{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:08:19Z","timestamp":1788955699946,"version":"build-2803163510"},"reference-count":18,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100009250","name":"national institute for social care and health research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009250","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hand Surg Eur Vol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Digital nerve injuries are the most common peripheral nerve injuries, usually diagnosed through physical examination and confirmed by surgical exploration. Exploration, while important for informing management, carries risk and associated healthcare costs. The diagnostic accuracy of physical examination in identifying complete nerve lacerations requiring repair remains uncertain. This study within a trial (SWAT) aimed to determine the positive predictive value (PPV) of specialist physical examination in identifying complete digital nerve lacerations requiring repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective SWAT was embedded within the NEON (Digital Nerve, Suture or Not) randomized controlled trial (ISRCTN16211574). Adult patients presenting with suspected complete digital nerve injury in flexor zone 2 across nine UK NHS hospitals (September 2020 to March 2024) were included. Physical examination was performed by hand surgery specialists, with surgical exploration as the reference standard. The primary outcome was the positive predictive value (PPV) of physical examination for complete laceration requiring repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 593 referred patients, 242 underwent surgical exploration. Complete laceration was confirmed in 137 (true positives), while 105 had partial or no visible lacerations (false positives), yielding a PPV of 57%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Specialist physical examination was unable to reliably predict complete digital nerve injury, resulting in a high false positive rate, with 43% of explored patients not requiring repair. Despite this limitation, surgical exploration remains pivotal, as no alternative bedside test currently provides sufficient accuracy. These findings highlight the urgent need for improved point-of-care diagnostic modalities to support surgical decision making and informed patient consent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence:<\/jats:title>\n                    <jats:p>II<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17531934251410456","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T06:07:36Z","timestamp":1770876456000},"page":"876-880","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Investigating the diagnostic accuracy of physical examination in digital nerve injury: a study within a trial"],"prefix":"10.1177","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6976-439X","authenticated-orcid":false,"given":"Ciar\u00e1n","family":"O\u2019Hanlon","sequence":"first","affiliation":[{"name":"Nuffield Department of Surgical Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D","family":"Gardiner","sequence":"additional","affiliation":[{"name":"Surgical Interventional Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loretta","family":"Davies","sequence":"additional","affiliation":[{"name":"Surgical Interventional Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Power","sequence":"additional","affiliation":[{"name":"Department of Hand and Peripheral Nerve Surgery, University of Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhilash","family":"Jain","sequence":"additional","affiliation":[{"name":"Surgical Interventional Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A","family":"Cook","sequence":"additional","affiliation":[{"name":"Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Beard","sequence":"additional","affiliation":[{"name":"Surgical Interventional Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK"},{"name":"NHMRC Clinical Trials Centre, Faculty of Medicine &amp; Health, University of Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6197-4093","authenticated-orcid":false,"given":"Justin Conrad Rosen","family":"Wormald","sequence":"additional","affiliation":[{"name":"Surgical Interventional Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-024-08004-0"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000001116"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/17531934241238736"},{"key":"e_1_3_3_5_1","unstructured":"British Society of Surgery of the Hand Standards of Care in Hand Trauma: Nerve Trauma Management (2024). Trauma standards. London: British Society for Surgery of the Hand; [date unknown]. Available from: http:\/\/bssh.ac.uk\/_userfiles\/pages\/files\/professionals\/Trauma%20standards\/5%20Nerve%20trauma%20Final.pdf"},{"key":"e_1_3_3_6_1","doi-asserted-by":"crossref","unstructured":"Cohen JF Korevaar DA Altman DG et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. 2016 6: e012799.","DOI":"10.1136\/bmjopen-2016-012799"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-021-03731-w"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0283907"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11940-018-0507-4"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.232063"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-24-00889"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-42230-x"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2006.06.002"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-84396-y"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002060"},{"key":"e_1_3_3_16_1","article-title":"Sonographic assessment of volar digital nerve injury in the context of penetrating trauma","volume":"194","author":"Umans H","year":"2012","unstructured":"Umans H, Kessler J, de la Lama M, Magge K, Liebling R, Negron J. Sonographic assessment of volar digital nerve injury in the context of penetrating trauma. Am J Roentgenol. 2012, 194: 1310\u20133.","journal-title":"Am J Roentgenol"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019190218"},{"key":"e_1_3_3_18_1","article-title":"The NEON (Nerve rEpair Or Not) trial: a randomized controlled trial of microsurgical repair versus nerve alignment for digital nerve injury","volume":"112","author":"Wormald JCR","year":"2025","unstructured":"Wormald JCR, Gardiner MD, Jerosch-Herold C, et al. The NEON (Nerve rEpair Or Not) trial: a randomized controlled trial of microsurgical repair versus nerve alignment for digital nerve injury. 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