Traumatic injury to peripheral nerves

This article reviews the epidemiology, classification, localization, prognosis, and mechanisms of recovery of traumatic peripheral nerve injuries (PNIs). Electrodiagnostic (EDx) assessments are critical components of treating patients with PNIs. In particular, motor and sensory nerve conduction studies, needle electromyography, and other electrophysiological methods are useful for localizing peripheral nerve injuries, detecting and quantifying the degree of axon loss, and contributing toward treatment decisions as well as prognostication. It is critical that EDx medical consultants are aware of the timing of these changes as well as limitations in interpretations. Mechanisms of recovery may include recovery from conduction block, muscle fiber hypertrophy, distal axonal sprouting, and axon regrowth from the site of injury. Motor recovery generally reaches a plateau at 18 to 24 months postinjury. When patients have complete or severe nerve injuries they should be referred to surgical colleagues early after injury, as outcomes are best when nerve transfers are performed within the first 3 to 6 months after onset.