Diagnostic Value of High-Resolution Ultrasound for Unilateral Digital Nerve Injuries in Small or Already Closed Wounds

Background: Diagnosing unilateral digital nerve injuries in small or already closed wounds is challenging, as clinical tests may be unreliable. Routine surgical exploration, although traditionally recommended, can represent an unnecessarily invasive procedure in cases without nerve rupture. High-resolution ultrasonography (US) offers a potential minimally invasive alternative. This study aimed to assess the reliability of US for evaluating unilateral digital nerve injuries in cases with small or previously sutured wounds. Methods: We retrospectively reviewed 19 digits from 19 patients with suspected unilateral digital nerve injury between April 2016 and December 2024. All underwent US evaluation within a mean of 8.9 days after injury. Injuries were classified as complete, partial or no tear based on long-axis US findings. Treatment decisions were guided by the US. Surgical findings were compared with preoperative US results. Clinical outcomes were assessed by pain resolution, numbness and sensory recovery. Results: US evaluation was feasible in all cases without local anaesthesia or complications. Nine patients had complete tears, six had partial tears and four had no tears. Twelve underwent surgery, and intraoperative findings matched US findings in all cases (100% accuracy). The remaining seven patients were managed conservatively. At follow-up (mean 6.6 months), all patients achieved improvement of numbness, hypaesthesia and local wound pain. Near-normal sensory recovery was achieved in 6/10 surgical patients and 4/6 conservative patients. No patients required additional treatment at the final follow-up. Conclusions: Early US evaluation is a reliable, safe and minimally invasive method for diagnosing unilateral digital nerve injuries in small or previously sutured wounds. This approach may prevent unnecessary surgical exploration in intact nerves and provide accurate guidance for treatment selection. Level of Evidence: Level III (Diagnostic)