BACKGROUND: Early surgical intervention in nerve palsies with a high probability of nerve integrity and natural recovery risks unnecessary surgery. Understanding the variables influencing surgeons to offer surgery might provide insight into variations in surgeon beliefs and guide treatment recommendations. METHODS: Sixty-nine surgeons of the Science of Variation Group participated in a survey consisting of six traumatic and three non-traumatic nerve palsy scenarios. Participants were asked what their preferred treatment was and how likely they were to offer surgery on a scale from 0 to 10. Participants were randomized to choose for themselves (n=31) or for a patient of their age and gender (n=38). RESULTS: There was no difference in the overall likelihood of offering surgery or in the types of treatment offered to patients compared to oneself. Surgery was least recommended for idiopathic palsies and most for ulnar (β 0.91 95% CI 0.10-1.7, p=0.027) or radial (β 0.92, 95% CI 0.12-1.7, p=0.025) nerve palsy following closed distal radius or humerus fractures. Longer symptom duration increased the likelihood of offering surgery. CONCLUSIONS: Surgeons were moderately likely to recommend surgery for nerve palsies, with notable variation in opinions regardless of whether they were deciding for themselves or for patients. For specific nerve palsies with a documented benign natural history this likely represents overtreatment. Future studies can assess if balancing awareness of a benign natural history with the pressure to act and the sense that recovery is "taking too long" might limit the rate of unnecessary surgery.