Neuropraxia following inguinal hernia surgery

Posted by davidsinclair @davidsinclair, Dec 12, 2025

Hello. I had keyhole surgery for an inguinal hernia on 11th July 2025. Immediately after surgery I was aware that I had no feeling in my left leg. 6 hours post op, and the surgeon assured me that it would be OK in a further hour or so. 2 weeks later and I left hospital using a wheelchair to get to the car, and from the car to the house wearing a leg brace and using 2 elbow crutches. Before being discharged from hospital, I was diagnosed with neuropraxia caused by a haematoma which had strangled the femoral nerve. The haematoma has since dispersed, however, nerve conduction studies concluded that there was no signal from the femoral nerve to the quad muscles. My surgeon told me that there has only ever been 38 cases worldwide from millions of similar operations, so therefore, not a lot of information available. Today is the 12th December 2025. 22 weeks post op and my leg is still numb, I am unable to flex my knee joint, and I am in constant pain and discomfort. Any help or advice would be greatly appreciated. Thanks for taking the time to read, and thanks to anyone who responds.

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tommy901 | @tommy901 | Dec 12, 2025

Here's a valid, we'll documented, peer-reviewed explanation on this subject:

That sounds like an extremely difficult recovery, and everything you describe fits with a very rare but documented complication: femoral nerve neuropraxia (or higher-grade nerve injury) after laparoscopic inguinal hernia repair, usually due to a postoperative hematoma or traction/compression around the femoral canal.

A few key points may help clarify what’s going on and what to expect:

Rarity & Surgeon’s Statement:

Your surgeon is correct that this complication is very rare—but when it does occur, it’s usually related to a hematoma compressing the femoral nerve. That part is well-documented. The “38 cases worldwide” figure is probably an understatement—there are more case reports than that—but it still remains rare enough that recovery timelines are not well-studied.

Understanding the Nerve Injury:

“Neuropraxia” is typically the mildest nerve injury (temporary conduction block).
But your nerve conduction study showing no signal to the quadriceps raises the possibility of:

Axonotmesis (axonal damage, but nerve sheath intact), or

A mixed injury (part neuropraxic, part axonotmetic).

If it were pure neuropraxia, some return of signal is usually seen within 6–12 weeks.

At 22 weeks, ongoing paralysis suggests damage more severe than just neuropraxia — but still often recoverable.

Expected Recovery Timeline>

For axonal injuries:

Nerve regrowth occurs at ~1 mm/day (about 1 inch per month).

For the femoral nerve (a long, proximal nerve), meaningful recovery may take 6–18 months, sometimes even 24 months.

The first signs of recovery are usually:

Twitching in the quadriceps.

Slight ability to lift the knee.

Reduction in numbness above the knee.

The fact that the hematoma resolved does not automatically mean the nerve instantly resumes function — the damage can take months to heal.

What is Concerning / Needs Attention>

At this point (5+ months):

Persistent quadriceps paralysis.

No measurable nerve conduction.

Ongoing severe pain.

These are not unusual in nerve injuries but indicate that:

You need ongoing neurology follow-up.

Repeat EMG/NCS every 3–4 months to look for early reinnervation.

Early involvement of a specialist peripheral nerve surgeon should be considered.

Proven Helpful Steps:

a. Physiotherapy is essential even without nerve signals
To prevent:

Knee contracture.

Muscle shortening.

Joint instability.

b. Electrical stimulation (NMES)
Helps preserve muscle bulk while you wait for nerve regrowth.

c. Pain management:

Burning/throbbing nerve pain often responds best to:

Pregabalin or gabapentin.

Duloxetine.

Amitriptyline (low dose at night).

d. Bracing:

A locked knee brace and crutches are exactly what patients typically need during early recovery.

Surgical Exploration?

Most femoral nerve injuries are treated conservatively, but surgical exploration is considered when:

There is no improvement at 6–9 months,

EMG shows no evidence of reinnervation.

There is suspicion of scar entrapment or ongoing compression.

A peripheral nerve specialist (not a general surgeon) is the one to assess this.

The Bottom Line:

At 22 weeks, lack of recovery is absolutely distressing—but not outside the recovery window for femoral nerve injuries.

Many cases show first signs of improvement between 6–12 months.

Full recovery can take 1–2 years, and some patients have partial but meaningful improvement even later.

