Peripheral Nerve Surgery
Core concepts
Understand peripheral nerve anatomy, the Seddon and Sunderland classifications of nerve injury, and the difference between neurapraxia, axonotmesis, and neurotmesis. Know the common entrapment neuropathies: carpal tunnel syndrome, cubital tunnel syndrome, and tarsal tunnel syndrome, including their electrodiagnostic findings and surgical indications. Learn the principles of nerve repair, grafting, and transfer, and the timing of surgery. Also cover traumatic nerve injury, brachial plexus injury, and peripheral nerve tumors.
Traps
- Assuming all nerve injuries need immediate surgery; neurapraxia often recovers spontaneously.
- Confusing carpal tunnel syndrome (median nerve, thenar wasting, nocturnal symptoms) with cubital tunnel syndrome (ulnar nerve, clawing, intrinsic wasting).
- Forgetting that electrodiagnostics guide but do not replace clinical assessment.
- Missing that nerve transfer is time-sensitive in proximal injuries.
Worked example / rule of thumb
A patient with nocturnal hand numbness, thenar atrophy, and a positive Tinel sign at the wrist has carpal tunnel syndrome; conservative treatment first, with surgery for refractory or severe cases. Rule of thumb: neurapraxia recovers in weeks to months without surgery, axonotmesis recovers slowly with Wallerian degeneration, and neurotmesis requires surgical repair.