Peripheral nerve injury classification

Classification of peripheral nerve injury assists in prognosis and determination of treatment strategy. Classification of nerve injury was described by Seddon in 1943 and by Sunderland in 1951.^[1] The lowest degree of nerve injury in which the nerve remains intact but signaling ability is damaged is called neurapraxia. The second degree in which the axon is damaged but the surrounding connecting tissue remains intact is called axonotmesis. The last degree in which both the axon and connective tissue are damaged is called neurotmesis.

Seddon's classification

In 1943, Seddon described three basic types of peripheral nerve injury ^[2] that include:

Neurapraxia (Class I)

Main article: Neurapraxia

It is a temporary interruption of conduction without loss of axonal continuity.^[3]In neurapraxia, there is a physiologic block of nerve conduction in the affected axons.

Other characteristics:

It is the mildest type of peripheral nerve injury.
There are sensory-motor problems distal to the site of injury.
The endoneurium, perineurium, and the epineurium are intact.
There is no wallerian degeneration.
Conduction is intact in the distal segment and proximal segment, but no conduction occurs across the area of injury.^[4]
Recovery of nerve conduction deficit is full,and requires days to weeks.
EMG shows lack of fibrillation potentials (FP) and positive sharp waves.

Axonotmesis (Class II)

Main article: Axonotmesis

It involves loss of the relative continuity of the axon and its covering of myelin, but preservation of the connective tissue framework of the nerve ( the encapsulating tissue, the epineurium and perineurium, are preserved ).^[5]

Other characteristics:

Wallerian degeneration occurs distal to the site of injury.
There are sensory and motor deficits distal to the site of lesion.
There is no nerve conduction distal to the site of injury (3 to 4 days after injury).
EMG shows fibrillation potentials (FP),and positive sharp waves (2 to 3 weeks postinjury).
Axonal regeneration occurs and recovery is possible without surgical treatment.Sometimes surgical intervention because of scar tissue formation is required.

Neurotmesis (Class III)

Main article: Neurotmesis

It is a total severance or disruption of the entire nerve fiber.^[6]A peripheral nerve fiber contains an axon (Or long dendrite), myelin sheath (if existence), their schwann cells, and the endoneurium. Neurotmesis may be partial or complete.

Other characteristics:

Wallerian degeneration occurs distal to the site of injury.
There is connective tissue lesion that may be partial or complete.
Sensory-motor problems and autonomic function defect are severe.
There is no nerve conduction distal to the site of injury (3 to 4 days after lesion).
EMG and NCV findings are as axonotmesis.
Because of lack of nerve repair, surgical intervention is necessary.

Sunderland's classification

In 1951, Sunderland expanded Seddon's classification to five degrees of peripheral nerve injury:

First-degree (Class I)

Seddon's neurapraxia and first-degree are the same.

Second-degree (Class II)

Seddon's axonotmesis and second-degree are the same.

Third-degree (Class III)

Third-degree is included within Seddon's Neurotmesis.

Sunderland's third-degree is a nerve fiber interruption. In third-degree injury, there is a lesion of the endoneurium, but the epineurium and perineurium remain intact. Recovery from a third-degree injury is possible, but surgical intervention may be required.

Fourth-degree (Class III)

Fourth-degree is included within Seddon's Neurotmesis.

In fourth-degree injury, only the epineurium remain intact. In this case, surgical repair is required.

Fifth-degree (Class III)

Fifth-degree is included within Seddon's Neurotmesis.

Fifth-degree lesion is a complete transection of the nerve. Recovery is not possible without an appropriate surgical treatment.

References

↑ "Peripheral Nerve Injuries".
↑ "Seddon classification of nerve injuries".
↑ Otto D.Payton & Richard P.Di Fabio et al.Manual of physical therapy. Churchill Livingstone Inc. ISBN 0-443-08499-8
↑ "ELECTRODIAGNOSTIC STUDIES OF THE HAND".
↑ "Classification of Nerve Injuries".
↑ Otto D.Payton & Richard P.Di Fabio et al.Manual of physical therapy. Churchill Livingstone Inc. Page:24. ISBN 0-443-08499-8

Neurotrauma (S06, Sx4, T09.3–4, 850–854, 950–957)

Traumatic brain injury	Intracranial hemorrhage Intra-axial Intraparenchymal hemorrhage Intraventricular hemorrhage Extra-axial Subdural hematoma Epidural hematoma Subarachnoid hemorrhage Brain herniation Cerebral contusion Cerebral laceration Concussion Post-concussion syndrome Second-impact syndrome Dementia pugilistica Chronic traumatic encephalopathy Diffuse axonal injury Abusive head trauma Penetrating head injury

Spinal cord injury	Anterior spinal artery syndrome Brown-Séquard syndrome Cauda equina syndrome Central cord syndrome Paraplegia Posterior cord syndrome Spinal cord injury without radiographic abnormality Tetraplegia (Quadriplegia)

Peripheral nerves	Nerve injury Peripheral nerve injury Wallerian degeneration Injury of accessory nerve Brachial plexus injury Traumatic neuroma

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Peripheral nerve injury classification

Seddon's classification

Neurapraxia (Class I)

Axonotmesis (Class II)

Neurotmesis (Class III)

Sunderland's classification

See also

References