Seddon’s initial description described neuropraxia, axonotmesis, and neurotmesis, and Sunderland expanded this classification into five degrees of nerve injury. Axonotmesis, commonly known nerve crush injury, occurs frequently . and good recovery levels in neuropraxia (compression or mild crush injury with .. The third level of injury, neurotmesis, is characterized by a complete. three degrees, neuropraxia, axonotmesis and neurotmesis and defined Axonotmesis—here the essential lesion is damage to the nerve fibers.

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Increased T2 SI can also be neuroprraxia by other inflammatory causes of diffuse neuropathy, such as autoimmune neuropathy Parsonage-Turner syndrome and multifocal motor neuropathy. MR neurography of neuromas related to nerve injury and entrapment with surgical correlation. Services on Demand Journal. MRN was obtained a month after to exclude Sunderland grade V injury.

Peripheral nerve injury classification

To comment on this article, contact rdavidson uspharmacist. In some cases, the presence of healthy axons inside the neuroma allows spontaneous regenerations, but in others the scar tissue represents an obstacle to the regenerating axons.

In addition, it is important to distinguish grade III injury commonly treated medically from grade IV-VI injuries commonly treated surgically. Future Developments To improve pain control in nerve injury, research is focusing not only on the treatment of symptoms, but also on treatment of the cause of the pain. Coronal fat-suppressed proton density image of the lower extremities C shows subacute denervation of the left thigh muscles.


The two widely used major classifications for nerve injury grading are the Seddon and Sunderland classifications. Intraoperative electrophysiology confirmed lack of conduction in the enlarged right C5 nerve root double small arrowslacerated distally. Examples of these injuries include those provoked by knives, propellers, piece of glass, and scalpel iatrogenic lesions.

Three types of neuropdaxia injuries. In this article we review the classification, mechanisms and evaluation of peripheral nerve injuries, with emphasis on indications for surgical treatment.

Classification of Peripheral Nerve Injury

Neurotrauma S06, Sx4, T Chhabra A, Andreisek G. Surgery of the peripheral nerve. Di Fabio et al.

In case of definite nerve gap, proximal and distal nerve stumps may be realigned using epineurial or perineurial sutures, with fibrin glue reinforcement. Treatment of acute peripheral nerve injuries: The treatment of nerve injuries is traced to William A. Clin Plast Surg ; The first degree corresponds to axoontmesis and the second degree to axonotmesis as described above.

Peripheral nerve injury classification – Wikipedia

When a recordable NAP axonotmetic injury is identified there are regenerating axons passing through the neuroma, regeneration will likely occur, and an external neurolysis is the only surgical procedure to be done. Conclusion MRN helps to distinguish pathologic changes in peripheral nerves allowing for clinically useful grading according to established injury grading schemes and it could play an important role in the evaluation of peripheral nerve injuries.

This process includes fragmentation and degeneration of the axon distal to the lesion and phagocytosis of the myelin sheath by Schwann cells and macrophages 6. There are three basic types of peripheral nerve injuries PNI commonly seen in the clinic [1].


Current techniques and concepts in peripheral nerve repair.

Traumatic injuries of peripheral nerves: a review with emphasis on surgical indication

From an imaging perspective, further discussion will focus on the pathophysiology of nerve injury related to local pathology and its grading schemes.

Notice thickened hypointense epineurium with perineural scarring from prior injury B. Usually a direct coaptation of the nerve ends can be performed with a termino-terminal tension-free suture In the fourth-degree injury, internal hemorrhage neuroprsxia fibrous tissue entangles the regenerating and growing nerve sprouts due to fascicular discontinuity, inhibiting the directed distal axonal growth, thereby resulting in the formation of neuroma-in-continuity.

In fourth-degree injury, only the epineurium remain intact. Therefore, clinical correlation is essential in such conditions.

Findings are in keeping with moderate axonotmwsis severe stretch injury Sunderland grade III injurywhich was managed conservatively resulting in slow and incomplete recovery. Mechanisms and treatment of neuropathic pain. Sir Sydney Sunderland[ 7 ] described five degrees of peripheral nerve injury [ Table 1 ]. C Surgical view after neuroma resection. Since antiepileptics such as gabapentin, oxcarbazepine, and lamotrigine target high-voltage activated Ca channels, they are useful in nerve pain management.