases were performed up to July 18, 2025.
- Included studies were retrospective, assessing ultrasound for nerve injuries with surgical, clinical, or electrodiagnostic reference standards. Quality was assessed using the Newcastle-Ottawa Scale.
Main Results:
- Twelve studies with 607 injuries were analyzed, showing pooled ultrasound sensitivity of 93% for diverse trauma types.
- Ultrasound identified specific pathologies: complete transection (29%), neuroma in continuity (24%), increased cross-sectional area (18%), and partial transection (8%).
- Ultrasound demonstrated comparable sensitivity to EMG/NCS (≥90%) and visualized structural details, aiding operative referral. Ultrahigh-frequency probes achieved 98% sensitivity for superficial nerves.
Conclusions:
- Ultrasound is a highly sensitive, noninvasive tool for diagnosing traumatic nerve injuries, surpassing electrodiagnostic studies in visualizing structural pathology.
- An "ultrasound-first" strategy in the acute phase, complemented by EMG/NCS in the subacute phase, can optimize diagnosis, referral, and surgical planning.
- Moderate study quality necessitates further research, particularly on specificity in larger disease-negative cohorts.
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