Numerous methods exist to assess hand and arm function after upper extremity peripheral nerve injury, but peripheral injuries are often unilateral, and few existing methods are designed to capture the unique consequences of unilateral injury. Unilateral impairment of an upper extremity can lead to increased or decreased use of the dominant hand, and either change may be adaptive or maladaptive depending on the individual patient's needs. To identify atypical hand usage (left/right choices), researchers and clinicians need to measure it. However, hand usage is traditionally assessed with self-report surveys, which do not necessarily reflect actual left/right-hand choices. Here, this gap in knowledge is addressed with the Block Building Task (BBT), which provides a rapid, quantitative, inexpensive assessment of left/right-hand choices in an unconstrained environment. In the BBT, participants build abstract shapes with interlocking plastic bricks, with no instructions about hand usage. The primary outcome is the fraction of reaches (i.e., for the initial pickup of each brick) made with each hand. After unilateral peripheral nerve injury, patients fell into three clusters: approximately typical hand use (44%), always use the dominant hand (44%), or never use the dominant hand (13%). Even among patients with an injured dominant hand, atypically elevated use of the dominant hand occurred regularly (36%). Notably, hand usage was not predicted by clinical characteristics, so the BBT provides an objective measurement of left/right-hand choices that are not otherwise predictable from the clinical characteristics of patients with peripheral nerve injury. The BBT protocol will be of interest to researchers or clinicians interested in the assessment of conditions with asymmetric effects on the upper limb.