# A Narrative Review of Perioperative Peripheral Nerve Injuries After Major Surgery: Clinical Recognition, Electrodiagnostic Evaluation, and Rehabilitation Implications

## TL;DR

This review discusses how to recognize and manage nerve injuries after major surgery, focusing on diagnosis and rehabilitation.

## Contribution

The paper provides a comprehensive overview of clinical recognition, electrodiagnostic evaluation, and rehabilitation for perioperative peripheral nerve injuries.

## Key findings

- Upper-limb PPNIs commonly affect the brachial plexus, ulnar, and median nerves.
- Lower-limb PPNIs often involve the lateral femoral cutaneous, sciatic, and common fibular nerves.
- Electrodiagnostic testing helps distinguish injury types and guide rehabilitation planning.

## Abstract

Perioperative peripheral nerve injuries (PPNIs) are complications of surgical and procedural care and may cause neuropathic pain and motor or sensory deficits that delay functional recovery. This narrative review summarizes common patterns of PPNI involving the extremities, practical bedside recognition, the role and timing of electrodiagnostic testing, and key rehabilitation considerations. Upper-limb involvement most often affects the brachial plexus, ulnar nerve, and median nerve. In contrast, lower-limb presentations commonly involve the lateral femoral cutaneous, sciatic, and common fibular nerves, often in the setting of prolonged procedures and positioning. Electrodiagnostic studies complement the clinical examination by refining localization, distinguishing conduction block from axonal injury, and informing prognosis and follow-up planning. From a rehabilitation perspective, early detection supports prompt mitigation of ongoing compression or traction, symptom management, protection of insensate tissues, and timely functional strategies (including orthoses and task-oriented therapy) while recovery is monitored over time.