Peripheral Nerve Injuries: Electrophysiology for the Neurosurgeon.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: None 2. Peripheral Nerve Injury. Nadi M(1), Dabbas W(2), Das JM(3). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. 2026 Feb 15. Author information: (1)Al-Balqa Applied University-Dalhousie University (2)Vice CEO and Medical Director and Neurosurgeon in Neuron clinics , Amman Jordan. (3)Imperial College Healthcare NHS Trust, London Peripheral nerve injuries (PNIs) represent a complex and often debilitating group of neuromuscular disorders that can result in significant sensory and motor dysfunction, chronic pain, and long-term disability. Historically, much of our understanding of peripheral nerves and PNIs has originated from military medicine and battlefield experiences. Sir Herbert Seddon first introduced his classification system for PNIs in 1942 while treating soldiers during World War II, and Sir Sydney Sunderland later expanded this framework to include 5 grades of injury (I–V), and Mackinnon and Dellon further refined it to incorporate mixed or grade VI injuries. While initially characterized in combat-related trauma, PNIs are now most commonly encountered in civilian settings—often from motor vehicle collisions, lacerations, fractures, or iatrogenic causes. These injuries can be profoundly disabling, frequently affecting young or working-age adults, leading to lifelong functional impairment and substantial socioeconomic consequences. Structurally, peripheral nerve trunks are composed of several concentric connective tissue layers critical to their integrity and function: the endoneurium, a delicate inner matrix surrounding individual axons and providing mechanical and metabolic support; the perineurium, a multilayered sheath that encloses fascicles and forms the principal component of the blood–nerve barrier; and the epineurium, a dense outer connective tissue layer that protects the nerve from mechanical stress and contains its vascular supply. Surrounding these is the mesoneurium (or paraneurium)—a loose areolar layer allowing the nerve to glide within its tissue bed, the disruption of which can contribute to entrapment or adhesions (see Image. Nerve Cell Anatomy). Understanding this microanatomy is essential for interpreting nerve injury classifications, correlating clinical presentations, and determining prognosis and surgical strategy. Recent advances in microsurgical techniques, nerve grafting and transfers, neurophysiologic monitoring, and targeted rehabilitation have improved outcomes following PNIs. However, early recognition, accurate localization, and timely intervention remain critical determinants of recovery. This review provides an updated, evidence-based overview of the classification, pathophysiology, diagnostic modalities, and management of peripheral nerve injuries. Designed for medical professionals as part of a continuing medical education activity, it emphasizes practical approaches, multidisciplinary coordination, and emerging innovations to bridge existing practice gaps and optimize functional restoration in patients with peripheral nerve injuries. Copyright © 2026, StatPearls Publishing LLC.