njuries to peripheral nerves are extremely common in many types of upper limb trauma. Injury to peripheral nerves can cause extreme dysfunction in the hand for the patient disrupting their professional and leisure activities. It is therefore vital that adequate treatment is available to repair peripheral nerves to prevent permanent financial loss for the patient as well as the healthcare economy. Galen was the first to describe the concept of the nerve but it was Paulus Aegineta in the 7th century who documented the first nerve repair and wound closure as a military surgeon. Since this time immense research has taken place to understand nerve pathology and physiology. Currently surgical repair involves either reconstruction with direct end-to-end anastomosis or by the insertion of nerve grafts. Despite the long history and major microsurgical research and improvement peripheral nerve repair remains a challenge to surgeons and still has suboptimal outcomes. This review aims to discuss the pathophysiology of nerve injuries including the limitations of surgical repair at a biological level. We will subsequently describe the current techniques, problems and advances in the surgical management of nerve injuries.