State-of-the-art in peripheral nerve injury diagnosis and therapy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Jiayu ,  CHEN Liang

Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China;

Corresponding?author：

CHEN Liang, Email: liangchen1960@163.com

Keywords：

Peripheral nerve injury; nerve repair; nerve entrapment; rehabilitation intervention

DOI：

10.7507/1002-1892.202511056

Video：

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The undulating characteristics of nerve fibers and the endoneurium are important factors in resisting traction force. The diagnostic accuracies of magnetic resonance neurography and ultrasonography for nerve injuries are 85.4% and 70.6%, respectively. Epineurial repair is the most commonly used technique. Nerve grafts are generally required when the defect exceeds 2 cm. Nerve transfers are primarily indicated for brachial plexus root avulsions or intraforaminal lesions. Painful neuromas can be treated with target muscle reinnervation. Surgery yields reliable results for carpal-tunnel syndrome, cubital-tunnel syndrome, the common peroneal nerve entrapment, and the lateral femoral cutaneous nerve entrapment syndrome. Effective rehabilitation interventions related to the central nervous system include sensory reeducation, cross-modal sensory substitution, motor imagery, and action observation with simultaneous peripheral nerve stimulation.

1.	Warner WS, Yeoh S, Light A, et al. Rapid-stretch injury to peripheral nerves: histologic results. Neurosurgery, 2020, 86(3): 437-445.
2.	Ozer K. Nerve lesions in volkmann ischemic contracture. J Hand Surg (Am), 2020, 45(8): 746-757.
3.	Wolfe SW, Pederson WC, Kozin SH, et al. Green’s operative hand surgery. 8th ed. Philadelphia: Elsevier, 2022: 1085-1126, 1189-1242.
4.	朱大年, 金學隆, 趙華, 等. 神經系統的功能//朱大年, 王庭槐. 生理學. 8版. 北京: 人民衛生出版社, 2013: 270-367.
5.	Lysak A, Farnebo S, Geuna S, et al. Muscle preservation in proximal nerve injuries: a current update. J Hand Surg (Eur Vol), 2024, 49(6): 773-782.
6.	Chu XL, Song XZ, Li Q, et al. Basic mechanisms of peripheral nerve injury and treatment via electrical stimulation. Neural Regen Res, 2022, 17(10): 2185-2193.
7.	Ferrante MA. The assessment and management of peripheral nerve trauma. Curr Treat Options Neurol, 2018, 20(7): 25. doi: 10.1007/s11940-018-0507-4.
8.	Khalil C, Hancart C, Le Thuc V, et al. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results. Eur Radiol, 2008, 18(10): 2283-2291.
9.	Winn RH. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia: Elsevier, 2023: 2114-2127, 2151-2160, 2161-2168.
10.	Pitman J, Fayad LM, Ahlawat S. A neuromuscular clinician's guide to magnetic resonance neurography. Muscle Nerve, 2025, 71(3): 293-308.
11.	Foesleitner O, Kirchner M, Preisner F, et al. High-resolution US vs MR neurography for diagnosis of upper extremity peripheral nerve disorders. Radiology, 2025, 314(3): e232063. doi: 10.1148/radiol.232063.
12.	Mathieu L, Cloquell Y, Murison JC, et al. Defects of the sciatic nerve and its divisions treated by direct suturing in 90 degrees knee flexion: report on the first clinical series. Eur J Trauma Emerg Surg, 2022, 48(6): 4955-4962.
13.	Lucchina S, Fusetti C, Lazzarol L, et al. End-to-side innervated sensate radial forearm flap in the hand: a 5-year follow-up. Hand Surg Rehab, 2019, 38: 207-210.
14.	Baltzer H, Woo A, Oh C, et al. Comparison of ulnar intrinsic function following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer: a matched cohort study of proximal ulnar nerve injury patients. Plast Reconstr Surg, 2016, 138: 1264-1272.
15.	Hattori Y, Kawaguchi Y, Takeda S, et al. Repair of median nerve motor injury using a collagen nerve conduit: a case report. JBJS Case Connect, 2025, 15(2). doi: 10.2106/JBJS.CC.25.00127.
16.	Lans J, Eberlin KR, Evans PJ, et al. A systematic review and meta-analysis of nerve gap repair: comparative effectiveness of allografts, autografts, and conduits. Plast Reconstr Surg, 2023, 151(5): 814e-827e.
17.	Adidharma W, Wang Y, Kotsis SV, et al. Utilization trends of nerve autograft alternatives for the reconstruction of peripheral nerve defects. Plast Reconstr Surg, 2024, 153(4): 863-872.
18.	Saffari S, Shin AY, Pulos N. Nerve autografts versus allografts for mixed motor/sensory nerve reconstruction. J Hand Surg Glob Online, 2024, 6(5): 694-699.
