What areas in the body have superficial sensory or motor nerves that are vulnerable to iatrogenic (inadvertent medical) injury?

From the Guidelines

Several areas in the body contain superficial nerves vulnerable to iatrogenic injury during medical procedures, including the common peroneal nerve, which can be damaged during knee surgeries or leg positioning, as it is located just medial to the biceps femoris tendon and near the fibular head 1.

Vulnerable Nerve Locations

The following nerves are at risk of iatrogenic injury:

• The common peroneal nerve, which can be injured during knee surgeries or leg positioning, leading to sensory loss or foot drop 1
• The spinal accessory nerve in the posterior triangle of the neck, which can be injured during lymph node biopsies, and can be directly imaged by US within the posterior cervical triangle 1
• The recurrent laryngeal nerve, which can be injured during thyroidectomy, particularly due to its variable relationships with the inferior thyroid artery and its branches 1

Anatomical Considerations

These nerves are vulnerable because they:

• Run close to the skin surface with minimal protective tissue
• Often cross over bony prominences where they can be compressed
• Frequently follow predictable anatomical paths that intersect common surgical approaches Understanding these vulnerable locations helps clinicians modify techniques to avoid nerve damage during procedures.

Clinical Implications

Awareness of these vulnerable nerve locations is crucial to minimize the risk of iatrogenic injury, particularly in procedures such as microphlebectomy, thyroidectomy, and lymph node biopsies 1.

From the Research

Areas Vulnerable to Iatrogenic Injury

The areas in the body with superficial sensory or motor nerves that are vulnerable to iatrogenic injury include:

• The radial nerve, which is at risk during osteosyntheses and other surgical interventions 2, 3
• The peroneal nerve, which is also at risk during osteosyntheses and other surgical interventions 2, 3
• The median nerve, which is at risk during carpal tunnel release and other surgical interventions 2, 3
• The spinal accessory nerve, which is at risk during surgical procedures in the posterior triangle of the neck 4
• The brachial plexus, which is at risk during various surgical procedures, including orthopaedic and plastic surgery 5
• The axillary, ulnar, and musculocutaneous nerves, which are also at risk during various surgical procedures 5

Surgical Interventions at Risk

The following surgical interventions are at risk for iatrogenic nerve injuries:

• Osteosyntheses 2, 3
• Carpal tunnel release 3
• Lymph node biopsy 3
• Orthopaedic surgery 5
• Plastic and reconstructive surgery 5
• Patient positioning and anesthesiologic interventions 2

Clinical Presentations

Iatrogenic nerve injuries can present with various clinical symptoms, including:

• Motor deficits 2, 3
• Sensory deficits 2, 3
• Mixed sensory and motor deficits 2
• Delayed diagnosis and treatment can result in significant functional impairment and morbidity 2, 3, 6