Maria Lua Sampaio de Lira Gulde

Peripheral neuropathy in athletes is increasingly recognized as a significant source of morbidity, with injury patterns varying according to the biomechanical demands of specific sports. Although peripheral nerve disorders in athletes may result from acute trauma, they more commonly arise from chronic, repetitive mechanical stress inherent to athletic activity. Despite their frequency, they frequently remain underdiagnosed, as clinical manifestations often overlap with other musculoskeletal disorders. Mechanisms of injury include compression, traction, laceration, ischemia, and repetitive microtrauma. Distinct athletic modalities are associated with characteristic neuropathies reflecting sport-specific kinematics and loading patterns. Awareness of these biomechanical factors and recognition of typical clinical presentations are essential for accurate assessment of athletes with suspected nerve injury. Diagnostic evaluation frequently requires advanced imaging modalities, particularly magnetic resonance neurography (MRN) and high-resolution ultrasound (HRUS), which enable detailed structural assessment of peripheral nerves and detection of secondary imaging findings. Electrodiagnostic studies may provide complementary functional information in selected cases. Early and precise diagnosis is critical to guide management, facilitate safe return to sport, and prevent long-term functional deficits. While most nerve disorders respond to conservative treatment, severe, progressive, or refractory cases may warrant surgical intervention to restore function and enable return to play (RTP). This review examines mechanisms of injury, clinical evaluation, classification systems, imaging findings, and sport-specific patterns of peripheral nerve injury across diverse athletic disciplines.

With the advent of high-resolution imaging techniques, advanced fat and vascular suppression methods, and three-dimensional isotropic acquisitions, MR neurography of fine-caliber nerves has become an indispensable tool in assessment of peripheral neuropathies, but successful imaging requires protocol planning, appropriate coil selection, and a thorough understanding of complex nerve anatomy.