Your next steps should include repeat EMG, aggressive PT, nerve-focused pain management, and possibly referral to a peripheral nerve specialist.

davidsinclair | @davidsinclair | Dec 12, 2025

Thank you for your kind words of encouragement. Unfortunately the NHS in the UK is on its knees for many reasons. I am awaiting an appointment with a peripheral nerve specialist/plastic surgeon, but unfortunately it will be their decision whether or not they will see me. I am also awaiting an appointment with a neurology physiotherapist. I should have had my nerve conduction studies at 8 weeks post op, or 12 weeks maximum. However it was week 18 before I was seen.

Helen, Volunteer Mentor | @naturegirl5 | Dec 13, 2025

In reply to @tommy901 "Here's a valid, we'll documented, peer-reviewed explanation on this subject: That sounds like an extremely difficult..." + (show)

@tommy901

Here's a valid, we'll documented, peer-reviewed explanation on this subject:

A few key points may help clarify what’s going on and what to expect:

Rarity & Surgeon’s Statement:

Understanding the Nerve Injury:

“Neuropraxia” is typically the mildest nerve injury (temporary conduction block).
But your nerve conduction study showing no signal to the quadriceps raises the possibility of:

Axonotmesis (axonal damage, but nerve sheath intact), or

A mixed injury (part neuropraxic, part axonotmetic).

If it were pure neuropraxia, some return of signal is usually seen within 6–12 weeks.

At 22 weeks, ongoing paralysis suggests damage more severe than just neuropraxia — but still often recoverable.

Expected Recovery Timeline>

For axonal injuries:

Nerve regrowth occurs at ~1 mm/day (about 1 inch per month).

For the femoral nerve (a long, proximal nerve), meaningful recovery may take 6–18 months, sometimes even 24 months.

The first signs of recovery are usually:

Twitching in the quadriceps.

Slight ability to lift the knee.

Reduction in numbness above the knee.

The fact that the hematoma resolved does not automatically mean the nerve instantly resumes function — the damage can take months to heal.

What is Concerning / Needs Attention>

At this point (5+ months):

Persistent quadriceps paralysis.

No measurable nerve conduction.

Ongoing severe pain.

These are not unusual in nerve injuries but indicate that:

You need ongoing neurology follow-up.

Repeat EMG/NCS every 3–4 months to look for early reinnervation.

Early involvement of a specialist peripheral nerve surgeon should be considered.

Proven Helpful Steps:

a. Physiotherapy is essential even without nerve signals
To prevent:

Knee contracture.

Muscle shortening.

Joint instability.

b. Electrical stimulation (NMES)
Helps preserve muscle bulk while you wait for nerve regrowth.

c. Pain management:

Burning/throbbing nerve pain often responds best to:

Pregabalin or gabapentin.

Duloxetine.

Amitriptyline (low dose at night).

d. Bracing:

A locked knee brace and crutches are exactly what patients typically need during early recovery.

Surgical Exploration?

Most femoral nerve injuries are treated conservatively, but surgical exploration is considered when:

There is no improvement at 6–9 months,

EMG shows no evidence of reinnervation.

There is suspicion of scar entrapment or ongoing compression.

A peripheral nerve specialist (not a general surgeon) is the one to assess this.

The Bottom Line:

At 22 weeks, lack of recovery is absolutely distressing—but not outside the recovery window for femoral nerve injuries.

Many cases show first signs of improvement between 6–12 months.

Full recovery can take 1–2 years, and some patients have partial but meaningful improvement even later.

Your next steps should include repeat EMG, aggressive PT, nerve-focused pain management, and possibly referral to a peripheral nerve specialist.

Jump to this post

@tommy901 Thank you. Could you please provide the reference for your source?

tommy901 | @tommy901 | Dec 13, 2025

In reply to @naturegirl5 "@tommy901 Thank you. Could you please provide the reference for your source?" + (show)

@naturegirl5 Medical & Scientific Articles:

1. Postoperative femoral neuropathy — PubMed review
A classic surgical review explaining that postoperative femoral nerve injury can occur from compression or retraction during surgery, and recovery often takes weeks to months with physiotherapy.
👉 https://pubmed.ncbi.nlm.nih.gov/1311869/

2. Femoral nerve involvement in hernia repair — case report review
Discusses documented cases of transient femoral nerve injury after inguinal hernia surgery and the role of EMG in diagnosis and monitoring recovery.
👉 https://pubmed.ncbi.nlm.nih.gov/15999220/

