ABSTRACT
Musculoskeletal complaints are among the most common encounters seen by primary care providers (PCPs), with pain being a principal chief complaint. As nearly all pain is transmitted from the peripheral to the central nervous system for interpretation by the brain through nerves, it is critical that the PCP understand the anatomy and function of working nervous system pathways. The nerve represents a unique bundle of axons that through a complex electrochemical process facilitates both voluntary and involuntary action. As the nerve anatomically extends throughout the axial and appendicular skeleton, and in many cases is quite super- cial, this tissue is vulnerable and can be injured through both overuse and acute trauma. In addition, nerve tissue can be injured by neoplastic, infectious, autoimmune, and idiopathic etiologies. Therefore, the PCP must carefully evaluate the patient’s complaint to identify the pain generator in order to facilitate appropriate treatment. An adequate history and physical exam are essential in distinguishing nerve injuries and are pivotal in localizing the lesion. Advanced imaging and ancillary testing may also assist in accurate diagnosis
when properly employed and interpreted. Since some nerve injuries require urgent surgical referral for treatment, it is important to recognize and diagnose various nerve injuries in a timely manner to avoid signicant long-term disability, especially in older patients with severe pain and brachial plexus injuries.11 This chapter reviews the anatomy and function of the peripheral nerve, identies common pathologic terminology, and concludes with an introduction to evaluation and management. Detailed assessment and management of specic nerve injuries are discussed in the appropriate musculoskeletal chapter (Table 12.1).
