Abstract
Peripheral nerve injuries and compression syndromes of the upper extremity are two disease entities that present diagnostic and therapeutic challenges. Nerve dysfunction can produce profound functional disability from numbness, paresthesia, pain, weakness, and loss of use of the extremity. Management ranges from immediate primary repair, observation with serial electrodiagnostic testing, and possible delayed repair, to nerve grafting with distal nerve transfers. Expected outcomes may be as great as functional muscle contraction or limited to return of protective sensation. The compressive syndromes often present more gradually as pressure or nerve impingement at known locations of compression symptoms. Though compression syndromes may occur acutely, dictating emergent decompression, first-line management is generally nonoperative splinting and activity modification with operative decompression reserved for recurrence and recalcitrant cases. Ultimately, for both nerve injuries and compressive syndromes, accurate diagnosis is required to determine the correct treatment and the level at which to intervene. In this chapter, we discuss nerve pathophysiology, principles for optimal nerve injury reconstruction and management, and the upper extremity compressive syndromes and their respective management.