Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Traumatic mononeuropathies

Laura Simionescu, MD
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD


Traumatic peripheral nerve injuries may cause significant disability and have a serious impact on the patient’s life. Therefore, early diagnosis, accurate and timely management, and close follow-up are warranted. This topic discusses the classification and evaluation of traumatic nerve injury, and briefly outlines treatment considerations. The specific neurologic deficits associated with particular nerve injuries are discussed more fully elsewhere.


The peripheral nerve consists of myelinated and unmyelinated nerve fibers. Unmyelinated axons are surrounded by the plasma membrane of a supporting cell called the Schwann cell. Myelinated axons are surrounded by a myelin sheath, a specialized structure of the Schwann cell that wraps around the axon and insulates it with layers of cell membrane. Gaps in myelin occur at regular intervals, called the nodes of Ranvier. The segments of axon covered by myelin between the gaps are called the internodal segments [1,2]. The myelin sheath has a low capacitance and a high resistance to electrical current, so that current flow is directed longitudinally along the axon, rather than transversely across the axon membrane. Ion channels within the axon membrane are differentially distributed at the node of Ranvier and under the myelin sheath. The differential expression of ion channels and the insulating properties of the myelin sheath result in a rapid mode of nerve transmission called saltatory conduction.


Traumatic nerve injury results from the application of kinetic energy to the nerve, with consequent compressive and tensile forces applied to the nerve. Examples include injuries from a sudden stretch of a limb; a laceration from a sharp object, and a gunshot wound with associated cavitation effect produced by the bullet moving through tissue with a high velocity [3].

Mononeuropathies caused by trauma produce signs and symptoms that relate to the specific location and severity of the injury. However, trauma is unique from other causes of mononeuropathy in several respects. The sudden nature of the event leads to a well-defined sequence of abnormalities on clinical neurophysiologic evaluation, and recovery is strongly related to the type and severity of injury. In addition, therapy is directed to anatomic reconstruction rather than disease modification.

