This narrative review covers the pathophysiology, classification, and surgical management of peripheral nerve injuries in the upper extremity. It explains why outcomes remain suboptimal despite advances in microsurgery, and surveys emerging alternatives to autologous nerve grafting including synthetic conduits, nerve transfers, and gene therapy.
In the trauma bay with a hand laceration, identifying the nerve injury grade changes your operative plan immediately. Neuropraxia and Sunderland Type 2 injuries can be observed — Type 4 injuries get a trial of 8-10 weeks before surgery, and Type 5 injuries go to the operating room.
When you do operate, the 1-3 mm/day regeneration rate is your planning tool: a radial nerve injury at the spiral groove is roughly 15-20 cm from the wrist extensors, meaning 5-7 months minimum before reinnervation even if repair is perfect.
For gaps too large for tensionless primary repair, autologous sensory nerve grafting remains standard, but counsel patients that fewer than half will achieve meaningful functional recovery. Younger patients consistently do better. Age is the most powerful prognostic variable and should frame your preoperative discussion about realistic expectations.
This narrative review covers the pathophysiology, classification, and surgical management of peripheral nerve injuries in the upper extremity. It explains why outcomes remain suboptimal despite advances in microsurgery, and surveys emerging alternatives to autologous nerve grafting including synthetic conduits, nerve transfers, and gene therapy.
In the trauma bay with a hand laceration, identifying the nerve injury grade changes your operative plan immediately. Neuropraxia and Sunderland Type 2 injuries can be observed — Type 4 injuries get a trial of 8-10 weeks before surgery, and Type 5 injuries go to the operating room.
When you do operate, the 1-3 mm/day regeneration rate is your planning tool: a radial nerve injury at the spiral groove is roughly 15-20 cm from the wrist extensors, meaning 5-7 months minimum before reinnervation even if repair is perfect.
For gaps too large for tensionless primary repair, autologous sensory nerve grafting remains standard, but counsel patients that fewer than half will achieve meaningful functional recovery. Younger patients consistently do better. Age is the most powerful prognostic variable and should frame your preoperative discussion about realistic expectations.