During surgery, there is a risk that a nerve may be unintentionally damaged. This can occur due to prolonged retraction(when tissues are held back to improve access), accidental cutting, or the nerve becoming trapped within a joint or fracture. Additionally, nerves may be affected by secondary indirect effects, such as swelling, scarring, or compression of surrounding tissues, which can cause issues even if the nerve is not directly injured. Changes in local anatomy after surgery can also lead to nerve tethering, where the nerve becomes stuck or restricted in its movement, further complicating recovery.
The possibility of nerve injury following surgery is understandably distressing for both the patient and the surgeon. For the patient, this may result in pain, numbness, weakness, or difficulty with movement. For the surgeon, it is a challenging and unfortunate complication despite the best of care. However, if a nerve injury or secondary effect like tethering occurs, there are treatment options available to manage symptoms, promote healing, and, in some cases, restore function. Early recognition and a multidisciplinary approach are key to achieving the best possible outcomes.
Some clinical examples:
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Lymph node biopsy at the neck
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Spinal accessory nerve
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Drooped and painful shoulder
Scapular winging
Restricted movement (abduction)
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Shoulder plating or replacement
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Axillary nerve
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Loss of deltoid contraction
Numbness over the regimental badge
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Humeral plating
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Radial nerve
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Wrist drop
Numbness over the back of hand
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Elbow surgery
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Ulnar nerve
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Clawed ring and little fingers
Clumsy hand
Hollowness in hand due to wasting of muscles
Numbness of ring and little fingers
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Distal biceps repair
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Posterior interosseous nerve
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Dropped fingers and thumb at the knuckles
Deviated wrist extension
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Distal radius plating
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Palmar cutaneous nerve of median nerve
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Numbness and pain over the base of thumb
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Hip replacement
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Sciatic nerve
(CPN component)
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Foot drop
Numbness over the back of foot
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Knee surgery
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Common peroneal nerve
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Foot drop
Numbness over the back of foot
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Ankle surgery
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Superficial peroneal nerve
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Numbness and pain over the back of foot
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The spectrum of nerve injury can range from a mild lesion, where there is a transient loss of function that recovers spontaneously, to the most severe cases, where no recovery is possible without surgical nerve repair. In many cases, the injury is mixed, with varying degrees of severity affecting different parts of the nerve.
Transient tingling is not uncommon after surgery, particularly in the limbs, and may be caused by postoperative swelling or the prolonged use of a tourniquet. While some symptoms can be closely monitored to see if they resolve on their own, there are certain signs that may indicate a more serious injury and could necessitate further evaluation or even surgical exploration.
The challenge to the surgeon lies in identifying a significant nerve lesion, which warrants prompt intervention.
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Clinical Signs That a Nerve May Be in Danger
Once the effects of general or regional anaesthesia wear off, certain symptoms and signs may suggest that a nerve has been significantly damaged. These include:
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Severe, burning, unrelenting pain
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Complete loss of movement, sensation, or sweating in the affected limb
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A positive Tinel’s sign (a tingling sensation when tapping over the nerve)
In such cases, urgent review and assessment by a specialist are recommended. Advanced imaging and neurophysiological tests can provide supplementary information to aid decision-making, but formal nerve exploration is the most definitive way to determine if the nerve is intact. If necessary, during exploration, the nerve may undergo neurolysis, repair, grafting, or, in some cases, a nerve transfer—where a nearby healthy nerve is rerouted to restore function to the damaged area.
Key Message
Nerve injury is a recognised complication of surgery. Prompt recognition and action can minimise the long-term disability caused by the injury.