Peripheral Nerve Injuries and Repair in the Upper Extremity‪.‬

Injuries to peripheral nerves are common in all forms of upper extremity trauma but management of them remains a challenge. The use of the operative microscope has facilitated repair of nerve injuries, however, complete restoration of function is often difficult, if not impossible, to obtain. Factors to consider when evaluating a potential nerve injury are: type and severity of the nerve injury, experience of the surgeon and ancillary staff (i.e., operative staff, occupational therapists, and electrodiagnostic technicians), available equipment, and patient variables. Galen was the first to distinguish nerves from tendon. In the 7th century CE, Aegineta reported on the repair of a nerve injury and Ferrara would later document a successful nerve repair in 1608. In the last 150 years, a more comprehensive understanding of nerve physiology has unfolded. During the 19th century, Waller elucidated the process of axonal degeneration following nerve transection. In the early 20th century, Ramon y Cajal further explained the process of nerve regeneration after injury. Experiences from the Civil War (Mitchell), World War I (Tinel), and World War II (Seddon and Woodhall) provided thousands of cases that served as a foundation for our current understanding of nerve injuries and their repair.