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:
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