Most commonly, nerve injury occurs from traction/stretch, laceration, compression, or ischemia. The nerve dysfunction results primarily from the direct mechanical forces applied to it and secondarily from the vascular compromise that follows, with consequent ischemic nerve damage.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Feb 27, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Dubuisson A, Kline DG. Indications for peripheral nerve and brachial plexus surgery. Neurol Clin 1992; 10:935.
  2. Gray H. Neurology. In: Anatomy of the Human Body, 20th edition, Lea & Febiger, Philadelphia 1918.
  3. Robinson LR. Traumatic injury to peripheral nerves. Muscle Nerve 2000; 23:863.
  4. Grant GA, Goodkin R, Kliot M. Evaluation and surgical management of peripheral nerve problems. Neurosurgery 1999; 44:825.
  5. Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve 1990; 13:771.
  6. Kim DH, Kline DG. Management and results of peroneal nerve lesions. Neurosurgery 1996; 39:312.
  7. Stewart JD. Focal Peripheral Neuropathies, 2nd edition, Raven Press, New York 1993.
  8. Seddon HJ. A Classification of Nerve Injuries. Br Med J 1942; 2:237.
  9. Sunderland S. Nerve Injuries and their Repair: a Critical Appraisal, Churchill Livingstone, Edinburgh 1991.
  10. Chaudhry V, Cornblath DR. Wallerian degeneration in human nerves: serial electrophysiological studies. Muscle Nerve 1992; 15:687.
  11. Birch R, Bonney G, Parry C. Surgical Disorders of the Peripheral Nerves, Churchill Livingstone, Edinburgh 1998.
  12. Nerve injuries: Operative results for major nerve injuries, entrapments, and tumors, 1st edition, Kline D, Hudson A (Eds), Saunders, Philadelphia 1995.
  13. Hall S. Nerve repair: a neurobiologist's view. J Hand Surg Br 2001; 26:129.
  14. Fox IK, Mackinnon SE. Adult peripheral nerve disorders: nerve entrapment, repair, transfer, and brachial plexus disorders. Plast Reconstr Surg 2011; 127:105e.
  15. Erra C, De Franco P, Granata G, et al. Secondary posterior interosseous nerve lesions associated with humeral fractures. Muscle Nerve 2016; 53:375.
  16. Katirji B. Peroneal nerve. In: Neuromuscular Function and Disease: Basic, Clinical, and Electrodiagnostic Aspects, 1st edition, Brown WF, Bolton CF, Aminoff MJ (Eds), W.B. Saunders, Philadelphia 2002. Vol 1, p.981.
  17. Moore AE, Stringer MD. Iatrogenic femoral nerve injury: a systematic review. Surg Radiol Anat 2011; 33:649.
  18. Weiss JM, Tolo V. Femoral nerve palsy following iliacus hematoma. Orthopedics 2008; 31:178.
  19. Padua L, Caliandro P, Bertolini C, et al. Post traumatic femoral mononeuropathy: prognosis of 7 cases. J Neurol 2006; 253:655.
  20. Hobson-Webb LD, Juel VC. The three dimensional assessment of peripheral nerve injury: an integrated clinical, neurophysiologic and sonographic approach. Clin Neurophysiol 2013; 124:1053.
  21. Katirji B. Electromyography in Clinical Practice: A Case Study Approach, Mosby, St. Louis 1998. p.302.
  22. Robinson LR. How electrodiagnosis predicts clinical outcome of focal peripheral nerve lesions. Muscle Nerve 2015; 52:321.
  23. Korus L, Ross DC, Doherty CD, Miller TA. Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation. J Neurol Neurosurg Psychiatry 2016; 87:188.
  24. Francel PC, Francel TJ, Mackinnon SE, Hertl C. Enhancing nerve regeneration across a silicone tube conduit by using interposed short-segment nerve grafts. J Neurosurg 1997; 87:887.
  25. GILLIATT RW, TAYLOR JC. Electrical changes following section of the facial nerve. Proc R Soc Med 1959; 52:1080.
  26. Gilliatt RW, Hjorth RJ. Nerve conduction during Wallerian degeneration in the baloon. J Neurol Neurosurg Psychiatry 1972; 35:335.
  27. Pilling JB. Nerve conduction during Wallerian degeneration in man. Muscle Nerve 1978; 1:81.
  28. Constantinovici A. The diagnostic value of somatosensory evoked potentials in the diseases of peripheral nervous system. Neurol Psychiatr (Bucur) 1989; 27:111.
  29. Goodin DS, Aminoff MJ. Clinical applications of somatosensory evoked potentials. In: Neuromuscular Function and Disease: Basic, Clinical, and Electrodiagnostic Aspects, 1st edition, Brown WF, Bolton CF, Aminoff MJ (Eds), W.B. Saunders, Philadelphia 2002. Vol 1, p.159.
  30. Filler AG, Howe FA, Hayes CE, et al. Magnetic resonance neurography. Lancet 1993; 341:659.
  31. Grant GA, Britz GW, Goodkin R, et al. The utility of magnetic resonance imaging in evaluating peripheral nerve disorders. Muscle Nerve 2002; 25:314.
  32. Ruijs AC, Jaquet JB, Kalmijn S, et al. Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg 2005; 116:484.
  33. Cudlip SA, Howe FA, Griffiths JR, Bell BA. Magnetic resonance neurography of peripheral nerve following experimental crush injury, and correlation with functional deficit. J Neurosurg 2002; 96:755.
  34. Takagi T, Nakamura M, Yamada M, et al. Visualization of peripheral nerve degeneration and regeneration: monitoring with diffusion tensor tractography. Neuroimage 2009; 44:884.
  35. Meek MF, Stenekes MW, Hoogduin HM, Nicolai JP. In vivo three-dimensional reconstruction of human median nerves by diffusion tensor imaging. Exp Neurol 2006; 198:479.
  36. Simon NG, Narvid J, Cage T, et al. Visualizing axon regeneration after peripheral nerve injury with magnetic resonance tractography. Neurology 2014; 83:1382.
  37. Padua L, Di Pasquale A, Liotta G, et al. Ultrasound as a useful tool in the diagnosis and management of traumatic nerve lesions. Clin Neurophysiol 2013; 124:1237.
  38. Gruber H, Peer S, Meirer R, Bodner G. Peroneal nerve palsy associated with knee luxation: evaluation by sonography--initial experiences. AJR Am J Roentgenol 2005; 185:1119.
  39. Peer S, Bodner G, Meirer R, et al. Examination of postoperative peripheral nerve lesions with high-resolution sonography. AJR Am J Roentgenol 2001; 177:415.
  40. Terzis JK, Konofaos P. Radial nerve injuries and outcomes: our experience. Plast Reconstr Surg 2011; 127:739.
  41. Garozzo D, Ferraresi S, Buffatti P. Surgical treatment of common peroneal nerve injuries: indications and results. A series of 62 cases. J Neurosurg Sci 2004; 48:105.
  42. Parry GJ. Electrodiagnostic studies in the evaluation of peripheral nerve and brachial plexus injuries. Neurol Clin 1992; 10:921.
  43. Kim DH, Murovic JA, Tiel RL, Kline DG. Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery 2004; 54:1421.
  44. Yegiyants S, Dayicioglu D, Kardashian G, Panthaki ZJ. Traumatic peripheral nerve injury: a wartime review. J Craniofac Surg 2010; 21:998.
  45. Kim DH, Han K, Tiel RL, et al. Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg 2003; 98:993.
  46. Kim DH, Kam AC, Chandika P, et al. Surgical management and outcomes in patients with median nerve lesions. J Neurosurg 2001; 95:584.
  47. Kim DH, Kam AC, Chandika P, et al. Surgical management and outcome in patients with radial nerve lesions. J Neurosurg 2001; 95:573.
  48. Kim DH, Murovic JA, Kim YY, Kline DG. Surgical treatment and outcomes in 45 cases of posterior interosseous nerve entrapments and injuries. J Neurosurg 2006; 104:766.
  49. Kim DH, Murovic JA, Kim YY, Kline DG. Surgical treatment and outcomes in 15 patients with anterior interosseous nerve entrapments and injuries. J Neurosurg 2006; 104:757.
  50. Sameem M, Wood TJ, Bain JR. A systematic review on the use of fibrin glue for peripheral nerve repair. Plast Reconstr Surg 2011; 127:2381.
  51. Ngeow WC. Scar less: a review of methods of scar reduction at sites of peripheral nerve repair. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109:357.
  52. Martínez de Albornoz P, Delgado PJ, Forriol F, Maffulli N. Non-surgical therapies for peripheral nerve injury. Br Med Bull 2011; 100:73.