Age-Related Effects on Peripheral Nerve Regeneration

• Published in: The Journal of hand surgery (American ed.)
• Main Authors: Porche, Ken M., Spinner, Robert J., Bishop, Allen T., Pulos, Nicholas, Shin, AlexanderY
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 16.08.2025
• Subjects: Age; nerve regeneration; Orthopedics; outcomes; peripheral nerve; nerve regeneration; outcomes; peripheral nerve; Age
• ISSN: 0363-5023; 1531-6564; 1531-6564
• DOI: 10.1016/j.jhsa.2025.07.013

Age considerably influences peripheral nerve regeneration, affecting outcomes after surgical repair of nerve injuries, particularly brachial plexus injuries. Historically, older patients were considered poor candidates for nerve reconstruction because of diminished regenerative capacity and reduced functional recovery. However, advances in surgical techniques, especially the use of nerve transfers, have led to meaningful functional improvements in patients >50 years of age. This review summarizes the current understanding of how aging affects nerve regeneration at cellular, molecular, and functional levels and provides evidence-based recommendations for managing brachial plexus injuries in older adults. Optimal outcomes in older patients are associated with early surgical intervention, strategic use of nerve transfers to shorten regeneration distances, and realistic patient expectations. Surgeons should consider age-related biological constraints while recognizing opportunities for considerable functional restoration using modern reconstructive strategies.