Electrical injury of the upper extremity requires mature management because the extremity can usually be preserved if the point of entrance (or contact) is on the dorsum of the arm. The converse is usually true if the contact is on the palmar-volar aspect of the hand and wrist, for significant loss of nerves, blood vessels and tendons occurs. Early amputation must be considered in this situation. The pathophysiology of these injuries is discussed along with a plan of management for functional return of the upper extremity.