During an operation, a nerve may be damaged by prolonged retraction, be inadvertently cut or trapped within a joint or fracture.

The possibility of nerve injury following surgery is distressing for both the patient and the surgeon involved.


Some clinical examples:

Operations Nerves at Risk

 Clinical Signs

 Lymph node biopsy at the neck  Spinal accessory nerve

 Drooped and painful shoulder

 Scapular winging

 Restricted movement (abduction)

 Shoulder plating or replacement  Axillary nerve 

 Loss of deltoid contraction

 Numbness over the regimental badge

 Humeral plating  Radial nerve

Wrist drop

Numbness over the back of hand

 Elbow surgery  Ulnar nerve

Clawed ring and little fingers

Clumsy hand

Hollowness in hand due to wasting of muscles

Numbness of ring and little fingers

 Distal biceps repair  Posterior interosseous nerve

Dropped fingers and thumb at the knuckles

Deviated wrist extension

 Distal radius plating

Palmar cutaneous nerve of median nerve  Numbness and pain over the base of thumb
 Hip replacement

Sciatic nerve

(CPN component)

Foot drop

Numbness over the back of foot

 Knee surgery Common peroneal nerve 

Foot drop

Numbness over the back of foot

 Ankle surgery

Superficial peroneal nerve  Numbness and pain over the back of foot 


The spectrum of a nerve injury may vary from a mild lesion with transient loss of function that recovers spontaneously to the most severe in which no recovery is possible unless the nerve is repaired. Often, an injury is mixed with components of variable severity. Transient tingling is not uncommon following surgery to a limb due to postoperative swelling or if there has been prolonged usage of tourniquet. While some symptoms may be observed closely for resolution, there are signs that could imply a more serious injury.


The challenge to the surgeon lies in identifying a significant nerve lesion, which warrants prompt intervention. 


What are the clinical signs to suggest a nerve is in danger?

Once the effects of general/regional anaesthesia have worn off, the following clinical symptoms/signs may imply that a nerve has been significantly damaged:

  • Severe, burning, unrelenting pain
  • Complete loss of movement, sensation and sweating in the limb
  • Positive Tinel’s sign 

In this situation, urgent review and assessment by a specialist is advised. In certain situations, advanced imaging and neurophysiology may provide supplementary information in the decision-making process, however formal exploration of the nerve is the definitive way of establishing if the nerve is intact. At the same time, neurolysis, nerve repair or grafting may be performed depending on the extent of injury. 


Key Message

Nerve injury is a recognised complication of surgery. Prompt recognition and action will ensure the disability from the nerve injury is kept to the minimum.

BOAST 5 - Peripheral Nerve Injury.pdf

The Management of Nerve Injuries (the blue book)_BOA 2011.pdf


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