'Think nerve' in upper extremity reconstruction

Upper extremity reconstruction may be greatly facilitated by 'thinking nerve' in the initial evaluation. Frequently, the obvious soft tissue deformity or bone or joint pathology distracts the reconstructive surgeon from an underlying nerve problem. When pain is a portion of the presenting complaints, thinking nerve becomes more obvious. This article attempts to direct the reconstructive surgeon approaching the upper extremity to look for underlying nerve injury in the region of a damaged wrist capsule, neuromas of the cutaneous nerve, and sites of nerve entrapment.