19.	Gorkisch K, Boese-Landgraf J, Vaubel E. Treatment and prevention of amputation neuromas in hand surgery. Plast Reconstr Surg, 1984, 73(2): 293-299.
20.	Lanier ST, Jordan SW, Ko JH, et al. Targeted muscle reinnervation as a solution for nerve pain. Plast Reconstr Surg, 2020, 146(5): 651e-663e.
21.	Kubiak CA, Kemp SWP, Cederna PS, et al. Prophylactic regenerative peripheral nerve interfaces to prevent postamputation pain. Plast Reconstr Surg, 2019, 144(3): 421e-430e.
22.	Chopan M, Spencer Nichols D, Chim H. Radial nerve fascicular transfer preserving long head through anterior incision for transhumeral targeted muscle reinnervation. Plast Reconstr Surg Glob Open, 2022, 10(8): e4483. doi: 10.1097/GOX.0000000000004483.
23.	Souza JM, Cheesborough JE, Ko JH, et al. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clin Orthop Relat Res, 2014, 472(10): 2984-2990.
24.	Pierrie SN, Gaston RG, Loeffler BJ. Targeted muscle reinnervation for prosthesis optimization and neuroma management in the setting of transradial amputation. J Hand Surg (Am), 2019, 44(6): 525. e1-525. e8.
25.	Jack MM, Smith BW, Spinner RJ. Neurosurgery for the neurologist: peripheral nerve injury and compression (what can be fixed?). Neurol Clin, 2022, 40(2): 283-295.
26.	Afshar A, Tabrizi A, Shariyate MJ. Autonomic component of carpal tunnel syndrome. J Hand Surg (Am), 2025, 50(4): 491-496.
27.	Sperry BW, Reyes BA, Ikram A, et al. Tenosynovial and cardiac amyloidosis in patients undergoing carpal tunnel release. J Am Coll Cardiol, 2018, 72(17): 2040-2050.
28.	DiBenedetto M, Soong M, Hunter A, et al. Prevalence and subtypes of tenosynovial amyloid in patients undergoing carpal tunnel release. J Hand Surg (Am), 2022, 47(6): 540-543.
29.	Doherty CD, Miller TA, Larocerie-Salgado J, et al. Reverse end-to-side anterior interosseous nerve-to-ulnar motor transfer for severe ulnar neuropathy. Plast Reconstr Surg, 2020, 146(3): 306e-313e.
30.	Power HA, Kahn LC, Patterson MM, et al. Refining indications for the supercharge end-to-side anterior interosseous to ulnar motor nerve transfer in cubital tunnel syndrome. Plast Reconstr Surg, 2020, 145(1): 106e-116e.
31.	Head LK, Zhang ZZ, Hicks K, et al. Evaluation of intrinsic hand musculature reinnervation following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer. Plast Reconstr Surg, 2020, 146(1): 128-132.
32.	Davidge KM, Yee A, Moore AM, et al. The supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer for restoring intrinsic function: clinical experience. Plast Reconstr Surg, 2015, 136(3): 344e-352e.
33.	Górecki M, Czarnecki P. The influence of shoulder arthrodesis on the function of the upper limb in adult patients after a brachial plexus injury: a systematic literature review with elements of meta-analysis. EFORT Open Rev, 2021, 6(9): 797-807.
34.	Maldonado AA, Bishop AT, Spinner RJ, et al. Five operations that give the best results after brachial plexus injury. Plast Reconstr Surg, 2017, 140(3): 545-556.
35.	William C, Warner Jr. , James HB. Paralytic disorders//Frederick MA, James HB. Campbell's Operative Orthopaedics. 14th ed. Philadelphia: Elsevier, 2021: 1369-1458.
36.	Jerosch-Herold C. Sensory relearning in peripheral nerve disorders of the hand: a web-based survey and delphi consensus method. J Hand Ther, 2011, 24(4): 292-299.
37.	Udina E, Cobianchi S, Allodi I, et al. Effects of activity-dependent strategies on regeneration and plasticity after peripheral nerve injuries. Ann Anat, 2011, 193(4): 347-353.
38.	Dahlin LB. The role of timing in nerve reconstruction. Int Rev Neurobiol, 2013, 109: 151-164.
39.	Schmidhammer R, Hausner T, Kr?pfl A, et al. Enhanced sensory re-learning after nerve repair using 3D audio-visual signals and kinaesthesia--preliminary results. Acta Neurochir Suppl, 2007, 100: 127-129.
40.	Bolognini N, Russo C, Vallar G. Crossmodal illusions in neurorehabilitation. Front Behav Neurosci, 2015, 9: 212. doi: 10.3389/fnbeh.2015.00212.
41.	Macuga KL, Frey SH. Neural representations involved in observed, imagined, and imitated actions are dissociable and hierarchically organized. Neuroimage, 2012, 59(3): 2798-2807.
42.	Bisio A, Avanzino L, Gueugneau N, et al. Observing and perceiving: A combined approach to induce plasticity in human motor cortex. Clin Neurophysiol, 2015, 126(6): 1212-1220.
43.	Jessen KR, Mirsky R. The success and failure of the schwann cell response to nerve injury. Front Cell Neurosci, 2019, 13: 33. doi: 10.3389/fncel.2019.00033.

