Surgical Exposures for Nerves of the Upper Limbs

Peripheral nerve surgery on the upper extremity often involves different approaches. These surgical exposures target the supra- and infraclavicular spaces, the medial and posterior brachial regions, the elbow (ulnar nerve exposure), and the wrist (median nerve exposure). The underlying pathologies addressed by surgery also vary, encompassing traumatic or iatrogenic injuries, entrapment neuropathies, and neoplastic lesions. These insults and their locations determine the type of surgical approach required. Although specific anatomic regions and pathologies differ, the surgical techniques remain constant. The surgeon must appreciate typical peripheral nerve anatomy, while allowing for anatomic variations. Upper extremity surgeries also require careful handling of soft tissue and dissection along peripheral nerves, intraoperative nerve stimulation, cautious measuring of nerve lengths, and confirmation of nerve identity prior to division. With strict adherence to these techniques and principles, peripheral nerve surgery on the upper extremity can be achieved in a safe and successful fashion.