Orthopedic Provider Accuracy for Ultrasound Detection of Peripheral Nerve Injuries: A Cadaveric Educational Study

Purpose To determine the ability of ultrasound to detect peripheral nerve injuries among orthopedic providers before and after a short educational module. Methods Fifteen orthopedic providers used handheld Butterfly iQ+ and cart-based Sonosite SII ultrasound to evaluate peripheral nerve injury patterns created in cadaveric specimens. Participants assessed complete lacerations, partial lacerations, intact nerves, end neuromas, and neuromas in continuity at three upper-extremity sites: the dorsoradial forearm (radial sensory nerve), proximal forearm (proximal median nerve), and distal forearm (distal median nerve). Each participant evaluated all sites with both devices and predicted the injury pattern. Testing was repeated three weeks later after a brief ultrasound educational module. Results Posteducational module, diagnostic accuracy improved for laceration patterns and intact nerves, whereas accuracy for neuroma identification remained limited. Participants with prior ultrasound experience generally performed better, and diagnostic performance was similar between the handheld and cart-based devices. Conclusions A brief targeted educational module showed modest gains in diagnostic accuracy for laceration patterns and intact nerves proposing that ultrasound may be useful as an adjunct for identifying these injuries. Similar observed performance between handheld and cart-based devices suggests that provider interpretation may be more important than ultrasound device. Clinical relevance Orthopedic providers should undergo focused training for clinical adoption of ultrasound to improve diagnostic accuracy in peripheral nerve injuries. Similar accuracy between handheld and cart-based systems may also reduce barriers to incorporate ultrasound into hand-surgery practice.