Can a hysteroscopy procedure cause foot drop and a bruise on the elbow?

Hysteroscopy Does Not Cause Foot Drop or Elbow Bruising

Foot drop and elbow bruising are not recognized complications of hysteroscopy procedures. These symptoms are anatomically and mechanistically unrelated to the hysteroscopic approach, which involves only transvaginal access to the uterine cavity without any manipulation of lower extremities or upper extremities 1, 2.

Why Hysteroscopy Cannot Cause These Complications

Anatomic Impossibility of Foot Drop from Hysteroscopy

• Hysteroscopy is performed entirely through the vagina and cervix with visualization limited to the uterine cavity, making any nerve injury to the lower extremities anatomically impossible 3, 2
• Foot drop results from injury to the common peroneal nerve, L5 nerve root, or central nervous system lesions affecting the motor pathway to foot dorsiflexors—none of which are in proximity to the hysteroscopic surgical field 4
• The common peroneal nerve is located at the fibular head in the lower leg, while L5 radiculopathy occurs in the lumbar spine—both locations are nowhere near the pelvis where hysteroscopy is performed 4

Documented Hysteroscopy Complications Do Not Include Peripheral Nerve Injury

• The most common hysteroscopic complications are uterine perforation (0.76%), fluid overload (0.20%), and bleeding (0.16%)—with no mention of peripheral nerve injuries in large prospective studies 2
• Entry-related complications account for approximately half of all hysteroscopic complications and are limited to the uterus and cervix 2
• The overall complication rate for diagnostic hysteroscopy is only 0.13%, and for operative hysteroscopy 0.95%, with complications confined to the surgical field 2

Alternative Explanations to Consider

Foot Drop Differential Diagnosis

• L5 radiculopathy and peroneal nerve injury are the most common causes of foot drop and should be investigated with appropriate imaging and electrodiagnostic studies 4
• Central causes including cortical infarction can rarely present as isolated foot drop and require brain imaging 5
• Positioning-related peroneal nerve compression can occur during any surgical procedure if the patient's leg is positioned against hard surfaces, but this would require documentation of improper positioning during the hysteroscopy 6

Elbow Bruising Considerations

• Elbow bruising during hysteroscopy could only occur from intravenous line placement, blood pressure cuff application, or incidental trauma during patient positioning—none of which are inherent risks of the hysteroscopic procedure itself
• These would represent standard perioperative events unrelated to the surgical technique 1

Critical Distinction: Neuraxial Anesthesia vs. Hysteroscopy

• If neuraxial anesthesia (spinal or epidural) was used, there is a recognized risk of neurological complications including motor block, but this would be an anesthesia complication, not a hysteroscopy complication 6
• Inability to straight-leg raise at 4 hours post-neuraxial block warrants urgent evaluation for epidural hematoma or abscess, which can cause irreversible damage if not evacuated within 8-12 hours 6
• However, neuraxial block complications typically present as bilateral lower extremity symptoms, not isolated unilateral foot drop 6

Documentation and Evaluation Pathway

If the patient received neuraxial anesthesia:

• Urgent neurological assessment is required if motor block persists beyond expected timeframes 6
• MRI of the spine should be obtained urgently if there is concern for epidural hematoma or abscess 6
• Document the Bromage scale score and timing of symptom onset relative to anesthesia administration 6

If no neuraxial anesthesia was used:

• Obtain MRI of the lumbar spine to evaluate for L5 radiculopathy 4
• Perform nerve conduction studies to assess for peroneal nerve injury 4
• Consider brain MRI if central etiology is suspected based on examination findings 5

Clinical Bottom Line

There is no plausible mechanism by which hysteroscopy could cause foot drop or elbow bruising. The patient's symptoms require standard neurological evaluation for foot drop (imaging and electrodiagnostic studies) and documentation of any perioperative positioning or vascular access issues that might explain the elbow bruise, but these are not complications of the hysteroscopic surgical technique itself 1, 4, 2.