Sensory protection to enhance functional recovery following proximal nerve injuries: current trends

Proximal nerve injury can lead to devastating functional impairment. Because axonal regeneration is slow, timely reinnervation of denervated muscle does not occur. These denervated muscles atrophy and lose function. Sensory protection is a surgical technique thought to prevent denervated muscle impairment using local sensory nerves to provide trophic support to the muscle until motor nerves can regenerate, and neuromuscular junctions are reestablished. We performed a comprehensive literature search using multiple databases to find primary articles reporting on the outcomes and treatment of sensory protection. This paper reviews the three main approaches to sensory protection: (1) end-to-end neurorrhaphy, (2) end-to-side neurorrhaphy, and (3) direct muscle neurotization. It discusses the evidence supporting each technique and outlines goals for future investigations.