Research Article| Volume 1, ISSUE 1, P52-66, July 1976

Download started.


Electrophysiological recordings in peripheral nerve surgery: A review

      This paper is only available as a PDF. To read, Please Download here.
      The use of electrophysiological techniques as an adjunct in the surgical repair of peripheral nerve injuries can improve the quality of the repair and thus the degree of functional recovery. These techniques provide objective information needed to assess the degree of injury and can assist the surgeon in making proper decisions regarding treatment of peripheral nerve lesions. The purposes of this paper are to review: (1) the current theories of the functions of peripheral nerves and their end organs, (2) the development of electrophysiological techniques, (3) the principles involved in their use, and (4) the present and possible future applications of these techniques in peripheral nerve surgery and to outline them.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Key A.
        • Retzius G.
        Studien in der Anatomie des Nervensystems und des Bindgewebes. Vol. 2. Samson and Wallin, Stockholm1976
        • Shanthaveerappa T.R.
        • Bourne G.H.
        The (25 p) is inserted percutaneously in a peripheral tie receptive fields of the recorded sensory units “perineural epithelium,” a metabolically active, continuous, protoplasmic cell barrier surrounding peripheral nerve fasciculi.
        J. Anat. 1962; 96: 527
        • Sunderland S.
        • Bradley K.C.
        The perineurium of peripheral nerves.
        Anat. Rec. 1952; 113: 125
        • Williams P.L.
        • Warwick R.
        (1975) Functional neuroanatomy of man. W. B. Saunders Company, Philadelphia1975
        • Sunderland S.
        The effect of rupture of the perineurium on the contained nerve fibers.
        Brain. 1946; 69: 149
        • Spencer P.S.
        • Weinberg H.J.
        • Raine C.S.
        • et al.
        The perineurial window—a new model of focal demyelination and remyelination.
        Brain Res. 1975; 96: 323
        • Smith J.W.
        Microsurgery of peripheral nerves.
        Plast. Reconstr. Surg. 1964; 33: 317
        • Michon J.
        Technique et resultats de la reparation des plaies des nerfs median et cubital.
        Rev. Chir. Orthop. 1966; 52: 582
        • Bora Jr., F.W.
        • Smith J.W.
        The repair of divided peripheral nerves with the fascicular stitch.
        J. Bone Joint Surg. 1967; 49-A: 575
        • Ito T.
        • Hirotani H.
        • Goto Y.
        • et al.
        : Therapy of peripheral nerve injuries by funicular suture (in Japanese).
        Orthop. Surg. (Tokyo). 1968; 19: 187
        • Ramon y Cajal S.
        Degeneration and regeneration of the nervous system. Vol. 1. Oxford University Press, London1928
        • Williams P.L.
        • Hall S.M.
        In vivo observations on mature myelinated nerve fibres of the mouse.
        J. Anat. 1970; 107: 31
        • Young J.Z.
        The history of the shape of a nerve fibre.
        in: LeGros Clark W.E. Medawar P.B. Essays on growth and form. Clarendon Press, Oxford1945: 41-94
        • Gutmann E.
        • Sanders F.K.
        Recovery of fibre numbers and diameters in the regeneration of peripheral nerves.
        J. Physiol. 1943; 101: 489
        • Bradley W.G.
        Disorders of peripheral nerves. Blackwell Scientific Publications, London1974
        • Spencer P.S.
        The morphology of injured peripheral nerve.
        in: Daniel R.K. Terzis J. Microsurgery, Boston. Little, Brown & Company, 1976
        • Hodgkin A.L.
        The conduction of the nervous impulse. Charles C Thomas, Publisher, Springfield, Ill.1964
        • Mountcastle V.B.
        Sensory receptors and neural encoding: Introduction to sensory processes.
        Medical physiology. Vol. 1. The C. V. Mosby Company, St. Louis1974: 285-306 (Chap. 9)
        • Boyd I.A.
        • Davey M.R.
        Composition of peripheral nerves. E. & S. Livingstone, Ltd., Edinburgh and London1968
        • Eyzaguirre C.
        • Fidone S.J.
        Physiology of the nervous system. ed. 2. Year Book Medical Publishers, Inc., Chicago1975
        • Feinstein B.
        • Lindegard B.
        • Nyman E.
        • et al.
        Morphologic studies of motor units in normal human muscles.