1. Warner WS, Yeoh S, Light A, et al. Rapid-stretch injury to peripheral nerves: histologic results. Neurosurgery, 2020, 86(3): 437-445.
2. Ozer K. Nerve lesions in volkmann ischemic contracture. J Hand Surg (Am), 2020, 45(8): 746-757.
3. Wolfe SW, Pederson WC, Kozin SH, et al. Green’s operative hand surgery. 8th ed. Philadelphia: Elsevier, 2022: 1085-1126, 1189-1242.
4. 朱大年, 金學隆, 趙華, 等. 神經系統的功能//朱大年, 王庭槐. 生理學. 8版. 北京: 人民衛生出版社, 2013: 270-367.
5. Lysak A, Farnebo S, Geuna S, et al. Muscle preservation in proximal nerve injuries: a current update. J Hand Surg (Eur Vol), 2024, 49(6): 773-782.
6. Chu XL, Song XZ, Li Q, et al. Basic mechanisms of peripheral nerve injury and treatment via electrical stimulation. Neural Regen Res, 2022, 17(10): 2185-2193.
7. Ferrante MA. The assessment and management of peripheral nerve trauma. Curr Treat Options Neurol, 2018, 20(7): 25. doi: 10.1007/s11940-018-0507-4.
8. Khalil C, Hancart C, Le Thuc V, et al. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results. Eur Radiol, 2008, 18(10): 2283-2291.
9. Winn RH. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia: Elsevier, 2023: 2114-2127, 2151-2160, 2161-2168.
10. Pitman J, Fayad LM, Ahlawat S. A neuromuscular clinician's guide to magnetic resonance neurography. Muscle Nerve, 2025, 71(3): 293-308.
11. Foesleitner O, Kirchner M, Preisner F, et al. High-resolution US vs MR neurography for diagnosis of upper extremity peripheral nerve disorders. Radiology, 2025, 314(3): e232063. doi: 10.1148/radiol.232063.
12. Mathieu L, Cloquell Y, Murison JC, et al. Defects of the sciatic nerve and its divisions treated by direct suturing in 90 degrees knee flexion: report on the first clinical series. Eur J Trauma Emerg Surg, 2022, 48(6): 4955-4962.
13. Lucchina S, Fusetti C, Lazzarol L, et al. End-to-side innervated sensate radial forearm flap in the hand: a 5-year follow-up. Hand Surg Rehab, 2019, 38: 207-210.
14. Baltzer H, Woo A, Oh C, et al. Comparison of ulnar intrinsic function following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer: a matched cohort study of proximal ulnar nerve injury patients. Plast Reconstr Surg, 2016, 138: 1264-1272.
15. Hattori Y, Kawaguchi Y, Takeda S, et al. Repair of median nerve motor injury using a collagen nerve conduit: a case report. JBJS Case Connect, 2025, 15(2). doi: 10.2106/JBJS.CC.25.00127.
16. Lans J, Eberlin KR, Evans PJ, et al. A systematic review and meta-analysis of nerve gap repair: comparative effectiveness of allografts, autografts, and conduits. Plast Reconstr Surg, 2023, 151(5): 814e-827e.
17. Adidharma W, Wang Y, Kotsis SV, et al. Utilization trends of nerve autograft alternatives for the reconstruction of peripheral nerve defects. Plast Reconstr Surg, 2024, 153(4): 863-872.
18. Saffari S, Shin AY, Pulos N. Nerve autografts versus allografts for mixed motor/sensory nerve reconstruction. J Hand Surg Glob Online, 2024, 6(5): 694-699.
19. Gorkisch K, Boese-Landgraf J, Vaubel E. Treatment and prevention of amputation neuromas in hand surgery. Plast Reconstr Surg, 1984, 73(2): 293-299.
20. Lanier ST, Jordan SW, Ko JH, et al. Targeted muscle reinnervation as a solution for nerve pain. Plast Reconstr Surg, 2020, 146(5): 651e-663e.
21. Kubiak CA, Kemp SWP, Cederna PS, et al. Prophylactic regenerative peripheral nerve interfaces to prevent postamputation pain. Plast Reconstr Surg, 2019, 144(3): 421e-430e.
22. Chopan M, Spencer Nichols D, Chim H. Radial nerve fascicular transfer preserving long head through anterior incision for transhumeral targeted muscle reinnervation. Plast Reconstr Surg Glob Open, 2022, 10(8): e4483. doi: 10.1097/GOX.0000000000004483.
