Peripheral Nerve and Brachial Plexus Injuries — Classification, Diagnosis, and Surgical Strategy

This episode reviews the core principles of peripheral nerve injuries and brachial plexus pathology, focusing on nerve microanatomy, injury classification, diagnosis, and surgical strategy.Topics include the structure of peripheral nerves, including the axon, endoneurium, perineurium, epineurium, Schwann cells, nodes of Ranvier, and vasa nervorum. The episode also explains Wallerian degeneration, bands of Büngner, and the critical principle that nerve regeneration occurs at approximately 1 mm per day.Injury severity is reviewed using the Seddon, Sunderland, and McKinnon classifications, with emphasis on neuropraxia, axonotmesis, neurotmesis, neuroma in continuity, and mixed sixth-degree injuries. The episode also covers brachial plexus anatomy using roots, trunks, divisions, cords, and terminal branches, including key clinical patterns such as Erb’s palsy, Klumpke’s palsy, and flail arm.Diagnostic and surgical decision-making focuses on pre-ganglionic vs post-ganglionic injuries, SNAPs, Horner syndrome, EMG timing, pseudomeningocele, advancing vs fixed Tinel’s sign, and timing of exploration. Surgical strategies include primary neurorrhaphy, nerve grafting, nerve transfers, and the reconstructive priority of restoring elbow flexion, then shoulder stability, then hand function.Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsperipheral nerve injury, brachial plexus injury, nerve regeneration, Wallerian degeneration, bands of Büngner, Schwann cells, Seddon classification, Sunderland classification, McKinnon classification, neuropraxia, axonotmesis, neurotmesis, neuroma in continuity, Erb palsy, Klumpke palsy, flail arm, preganglionic injury, postganglionic injury, root avulsion, SNAPs, Horner syndrome, pseudomeningocele, EMG timing, Tinel sign, nerve grafting, sural nerve graft, nerve transfer, obstetric brachial plexus palsy, Narakas classification