Fitting pieces in the peripheral nerve puzzle

Findings from comparative microneurography are reviewed, i.e., data obtained by exploring human nerves with tungsten electrodes or concentric needle electrodes under similar conditions. It has emerged that activity in single myelinated fibers originates near nodes of Ranvier. Other data have shown that Ranvier nodes tend to cluster in certain regions of a fascicle and belong to fibers of the same modality which innervate the same skin area. This segregation involves all four main classes of myelinated low-threshold skin afferents. Fiber populations of the same modality may act as peripheral projection modules involved in somatosensory processing of tactile stimuli to cognitive levels. The fiber bundle arrangement of the nerves may be important for conserving functional gnosis in conditions where peripheral nerve fibers are lost. This organization may also be critical as a substrate to promote reinnervation after nerve cut followed by peripheral nerve suture. It is therefore less critical for an outgrowing fiber to find its exact distal counterpart. Even if misguided outgrowth occurs into the endoneurial tube of a neighboring distal fiber of the same modality with an adjacent receptive field, function can be reestablished. A precise nerve topography might also be of significance for obtaining a functionally satisfactory recovery after avulsion injuries treated by nerve root implantation into the spinal cord. Thus, there is in man an ordered nerve fiber organization, both in the periphery and in the CNS, which may have profound functional significance both under normal conditions and in disease.