Acute nerve injuries in the hand are common. Mechanisms of injury vary and include sharp transection, direct and indirect blunt trauma resulting in contusions and traction injuries respectively, ischaemic and compression injuries and chemical, thermal or electrical injury. Sharp, penetrating injuries are the most common, with patients typically presenting after a laceration with glass or a knife. Both blunt and sharp injuries can be associated with bony injuries as well as injury to the vascular and tendinous structures. The management principles of nerve injuries in the hand follow those of nerve injuries elsewhere, however the distal nature of the injuries often means that some treatment strategies are less applicable. In this article we will discuss the basic structure of nerves as well as the anatomy of the peripheral nerves in the hand, followed by the treatment strategies that can be employed to address acute nerve injuries in the hand.