        Acta Anat. 1955; 23: 127
        • Matthews P.B.C.
        Muscle spindles and their motor control.
        Physiol. Rev. 1964; 44: 219
        • Sinclair D.C.
        Cutaneous sensation and the doctrine of specific energy.
        Brain. 1955; 78: 584
        • Burgess P.R.
        Patterns of discharge evoked in cutaneous nerves and their significance for sensation.
        in: Bonica J.J. Advances in neurology. Vol. 4. Raven Press, New York1974: 11-18
        • Petit D.
        • Burgess P.R.
        Dorsal column projection of receptors in cat hairy skin supplied by myelinated fibers.
        J. Neurophysiol. 1968; 31: 849
        • Boring E.G.
        Sensation and perception in the history of experimental psychology. Appleton-Century- Crofts, Inc., New York1942
        • Muller J.
        Herrnstein R.J. Boring E.G. A source book in the history of psychology. Harvard University Press, Cambridge1966: 26-29
        • Sinclair D.
        Cutaneous sensation. Oxford University Press, London1967
        • Von Frey M.
        The distribution of afferent nerves in the skin.
        J. A. M. A. 1906; 47: 645
        • Head H.
        The afferent nervous system from a new aspect.
        Brain. 1905; 28: 99
        • Nafe J.P.
        The psychology of felt experience.
        Am. J. Psychol. 1927; 39: 367
        • Melzack R.
        • Wall P.D.
        On the nature of cutaneous sensory mechanisms.
        Brain. 1962; 85: 331
        • Munger B.L.
        Patterns of organization of peripheral sensory receptors.
        in: Loewenstein W.R. Handbook of sensory physiology. Springer-Verlag, Berlin1971: 523-556
        • Munger B.L.
        The intraepidermal innervation of the snout skin of the opossum.
        J. Cell Biol. 1965; 26: 79
        • Winkelmann R.K.
        • Breathnach A.S.
        The Merkel cell.
        J. Invest. Dermatol. 1973; 60: 2
        • Iggo A.
        An electrophysiological analysis of afferent fibres in primate skin.
        Acta Neurovegetativa. 1962; 24: 175
        • Iggo A.
        New specific sensory structures in hairy skin.
        Acta Neurovegetativa. 1962; 24: 225
        • Chambers M.R.
        • Andres K.H.
        • von During M.
        • et al.
        : The structure and function of the slowly adapting type II mechanoreceptor in hairy skin.
        Q. J. Exp. Physiol. 1972; 57: 417
        • Merzenich M.M.
        Some observations on the encoding of somesthetic stimuli by receptor populations in the hairy skin of primates. Johns Hopkins University, Baltimore1968 (Ph.D. thesis)
        • Mountcastle V.B.
        The problem of sensing and the neural coding of sensory events.
        in: Quarton G.C. Melnechuk T. Schmitt F.O. The neurosciences. Rockefeller University Press, New York1967: 393-408
        • Andres K.H.
        • von During M.
        Morphology of cutaneous receptors.
        in: Iggo A. Handbook of sensory physiology. Vol. 2. Springer-Verlag, New York1973: 3-28
        • Burgress P.R.
        • Petit D.
        • Warren R.M.
        Receptor types in cat hairy skin supplied by myelinated fibers.
        J. Neurophysiol. 1968; 31: 833
        • Merzenich M.M.
        • Harrington T.
        The sense of flutter-vibration evoked by stimulation of the hairy skin of primates: Comparison of human sensory capacity with the responses of mechanoreceptive afferents innervating the hairy skin of monkeys.
        Exp. Brain Res. 1969; 9: 236
        • Loewenstein W.R.
        • Mendelson M.
        Components of receptor adaptation in a Pacinian corpuscle.
        J. Physiol. 1965; 177: 377
        • Dastur D.K.
        Cutaneous nerves in leprosy. The relationship between histopathology and cutaneous sensibility.
        Brain. 1955; 78: 615
        • Talbot W.H.
        • Darian-Smith I.
        • Kornhuber H.H.
        • et al.
        : The sense of flutter-vibration: Comparison of the human capacity with response patterns of mechanoreceptive afferents from the monkey hand.
        J. Neurophysiol. 1968; 31: 301
        • Burgess P.R.
        • Perl E.R.
