Peripheral nerve injuries, regeneration and repair

Abstract

Peripheral nerve injuries (PNIs) represent a significant clinical challenge, frequently affecting otherwise healthy individuals and leading to substantial motor, sensory and autonomic dysfunction. This article provides a comprehensive review of the fundamental aspects of PNIs, including the underlying anatomy, common aetiologies, and classifications of PNI using the Seddon and Sunderland systems. The pathophysiology of nerve injury is explored in detail describing the critical processes of Wallerian degeneration and the subsequent regenerative cascade, which are essential for determining the timing and approach to intervention. Clinical evaluation (combining detailed history, physical examination, electrodiagnostic studies, and advanced imaging such as MRI scans) is crucial for accurate localization and characterization of the injury. The current clinical management strategies, ranging from non-operative rehabilitation for low-grade injuries to surgical interventions for more severe injuries are also discussed in detail. Finally, we discuss emerging therapies designed to overcome the limitations of traditional repair. These therapies hold significant promise for enhancing axonal regeneration and functional recovery, though rigorous clinical trials are necessary to establish their efficacy and facilitate routine clinical adoption.