3. Iatrogenic femoral nerve injury (literature scoping review)
Systematic review showing that most cases recover motor and sensory function within several months but ischemic or axonal injuries take longer — and outlining the role of electrodiagnostic monitoring.
👉 https://pmc.ncbi.nlm.nih.gov/articles/PMC8593564/

4. Femoral nerve and lumbar plexus injury after surgery — electrodiagnostic study
Study of femoral neuropathy after lumbar surgical approaches — shows that many serious injuries still show significant improvement within 12 months and that serial EMG/NCS is helpful for prognosis.
👉 https://pubmed.ncbi.nlm.nih.gov/28560607/

davidsinclair | @davidsinclair | Dec 16, 2025

Firstly, thanks to Helen for raising this question, and a big thank you to Tommy for his reference sources. These could prove invaluable.

davidsinclair | @davidsinclair | Dec 19, 2025

In reply to @tommy901 "Here's a valid, we'll documented, peer-reviewed explanation on this subject: That sounds like an extremely difficult..." + (show)

@tommy901

Here's a valid, we'll documented, peer-reviewed explanation on this subject:

A few key points may help clarify what’s going on and what to expect:

Rarity & Surgeon’s Statement:

Understanding the Nerve Injury:

“Neuropraxia” is typically the mildest nerve injury (temporary conduction block).
But your nerve conduction study showing no signal to the quadriceps raises the possibility of:

Axonotmesis (axonal damage, but nerve sheath intact), or

A mixed injury (part neuropraxic, part axonotmetic).

If it were pure neuropraxia, some return of signal is usually seen within 6–12 weeks.

At 22 weeks, ongoing paralysis suggests damage more severe than just neuropraxia — but still often recoverable.

Expected Recovery Timeline>

For axonal injuries:

Nerve regrowth occurs at ~1 mm/day (about 1 inch per month).

For the femoral nerve (a long, proximal nerve), meaningful recovery may take 6–18 months, sometimes even 24 months.

The first signs of recovery are usually:

Twitching in the quadriceps.

Slight ability to lift the knee.

Reduction in numbness above the knee.

The fact that the hematoma resolved does not automatically mean the nerve instantly resumes function — the damage can take months to heal.

What is Concerning / Needs Attention>

At this point (5+ months):

Persistent quadriceps paralysis.

No measurable nerve conduction.

Ongoing severe pain.

These are not unusual in nerve injuries but indicate that:

You need ongoing neurology follow-up.

Repeat EMG/NCS every 3–4 months to look for early reinnervation.

Early involvement of a specialist peripheral nerve surgeon should be considered.

Proven Helpful Steps:

a. Physiotherapy is essential even without nerve signals
To prevent:

Knee contracture.

Muscle shortening.

Joint instability.

b. Electrical stimulation (NMES)
Helps preserve muscle bulk while you wait for nerve regrowth.

c. Pain management:

Burning/throbbing nerve pain often responds best to:

Pregabalin or gabapentin.

Duloxetine.

Amitriptyline (low dose at night).

d. Bracing:

A locked knee brace and crutches are exactly what patients typically need during early recovery.

Surgical Exploration?

Most femoral nerve injuries are treated conservatively, but surgical exploration is considered when:

There is no improvement at 6–9 months,

EMG shows no evidence of reinnervation.

There is suspicion of scar entrapment or ongoing compression.

A peripheral nerve specialist (not a general surgeon) is the one to assess this.

The Bottom Line:

At 22 weeks, lack of recovery is absolutely distressing—but not outside the recovery window for femoral nerve injuries.

Many cases show first signs of improvement between 6–12 months.

Full recovery can take 1–2 years, and some patients have partial but meaningful improvement even later.

Your next steps should include repeat EMG, aggressive PT, nerve-focused pain management, and possibly referral to a peripheral nerve specialist.

Jump to this post

@tommy901
Good day Tommy.

Further to your response to my enquiry regarding neuropraxia.