        Cutaneous mechanoreceptors and nociceptors.
        in: Iggo A. Handbook of sensory physiology. Vol. 2. Springer-Verlag, New York1973: 30-78
        • Macintosh S.R.
        Observations on the structure and innervation of the rat snout.
        J. Anat. 1975; 119: 537
        • Hensel H.
        Cutaneous thermoreceptors.
        in: Iggo A. Handbook of sensory physiology. Vol. 2. Springer-Verlag, New York1973: 79-110 (Chap. 3.)
        • Barker D
        Symposium on muscle receptors. Hong Kong University Press, Hong Kong1962
        • Merrillees N.C.R.
        The fine structure of muscle spindles in the lumbrical muscles of the rat.
        J. Biophys. Biochem. Cytol. 1960; 7: 725
        • Barker D.
        The innervation of mammalian skeletal muscle.
        in: deReuck V. S Knight J. Myotatic, kinesthetic, and vestibular mechanisms. Little, Brown & Company, Boston1967: 3-15
        • Matthews P.B.C.
        Mammalian muscle receptors and their central actions. Edward Arnold (Publishers) Ltd., London1972
        • Henneman E.
        Peripheral mechanisms involved in the control of muscle.
        in: Mountcastle V.B. Medical physiology. ed. 13. The C. V. Mosby Company, St. Louis1974: 617-635 (Chap. 22)
        • Landau W.M.
        The duration of neuro muscular function after nerve section in man.
        J. Neurosurg. 1953; 10: 64
        • Gilliatt R.W.
        Recent advances in the pathophysiology of nerve conduction.
        in: Desmedt J.E. New developments in electromyography and clinical neurophysiology. S. Karger, Basel1973: 2-18
        • Bowden R.E.M.
        • Gutmann E.
        Denervation and reinnervation of human voluntary muscle.
        Brain. 1944; 67: 273
        • Gutmann E.
        Histology of degeneration and regeneration.
        in: Licht S. Electrodiagnosis and electrotherapy. E. Licht, Publisher, New Haven, Conn.1961 (Chap. 4)
        • Dellon A.L.
        • Witebsky F.G.
        • Terrill R.E.
        The denervated Meissner corpuscle: A sequential histological study after nerve division in the rhesus monkey.
        Plast. Reconstr. Surg. 1975; 56: 182
        • Aguilar C.E.
        • Bisby M.A.
        • Cooper E.
        • et al.
        Evidence that axoplasmic transport of trophic factors is involved in the regulation of peripheral nerve fields in salamanders.
        J. Physiol. 1973; 234: 449
        • Cooper E.
        • Diamond J.
        • Maclntyre L.
        • et al.
        Control of collateral sprouting in mechanosensory nerves of salamander skin.
        J. Physiol. 1975; 249: 21P
        • Ducker T.B.
        Metabolic factors in surgery of peripheral nerves.
        Surg. Clin. North Am. 1972; 52: 1109
        • Brattgard S.O.
        • Edstrom J.E.
        • Hyden H.
        The productive capacity of the neuron in retrograde reaction.
        Exp. Cell. Res. 1958; 5: 185
        • Guth L.
        Regeneration in the mammalian peripheral nervous system.
        Physiol. Rev. 1956; 36: 441
        • Hudson A.
        • Morris J.
        • Weddell G.
        An electron microscopic study of regeneration in sutured rat sciatic nerves.
        Surg. Forum. 1970; 21: 451
        • Barton A.A.
        An electron microscope study of degeneration and regeneration of nerve.
        Brain. 1962; 85: 799
        • Holmes W.
        • Young J.Z.
        Nerve regeneration after immediate,and delayed suture.
        J. Anat. 1942-43; 77: 63
        • Guth L.
        “Trophic” influences of nerve on muscle.
        Physiol. Rev. 1968; 48: 645
        • Guth L.
        • Yellin H.
        The dynamic nature of the socalled “fiber types” of mammalian skeletal muscle.
        Exp. Neurol. 1971; 31: 277
        • Yellin H.
        Limitations to the neuroregulation of enzymes in mammalian skeletal muscle.
        Anat. Rec. 1975; 182: 479
        • Ridley A.
        A biopsy study of the innervation of forearm skin grafted to the fingertip.
        Brain. 1970; 93: 547
        • Cass D.T.
        • Mark R.F.
        Reinnervation of axolotl limbs. I. Motor nerves.
        Proc. R. Soc. Lond. 1975; 190: 45
        • Johnston B.T.
