Procedures · Peripheral Nerve & Brachial Plexus Surgery

Peripheral Nerve Injury

Medically reviewed by Dr. Khalid Almutairi, Consultant Plastic Surgeon — updated 2026-08-13

A peripheral nerve is like a cable carrying thousands of fibres: some deliver movement commands to muscles, others return sensation from the skin. When the cable is cut or crushed, the signal stops — weakness or paralysis of specific muscles, numbness in a defined area, and sometimes burning nerve pain. Understanding precisely what has happened to the nerve is the foundation of every treatment decision that follows.

Care is led by Dr. Khalid Almutairi, a consultant plastic and reconstructive surgeon, fellowship trained in hand surgery and microsurgery in Canada and the USA.

Types of nerve injury

Not all nerve injuries are alike. A nerve may be intact but temporarily "stunned" after blunt trauma or compression — such injuries often recover spontaneously over weeks to months. The fibres inside may tear while the outer sleeve survives, allowing some slow regrowth. A complete division — usually from a sharp wound — will not recover on its own and needs surgical repair. Distinguishing between these patterns rests on repeated examination, with electrodiagnostic testing where needed.

Why timing matters

A repaired nerve regenerates very slowly and must cover the whole distance from the injury to the muscle. A muscle that remains without nerve supply for too long gradually loses its ability to recover after later nerve reconstruction — if regeneration arrives too late, its benefit for movement is reduced. Persistent weakness or numbness after an injury should therefore be assessed without delay, although decisions rest on individual evaluation rather than rigid time limits.

Assessment and investigations

Assessment begins with the story: the mechanism, timing, and level of the injury. Careful examination of movement and sensation then maps which fibres are affected and whether the deficit is complete or partial, with repeat visits watching for signs of spontaneous recovery. Ultrasound, MRI, or electrodiagnostic studies (nerve conduction studies and EMG) may be requested where needed — not all are necessary for every patient.

How nerves recover — and why it differs from wound healing

A sutured nerve does not "knit" and work immediately the way skin heals. The repair only restores the pathway; the fibres must then grow along it toward their target, slowly, over months. The wound can therefore be fully healed while true recovery has barely begun, and movement and sensation continue improving gradually for a long time. The extent of recovery depends on the level of injury, the distance to the muscle, the patient's age, and the timing of treatment — and a complete return of movement or sensation cannot be guaranteed.

Surgical treatment options

The appropriate tool is chosen according to the injury:

• Direct repair: suturing the nerve ends under magnification when they can be brought together without harmful tension — the first choice for a suitable recent division.
• Nerve grafting: when a gap prevents tension-free repair, it is bridged with a graft — usually from a sensory nerve whose small territory can be spared, with expected numbness in that area.
• Nerve transfer: redirecting a functioning nerve or branch — one whose contribution can be safely spared — to the more important injured nerve close to the muscle, shortening the regeneration distance. An important option for injuries close to the spinal cord or presenting relatively late.
• Neurolysis: freeing an intact nerve trapped in compressing scar.
• Treatment of painful neuroma: when the end of a divided nerve grows into a disorganised, painful knot, surgical options are considered according to the case.

When time has run out: functional reconstruction

If the window for reinnervation has passed, or reconstruction has not succeeded, the road does not end. In selected cases the tendon of a well-functioning muscle can be transferred to perform the lost movement — or, in specific situations, an entire muscle can be transferred with its vessels and nerve by microsurgery. Each of these tools has its own page within this area.

Rehabilitation

While awaiting regeneration, physiotherapy keeps the joints supple so they do not stiffen before movement returns, and supportive splints may be used. Once the signal returns, motor training begins, and sensory re-education may be added to teach the brain to read the new sensation. The programme is always individual.

Limitations and risks

Risks of nerve surgery include incomplete recovery, persistent numbness or weakness, neuropathic pain or neuroma, and donor-site numbness after grafting, in addition to general surgical risks. Expectations and risks are discussed frankly for each case before any decision.

Will sensation and movement return completely?

Improvement is expected in many cases, but a complete return cannot be guaranteed; the outcome is shaped by the injury's level, the distance, age, and timing. Realistic expectations are discussed for your specific case.

How long does recovery take?

Usually months, and improvement may continue beyond a year depending on the distance regeneration must travel. Regular follow-up is what tracks the progress.

What is the difference between a graft and a nerve transfer?

A graft bridges a gap in the injured nerve itself, so it regenerates across it from the injury site. A transfer borrows a healthy nerve close to the muscle and connects it directly, shortening both distance and time. The choice depends on the injury's level, its timing, and the nerves available.

When is a nerve injury an emergency?

Sharp wounds with immediate loss of movement or sensation — especially with bleeding or a pale limb — require immediate attendance at an emergency department so vessels and nerves are assessed together.

Medical-information notice

This is general information and does not replace consultation and examination. Any persistent numbness or weakness after an injury deserves medical assessment without delay.