Firstly, your diagnosis of part neuropraxia part axonotmetic was spot on, as confirmed by a report from my neurologist. She has stated -
I have an isolated severe left femoral nerve axonal problem,
Neurophysiology shows no sign of reinervation to the two parts of the left quadreceps that were studied, therefore not a pure neuropraxic injury. Give the significant axonal pathology seen, and ifthere is going to be spontaneous recovery, it may be slowand incomplete and could take between 12 - 24 months.
Despite the neurologist referring me for treatment by a neuro Physio, they have said that they would not consider seeing me because it is not their speciality, they only deal with peripheral nerve injuries. Stranger still is that the neurologist also referred me to a peripheral nerve specialist/plastic surgeon. Today I am 23 weeks post op, I have not been seen by a physio for over 10 weeks.
Obviously I am concerned that the longer this goes untreated, the less chance I have of any form of recovery.

tommy901 | @tommy901 | Dec 19, 2025

In reply to @davidsinclair "@tommy901 Good day Tommy. Further to your response to my enquiry regarding neuropraxia. Firstly, your diagnosis..." + (show)

@davidsinclair Thanks for the kind statement about the diagnosis, however, I want be clear that **I haven't diagnosed** anything about this issue. This information was totally retrieved from valid studies about this situation. The following information also has been researched the same way. Links to validate the following statements will be stated below for further references:

What the findings mean:

1. “Isolated severe left femoral nerve axonal problem”.

The femoral nerve (which powers the quadriceps and helps with knee extension and hip flexion) has suffered significant axonal damage.
Axonal injury means the actual nerve fibers are damaged—not just compressed or “stunned.”

2. “No sign of reinervation”
Reinervation means damaged nerves starting to reconnect with muscle.
At this point, testing shows no measurable regrowth or reconnection in the studied parts of the quadriceps.
This confirms the injury is not neuropraxia, which is the mildest and fastest-recovering nerve injury.

3. Prognosis: slow and possibly incomplete recovery.

With axonal femoral nerve injuries:

Recovery, if it occurs, is slow.
Often 12–24 months.
Recovery may be partial, not full.
Nerves regrow at roughly 1 mm per day, and muscle health must be preserved while waiting.

Why the lack of treatment is concerning (and why you’re right to worry).
You are correct to be concerned.

Key issue:
Even when nerves are slow to recover, muscle and joint function must be maintained, or permanent disability can occur even if the nerve eventually improves.

Without physio:
Quadriceps muscle can atrophy.
Knee can develop stiffness or instability.
Abnormal movement patterns can become permanent.
Pain and gait problems can worsen.
Physiotherapy does NOT require nerve recovery to begin.
It focuses on muscle preservation, joint mobility, safety, and compensation strategies.
The referral confusion (important point):

A neuro-physio refusing because they “only treat peripheral nerve injuries” makes no sense — the femoral nerve is a peripheral nerve.
This suggests a miscommunication, inappropriate triage, or local service limitation, not a medical contraindication.
The referral to a peripheral nerve specialist/plastic surgeon is appropriate because:

Severe axonal injuries sometimes require:

Surgical exploration.
Neurolysis (freeing the nerve).
Nerve grafting or transfer (in select cases).
However, surgical opinion does not replace physiotherapy.
What should be happening right now (best practice):

At 23 weeks post-op, standard care would usually include:

1. Immediate physiotherapy (non-negotiable).
Even without reinervation:
Passive and active-assisted quad work.
Hip flexor strengthening.
Knee stabilization.
Gait training.
Bracing assessment (e.g., knee brace to prevent buckling).

2. Regular neurophysiology follow-up
Repeat EMG/NCS every 3–6 months
Looking for any early signs of reinnervation.

3. Clear surgical timeline:
If no recovery by 6–9 months, many specialists consider:

Surgical exploration.
Intervention before muscle becomes irreversibly denervated.

Practical steps you can take now
Urgent actions:

Ask your neurologist (or GP) to:

Re-refer you explicitly to general neuro-rehabilitation or musculoskeletal physio.

State clearly: “Femoral nerve palsy with quadriceps weakness—physio for muscle preservation and gait safety”.

Request:
Written clarification on why physio was declined.
Expedited appointment with the peripheral nerve specialist.

If available:
Seek private physiotherapy temporarily (even 1–2 sessions can establish a home program).

Bottom line:

This is a serious femoral nerve injury, not a minor one.
Recovery can happen, but time is critical.
Lack of physiotherapy for 10+ weeks is not acceptable care for this condition.
You are absolutely right to advocate for yourself

tommy901 | @tommy901 | Dec 19, 2025

In reply to @tommy901 "@davidsinclair Thanks for the kind statement about the diagnosis, however, I want be clear that **I..." + (show)

@tommy901

What the findings mean:

1. “Isolated severe left femoral nerve axonal problem”.

3. Prognosis: slow and possibly incomplete recovery.

With axonal femoral nerve injuries:

Recovery, if it occurs, is slow.
Often 12–24 months.
Recovery may be partial, not full.
Nerves regrow at roughly 1 mm per day, and muscle health must be preserved while waiting.