        • Schrameck J.E.
        • Mark R.F.
        Reinnervation of axolotl limbs. II. Sensory nerves.
        Proc. R. Soc. Lond. 1975; 190: 59
        • Sperry R.W.
        The problem of central nervous reorganization after nerve regeneration and muscle transposition.
        Q. Rev. Biol. 1945; 20: 311
        • Guth L.
        Axonal regeneration and functional plasticity in the central nervous system.
        Exp. Neurol. 1974; 45: 606
        • Sunderland S.
        Nerves and nerve injuries. E. & S. Livingstone, Ltd., London1968
        • Erlanger J.
        • Gasser H.S.
        Electrica signs of nervous activity. University of Pennsylvania Press, Philadelphia1937
        • Brindley F.J.
        Excitation and conduction in nerve fibres.
        in: Mountcastle V.B. Medical physiology. Vol. 1. The C. V. Mosby Company, St. Louis1974: 34-76 (Chap. 2)
        • Iggo A.
        Electrophysiological and histological studies of cutaneous mechanoreceptors.
        in: Kenshalo D.R. The skin senses. The Charles C Thomas Company, Springfield, Ill.1969: 84-106
        • Marinacci A.A.
        The problem of unusual anomalous innervation of hand muscles.
        Bull. Los Angles Neurol. Soc. 1964; 29: 133
        • Marinacci A.A.
        Diagnosis of “all median hand,”.
        Bull. Los Angeles Neurol. Soc. 1964; 29: 191
        • Hursch J.B.
        Conduction velocity and diameter of nerve fibres.
        Am. J. Physiol. 1939; 127: 131
        • Licht S.
        History of electrodiagnosis.
        Electrodiagnosis and electrotherapy. Chap. 1, ed. 2. E. Licht, Publisher, New Haven, Conn.1961
        • Howard F.M.
        The electromyogram and conduction velocity studies in peripheral nerve trauma.
        Clinical neurology. Proceedings of Congress of Neurological Surgeons. The Williams & Wilkins Company, Boston1970 (Chap. 5)
        • Hodes R.
        • Larrabee M.G.
        • German W.
        The human electromyogram in response to nerve stimulation and the conduction velocity of motor axons.
        Arch. Neurol. Psychiatry. 1948; 60: 340
        • Gilliatt R.W.
        Nerve conduction: Motor and sensory.
        in: Licht S. Electrodiagnosis and electrotherapy. Chap. 14, ed. 2. E. Licht, Publisher, New Haven, Conn1961: 385-411
        • Dawson G.D.
        • Scott J.W.
        The recording of nerve action potentials through skin in man.
        J. Neurol. Neurosurg. Psychiatry. 1949; 12: 259
        • Dawson G.D.
        The relative excitability and conduction velocity of sensory and motor nerve fibres in man.
        J. Physiol. 1956; 131: 436
        • Buchthal F.
        • Rosenfalck A.
        Evoked action potentials and conduction velocity in human sensory nerves.
        Brain Res. 1966; 3: 1
        • Buchthal F.
        • Rosenfalck A.
        Sensory potentials in polyneuropathy.
        Brain. 1971; 94: 241
        • Ballantyne J.P.
        • Campbell M.J.
        Electrophysiological study after surgical repair of sectioned human peripheral nerves.
        J. Neurol. Neurosurg. Psychiatry. 1973; 36: 797
        • Veale J.L.
        • Mark R.F.
        • Rees S.
        Differential sensitivity of motor and sensory fibres in human ulnar nerve.
        J. Neurol. Neurosurg. Psychiatry. 1973; 36: 75
        • Kline D.G.
        Early evaluation of peripheral nerve lesions in continuity with a note on nerve recording.
        Am. Surg. 1968; 34: 77
        • Kline D.G.
        • DeJonge B.R.
        Evoked potentials to evaluate peripheral nerve injuries.
        Surg. Gynecol. Obstet. 1968; 127: 1239
        • Kline D.G.
        • Hackett E.R.
        • May P.R.
        Evaluation of nerve injuries by evoked potentials and electromyography.
        J. Neurosurg. 1969; 31: 128
        • Vanderark G.D.
        • Meyer G.A.
        • Kline D.G.
        • et al.
        Peripheral nerve injuries studied by evoked potential recordings.
        Milit. Med. 1970; 135: 90
        • Kline D.G.
