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:

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:

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:

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.

See also

References

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