Update on peripheral nerve injuries

Experimental work relating to factors affecting nerve regeneration is reviewed. There is increasing evidence that the nerve sprouts are preprogrammed for their peripheral reinnervation; old endoneurial tubes being discarded. Fascicular suture shows no significant improvement in function compared with epineural suture. The importance for sensory re-education and the need for repeatable sensory function tests is emphasized. Recent experimental work on the mechanisms of causalgia is reviewed and management of painful peripheral nerve disorders discussed. Striking advances have been made in the diagnosis, surgical treatment and rehabilitation of traction lesions of the brachial plexus. These are discussed with special reference to electrodiagnosis, functional splinting and management of pain. Surgery for obstetric palsies is now being undertaken and similar lesions to those in the adult being repaired with success. Reconstructive procedures for permanent paralysis are reviewed. Postirradiation plexus lesions present a formidable challenge but surgery can sometimes alleviate pain.