23. Souza JM, Cheesborough JE, Ko JH, et al. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clin Orthop Relat Res, 2014, 472(10): 2984-2990.
24. Pierrie SN, Gaston RG, Loeffler BJ. Targeted muscle reinnervation for prosthesis optimization and neuroma management in the setting of transradial amputation. J Hand Surg (Am), 2019, 44(6): 525. e1-525. e8.
25. Jack MM, Smith BW, Spinner RJ. Neurosurgery for the neurologist: peripheral nerve injury and compression (what can be fixed?). Neurol Clin, 2022, 40(2): 283-295.
26. Afshar A, Tabrizi A, Shariyate MJ. Autonomic component of carpal tunnel syndrome. J Hand Surg (Am), 2025, 50(4): 491-496.
27. Sperry BW, Reyes BA, Ikram A, et al. Tenosynovial and cardiac amyloidosis in patients undergoing carpal tunnel release. J Am Coll Cardiol, 2018, 72(17): 2040-2050.
28. DiBenedetto M, Soong M, Hunter A, et al. Prevalence and subtypes of tenosynovial amyloid in patients undergoing carpal tunnel release. J Hand Surg (Am), 2022, 47(6): 540-543.
29. Doherty CD, Miller TA, Larocerie-Salgado J, et al. Reverse end-to-side anterior interosseous nerve-to-ulnar motor transfer for severe ulnar neuropathy. Plast Reconstr Surg, 2020, 146(3): 306e-313e.
30. Power HA, Kahn LC, Patterson MM, et al. Refining indications for the supercharge end-to-side anterior interosseous to ulnar motor nerve transfer in cubital tunnel syndrome. Plast Reconstr Surg, 2020, 145(1): 106e-116e.
31. Head LK, Zhang ZZ, Hicks K, et al. Evaluation of intrinsic hand musculature reinnervation following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer. Plast Reconstr Surg, 2020, 146(1): 128-132.
32. Davidge KM, Yee A, Moore AM, et al. The supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer for restoring intrinsic function: clinical experience. Plast Reconstr Surg, 2015, 136(3): 344e-352e.
33. Górecki M, Czarnecki P. The influence of shoulder arthrodesis on the function of the upper limb in adult patients after a brachial plexus injury: a systematic literature review with elements of meta-analysis. EFORT Open Rev, 2021, 6(9): 797-807.
34. Maldonado AA, Bishop AT, Spinner RJ, et al. Five operations that give the best results after brachial plexus injury. Plast Reconstr Surg, 2017, 140(3): 545-556.
35. William C, Warner Jr. , James HB. Paralytic disorders//Frederick MA, James HB. Campbell's Operative Orthopaedics. 14th ed. Philadelphia: Elsevier, 2021: 1369-1458.
36. Jerosch-Herold C. Sensory relearning in peripheral nerve disorders of the hand: a web-based survey and delphi consensus method. J Hand Ther, 2011, 24(4): 292-299.
37. Udina E, Cobianchi S, Allodi I, et al. Effects of activity-dependent strategies on regeneration and plasticity after peripheral nerve injuries. Ann Anat, 2011, 193(4): 347-353.
38. Dahlin LB. The role of timing in nerve reconstruction. Int Rev Neurobiol, 2013, 109: 151-164.
39. Schmidhammer R, Hausner T, Kr?pfl A, et al. Enhanced sensory re-learning after nerve repair using 3D audio-visual signals and kinaesthesia--preliminary results. Acta Neurochir Suppl, 2007, 100: 127-129.
40. Bolognini N, Russo C, Vallar G. Crossmodal illusions in neurorehabilitation. Front Behav Neurosci, 2015, 9: 212. doi: 10.3389/fnbeh.2015.00212.
41. Macuga KL, Frey SH. Neural representations involved in observed, imagined, and imitated actions are dissociable and hierarchically organized. Neuroimage, 2012, 59(3): 2798-2807.
42. Bisio A, Avanzino L, Gueugneau N, et al. Observing and perceiving: A combined approach to induce plasticity in human motor cortex. Clin Neurophysiol, 2015, 126(6): 1212-1220.
43. Jessen KR, Mirsky R. The success and failure of the schwann cell response to nerve injury. Front Cell Neurosci, 2019, 13: 33. doi: 10.3389/fncel.2019.00033.

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