        • Nulsen F.E.
        The neuroma in continuity: Its preoperative and operative management.
        Surg. Clinics North Am. 1972; 52: 1189
        • Kline D.G.
        • Hackett E.R.
        Value of electrophysiologic tests for peripheral nerve neuromas.
        J. Surg. Oncol. 1970; 2: 299
        • Kline D.G.
        Operative management of major nerve lesions of the lower extremity.
        Surg. Clin. North Am. 1972; 52: 1247
        • Kline D.G.
        • Hackett E.R.
        • May P.R.
        Electrophysiological studies of fractional nerve injuries.
        Curr. Top. Surg. Res. 1970; 2: 205
        • Kline D.G.
        • Hackett E.R.
        • May P.R.
        Partial nerve laceration evaluated by evoked potentials.
        J. Surg. Res. 1970; 10: 81
        • Hakstian R.W.
        Funicular orientation by direct stimulation. An aid to peripheral nerve repair.
        J. Bone Joint Surg. 1968; 50A: 1178
        • Vandeputt J.
        • Tanner J.C.
        • Huypens L.
        Electrophysiological orientation of the cut ends in primary peripheral nerve repair.
        Plast. Reconstr. Surg. 1969; 44: 378
        • Williams H.B.
        • Terzis J
        Single fascicular recordings: An intraoperative diagnostic tool for the management of peripheral nerve lesions.
        Plast. Reconstr. Surg. May, 1976; 57
      1. Terzis, J.: Functional aspects of reinnervation of free skin grafts. Submitted for publication.

        • Terzis J.
        • Williams H.B.
        Functional aspects of reinnervation of skin grafts.
        Surg. Forum. 1974; 25: 518
        • Terzis J.
        Sensory mapping.
        in: Entin M. Clinics in plastic surgery. W. B. Saunders Company, Philadelphia1976
        • Daniel R.K.
        • Terzis J.
        • Schwarz G.
        Neurovascular free flaps. A preliminary report.
        Plast. Reconstr. Surg. 1975; 56: 13
        • Daniel R.K.
        • Terzis J.
        • Midgley R.
        Restoration of sensation to an anesthetic hand by a free neurovascular flap from the foot.
        Plast. Reconstr. Surg. 1976; 57: 275
      2. Daniel, R. K., Terzis, J., and Cunningham, D.: Sensory skin flaps for pressure sore in paraplegic patients, Plast. Reconstr. Surg. In press.

        • Hensel H.
        • Boman K.A.
        Afferent impulses in cutaneous sensory nerves in human subjects.
        J. Neurophysiol. 1960; 23: 564
        • Vallbo A.B.
        • Hagbarth K. -E.
        Activity from skin mechanoreceptors recorded percutaneously in awake human subjects.
        Exp. Neurol. 1968; 21: 270
        • Hagbarth K. -E.
        • Vallbo A.B.
        Discharge characteristics of human muscle afferents during muscle stretch and contraction.
        Exp. Neurol. 1968; 22: 674
        • Torebjork H.E.
        • Hallin R.G.
        C-fibre units recorded from human sensory nerve fascicles in situ. A preliminary report.
        Acta Soc. Medicorum Upsaliensis. 1970; 75: 81
        • Van Hees J.
        • Gybels J.M.
        Pain related to single afferent C fibers from human skin.
        Brain Res. 1972; 48: 397
        • Torebjork H.E.
        Afferent C units responding to mechanical, thermal and chemical stimuli in human nonglabrous skin.
        Acta Physiol. Scand. 1974; 92: 374
        • Torebjork H.E.
        • Hallin R.G.
        Identification of afferent C units in intact human skin nerves.
        Brain Res. 1974; 67: 387
        • Konietzny F.
        • Hensel H.
        Warm fiber activity in human skin nerves.
        Pfluegers Arch. 1975; 359: 265
        • Ramon y Cajal S.
        Histologic du systeme nerveaux de l'homme et des vertebres, Madrid. Instituto Ramon y Cajal, 1952
        • Skoglund S.
        Joint receptors and kinaesthesis.
        in: Iggo A. Handbook of sensory physiology. Vol. 2. Springer-Verlag, New York1973: 111-136 (Chap. 4)
        • Sunderland S.
        The intraneural topography of the radial, median and ulnar nerves.
        Brain. 1945; 68: 243