Iatrogenic nerve injuries: prevalence, diagnosis and treatment.

Traumatic nerve injuries are relatively uncommon and affect primarily younger patients. Iatrogenic nerve damage is even less common. Possible causes include (1, 2): Direct damage during surgery Pressure or traction because of positioning during anesthesia Injection of neurotoxic substances Compression of a hematoma secondary to drawing blood or through anticoagulation Tourniquet Dressings, casts or orthotic devices Radiation. Iatrogenic nerve injuries in one series accounted for 17.4% of all traumatic nerve injuries (3). In this study the nerve lesion was associated with a surgical procedure in 94% of patients. Others have also documented that post-operative nerve lesions are most common (4– 7). Large series indicate that 25.2% of sciatic nerve injuries are secondary to medical intervention (8). Similarly, 60% of femoral nerve lesions (9, 10) and 94% of accessory nerve lesions (11) are iatrogenic. In a retrospective study from Topuz et al., 29 of 73 patients with post-operative nerve injuries had sciatic nerve damage secondary to an intragluteal injection (12). Nerve injuries with neurological deficits have a variable course. If the motor and sensory changes do not resolve spontaneously, operative measures are necessary (Figure 1). In a study by Khan and Birch, 291 of 612 patients with iatrogenic nerve injuries required surgery (13). Carofino et al. reported that 15 of 26 patients with iatrogenic nerve damage following shoulder surgery failed to improve spontaneously and required surgery (14). In view of the results of the above mentioned studies, we will concentrate primarily on the group requiring post-traumatic procedures on peripheral nerves. Figure 1 Algorithmic approach to iatrogenic peripheral nerve damage (modified from Antoniadis G, Pedro M, Konig R: Iatrogene Nervenlasionen-chirurgische Therapieoptionen. Neurologisch: Fachmagazin fur Neurologie 2/13, 24-26) We will address the causes, diagnostic approaches and treatment strategies for iatrogenic nerve damage. Our goal is to increase the reader’s level of suspicion for such lesions so that they can be treated in a more timely fashion than is generally the case today.