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Anatomy & Physiology

The anatomy and physiology of peripheral nerve injury is vital information for the treating surgeon.

• The accurate and finely detailed surgical anatomy of peripheral nerves is difficult to find in any one textbook or resource.

• The detailed intrafascicular anatomy may be described in individual, historical anatomic research papers, but it is very difficult to find this information quickly.
• The intraneural sensory and motor topography so critical for nerve transfer surgery is not readily available.
• The pathophysiology of nerve injury presented with relevant clinical examples provides the combined expertise of years of clinical experience and practice.
• This experiential wisdom is difficult to gain in most typical patient practices where these injuries are relatively rare.
• Every effort has been made to convey clear algorithms for a step by step logical plan for management of the nerve injured patient based on the underlying pathophysiology.
This section of the website presents information organized as follows.

The General Information section reviews the following:
• A broad overview of the normal anatomy of peripheral nerves and key anatomic variants and anomalies with emphasis on points pertinent to patient diagnosis and surgical intervention.
• Note that variation exists between patients and sources, and we are providing one example of this information. Nothing can substitute for sound clinical judgment and close observation as part of individualized patient care.
• The clinically relevant pathophysiology of nerves, and how that influences management strategy.
• Note that our understanding of the pathophysiology of nerve injury and recovery changes with new data gained from ongoing neuroscience research in the field.  Some areas are controversial, and a clear consensus is sometimes lacking.  We highlight these points conscientiously wherever possible, but further individual investigation by the treating surgeon is recommended for all patient care. 
The By Region section contains detailed anatomic dissections reviews the following:
• Anatomy of the peripheral nerve end organ organized by anatomic region.
• This will allow you to think through the anatomy of all the major regions of the extremity from shoulder to fingers.
• It also presents anatomic dissections of the brachial plexus and the superficial sensory nerves.
• The anatomy, with an emphasis on surgical anatomy, is illustrated by the use of photos, video and text.
The By Nerve section contains detailed anatomic dissections and reviews the following:
• Anatomy of the peripheral nerves and their corresponding end organs.
• This will allow you to think through the anatomy of all the major peripheral nerves of the extremity by the nerve in question from spinal nerve root to motor or sensory end organ.
• The anatomy, with an emphasis on surgical anatomy, is illustrated by the use of photos, video and text.
In other sections of the website you will find:
• Evaluation and Management, including the pertinent history and physical examination, as well as an overview of diagnostic tests and treatment (non-operative and operative) options. Understanding this information is critical to treating patients -- consider reviewing this section.
• Surgical Options, including step-by-step surgical tutorials with intraoperative, narrated videos.
• Case Studies section, including case examples that will walk you through clinical scenarios that may be similar to that of the patient you are treating.