Peripheral nerve injuries affecting the hand and upper extremities are prevalent and can lead to significant functional impairments. While not every case of peripheral nerve injury allows for surgical intervention, a comprehensive understanding of the biomechanical principles underlying nerve repair can significantly enhance the chances of successful recovery. This chapter focuses on the various mechanisms that can cause nerve injury, such as laceration, crush injuries, and ballistic trauma, each presenting unique challenges for repair. In addition, the text offers a concise overview of the historical advancements in biomechanical techniques for nerve repair, shedding light on how these innovations have paved the way for modern practices. The core biomechanical principles essential for effective nerve repair are thoroughly reviewed, emphasizing their importance in achieving optimal outcomes. The chapter explores a range of nerve repair constructs and introduces new technologies that push the boundaries of what’s possible in nerve repair. From piezoelectric scaffolds that generate electrical stimulation to encourage nerve regeneration to topological designs that mimic natural nerve pathways to enhance healing, these diverse approaches showcase the ongoing evolution and innovation in the field of nerve repair, inspiring hope for the future.