Nerve repair

Conservative treatment

Surgical repair

Expectant management (e.g., closed injuries of the nerve with a high rate of spontaneous recovery)

Activity modification (e.g., avoid sports or activities that increase the likelihood of further nerve injury)

Splinting

• Prevents stiffness and contractures of joints

• Supports residual nerve functionality and reinnervation

Physiotherapy

Electrical stimulation: supports the regeneration of the proximal axons and reinnervation of the denervated muscles after surgical nerve repair

Analgesia

• Nonopioid analgesics (e.g., NSAIDs)

• Infiltration with local anesthetics

Drug therapy

• Treatment of chronic neuropathic pain following peripheral nerve injury (e.g., gabapentin)

• Used in combination with surgical treatment to enhance remyelination and motor regeneration (e.g., lithium)

Open, non-contaminated, sharp injuries and concomitant vascular injuries → immediate surgical exploration and repair

Open, contaminated injuries and postreduction palsy → early surgical exploration and repair (within 3 weeks)

Patients without clinical or electromyographic signs of spontaneous recovery → delayed surgical exploration and repair (within 3 months)

Nerve repair (neurorrhaphy): reconstruction of nerve continuity

Nerve transfer: an intact healthy nerve is redirected towards a denervated nerve in order to restore the innervation of its target organ

Tendon transfer: a tendon from a sufficiently powerful muscle is redirected towards another tendon in order to restore its motion and function