Why the lack of treatment is concerning (and why you’re right to worry).
You are correct to be concerned.

Key issue:
Even when nerves are slow to recover, muscle and joint function must be maintained, or permanent disability can occur even if the nerve eventually improves.

Severe axonal injuries sometimes require:

At 23 weeks post-op, standard care would usually include:

2. Regular neurophysiology follow-up
Repeat EMG/NCS every 3–6 months
Looking for any early signs of reinnervation.

3. Clear surgical timeline:
If no recovery by 6–9 months, many specialists consider:

Surgical exploration.
Intervention before muscle becomes irreversibly denervated.

Practical steps you can take now
Urgent actions:

Ask your neurologist (or GP) to:

Re-refer you explicitly to general neuro-rehabilitation or musculoskeletal physio.

State clearly: “Femoral nerve palsy with quadriceps weakness—physio for muscle preservation and gait safety”.

Request:
Written clarification on why physio was declined.
Expedited appointment with the peripheral nerve specialist.

If available:
Seek private physiotherapy temporarily (even 1–2 sessions can establish a home program).

Bottom line:

Jump to this post

@tommy901 Source's:

Here are https links to authoritative medical and scientific sources that back up key points from the explanation above — including nerve injury severity, axonal regeneration, physiotherapy/rehabilitation roles, and recovery timelines:

Peripheral Nerve Injury & Regeneration Basics:

Peripheral nerve injury classification and severity (explains axonal vs other types of nerve damage, and the implications for recovery):
https://en.wikipedia.org/wiki/Nerve_injury_classification �
Wikipedia

Axonotmesis (axon damage) — what it is and how regeneration occurs, including physical therapy in treatment:
https://en.wikipedia.org/wiki/Axonotmesis �
Wikipedia

Peripheral Neuropathy and femoral nerve specifics — weakness with knee extension due to femoral nerve dysfunction:
https://www.medlink.com/articles/femoral-neuropathy �
Medlink

Mayo Clinic overview of peripheral nerve injuries — injuries heal slowly and may take many months or years:
https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/diagnosis-treatment/drc-20355632 �
Mayo Clinic

Recovery Timeline & Regeneration Rate
Peripheral nerve regeneration facts — axon regrowth rate (~1 mm/day) and factors that influence return of nerve function:
https://now.aapmr.org/peripheral-neurological-recovery-and-regeneration/ �
PM&R KnowledgeNow

Recovery timelines after peripheral nerve palsy — complete recovery in many cases can take months to less than 2 years:
https://www.sciencedirect.com/science/article/abs/pii/S0883540317309622 �
ScienceDirect

Physiotherapy & Rehabilitation
Peripheral nerve injury rehabilitation principles — overview of physio roles and strategies after nerve damage:
https://www.physio-pedia.com/Nerve_Injury_Rehabilitation �
Physiopedia

Physiotherapeutic techniques — how targeted therapy supports recovery and function:
https://pubmed.ncbi.nlm.nih.gov/26171327/ (PMC link actually) https://pmc.ncbi.nlm.nih.gov/articles/PMC4705788/ �
PubMed Central

Clinical guideline recommending early rehab after nerve injury — physiotherapy should begin as soon as feasible after trauma or surgery:
https://pubmed.ncbi.nlm.nih.gov/38831698/ �
PubMed

Role of Exercise / Electrical Stimulation
Exercise & electrical stimulation may support nerve regeneration (preclinical evidence, mechanism):
https://www.mdpi.com/2075-4418/13/3/364 �
MDPI

Non-surgical electrical stimulation therapy for nerve injury — explores how electrotherapy can reduce atrophy and support reinnervation:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9998520/ �
PubMed Central
Why Delays in Treatment Can Matter

Reinnervation window for meaningful recovery — reinnervation ideally achieved within ~12–18 months after injury:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10696649/ �
PubMed Central

Denervated muscle atrophy over time — if nerves reach muscles too late, fibrosis limits full functional restoration:
https://journals.lww.com/nrronline/fulltext/2023/12000/repair_and_regeneration_of_peripheral_nerve.2.aspx �
Lippincott Journals

Please understand that I haven't included any*OPINIONS* of mine. The references are the lasted and updated KNOWN about this subject.

I sincerely hope this information puts a higher perspective on the information you have presented.

Regards

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