Prognostic value of multimodal neurophysiological - ultrasound assessments in median and ulnar nerve injury repair.

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. 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. 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. 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.