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Trauma to peripheral nerves is relatively common. The most common injury is from blunt trauma or from penetrating missiles, such as bullets or other objects. In the vast majority of gunshot wounds, the nerve is not divided. Occasionally, a complete or partial transection of the nerve develops. In 1978, Luce and Griffin reported that approximately 50% of nerve deficits after high-velocity shotgun injuries to the upper extremity involve complete transection. Injuries from stab wounds or foreign bodies (eg, glass, sheet metal) resulting in clean lacerations of nerves are not common. However, this form of injury is significant because it presents an opportunity for primary repair of a peripheral nerve immediately after an injury.

Nerve injury can be associated with fractures and fracture-dislocations. The probability of nerve injury is doubled with fracture associated with shoulder dislocation. Approximately 95% of peripheral nerve injuries associated with a fracture occur in the upper extremity. The most common form is radial nerve injuries associated with humeral fractures. The most common injury resulting from dislocations or fracture-dislocation of the elbow seems to be ulnar nerve neurapraxia, which spontaneously resolves after a closed reduction. Radial nerve palsy after fracture of the humerus is the most common nerve lesion in long bone fractures.

The average incidence of radial nerve lesions is approximately 11%. Most reported series of radial nerve lesions are associated with fractures of the middle third of the humerus. A review of the literature demonstrated that 60% of radial nerve lesions were found in midshaft fractures and that 28% were found in fractures in the distal one third. However, in 1981, Pollack et al (and others in 1983) reported that 63% of radial nerve lesions were found in fractures of the distal one third of the humerus.

The reported incidence rate of nerve injury with supracondylar fractures in children ranges from 12-16%. Posterior, medially displaced fractures are more likely to be associated with neural compromise. Several studies suggest that 86-100% of these injuries are neurapraxias. A greater incidence of high-grade nerve injuries occurs with open fractures. In 1993, Foster et al found that in 64% of open humeral shaft fractures, nerves were either lacerated or interposed between fracture fragments.

Neural injury is more common with dislocations, which result in stretch injuries to the nerve, occurring in 18% or more of knee dislocations and more than 13% of posterior hip dislocations.3 Nerve injury is common in dislocations of the shoulder, with an incidence rate of 48%.

In 1967, Bado reported a 20% incidence rate of radial nerve palsy with lateral radial head dislocations. A 34% risk of nerve injury exists with isolated greater tuberosity fracture dislocation. The literature reveals that in nerve injury from traumatic dislocation and fracture-dislocation of the hip, the incidence rate is approximately 10% in adults and 5% in children. A possible explanation for the low incidence of nerve injury in children is that younger children are more susceptible to dislocation after relatively low-energy trauma. However, in high-energy trauma (eg, motor vehicle accidents), considerably higher incidence of nerve injury would be reported in children. Axonal loss in anterior dislocation of the shoulder was observed in 48% of 77 patients. Of these patients, 51% had a solitary nerve lesion and the axillary nerve was involved most frequently in 42% of the patients.

Upper extremity nerve injury commonly results from impact to the neck and shoulder. One such injury, a burner (also called a stinger), is characterized by pain that radiates down one upper extremity. Numbness, paresthesias, or weakness can develop and commonly recur, leading to further disability and occasionally chronic syndromes. Burners are usually brief and self-limited, although recovery can take weeks or months in some cases.

Iatrogenic etiology is another possible cause of injury. The incidence of nerve injuries varies from 1-10% in patients with closed forearm fractures treated by plating. However, determining whether the injury resulted from fracture or operative intervention often is difficult. The reviews by Small in 1988 and the Arthroscopy Association of America in 1986 have demonstrated a low incidence of nerve injury after shoulder arthroscopy. Associated trauma can increase the probability of nerve injury. For example, a hematoma formation at the site of injury increases the probability of nerve injury 4.4-fold. The sex of the individual, the cause of trauma, the position of the arm during the fall, the side of the body on which the injury occurs, dominance of the right or left side, the presence of diabetes mellitus, or the use of an anticoagulant does not influence the frequency of nerve damage.