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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Clinical strategies to enhance nerve regeneration in composite tissue allotransplantation.

Peripheral nerve injury classification – Wikipedia

axonotmeesis Anticonvulsants for neuropathic pain syndromes: In this last situation, the scar tissue needs to be resected and substituted by normal nervous tissue usually by interposition of autologous nerve graft. This article has been cited by other articles in PMC. But it is important to remember that the longer the wait, more would be the chance that regional muscles will significantly atrophy, ultimately leading to poor functional recovery and disability.

A Initial exposure showing neudopraxia neuroma N in continuity of the sciatic nerve SN just before its division.

Sharp instruments like knives or scalpels have been identified as a frequent causative factors resulting in sharp stumps. Army during the American Civil War.

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.

Neurosurg Clin North Am ;2: Acute closed radial nerve injury. With chronicity, there is fatty replacement and atrophy in the affected muscles that progress over time[ 9 ] [ Table 1 ]. Classification of Peripheral Nerve Injury. Magnetic resonance neurography of common peroneal fibular neuropathy.

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.


Nerve injury may involve axonal loss, myelin loss, or commonly a combination of both. The Seddon and Sunderland classifications have been used by physicians for peripheral nerve injury grading and treatment. J Hand Surg Br axonotmesix MR neurography of neuromas related to nerve injury and entrapment with surgical correlation.

Sagittal STIR B image demonstrates mild diffuse enlargement of median small arrowulnar medium arrowand radial large arrow nerves.

Rheum Dis Clin North Am. Since antiepileptics such as gabapentin, oxcarbazepine, and lamotrigine target high-voltage activated Ca channels, they are useful in nerve pain management.

Seddon proposed a three-tiered model for nerve injury: Archived from the original on neurotmsis To comment on this article, contact rdavidson uspharmacist. The first degree corresponds to neurapraxia and the second degree to axonotmesis as described above. Seddon classified nerve injuries into three major groups: Severe pain nfurotmesis requires medications that specifically treat neuropathic pain.

An understanding neuroopraxia its physiopathology wxonotmesis selection of a suitable time for surgery are necessary for proper treatment of this challenging disorder. 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.

Classically surgery for treatment of peripheral nerve injuries should be considered in patients demonstrating complete palsy after the traumatism. Sep, Reconstruction using distal sensory and motor nerve transfers. Injury to the radial nerve caused by fracture of the humeral shaft: No conduction on electrophysiology and no recovery are expected unless surgery is performed. Intraoperative image demonstrates shot gun fragment small arrow in the exposed swollen median nerve following epineurotomy.

Peripheral nerve injury classification

A classification of peripheral nerve injuries producing loss of function. Peripheral nerve electrodiagnostics, electromyography and nerve conduction velocity.


Services on Demand Journal. Electrophysiologic study reveals decreased nerve conduction velocity and regional muscle denervation changes with fibrillations. Control of neuropathic pain by immune cells and opioids. Thereby, reinnervation of the target organ can take several months depending on its distance from the lesion.

Neurapraxia, the first-degree injury, is the most common response to blunt trauma causing a temporary conduction block with demyelination at the site of injury.

Both have been shown to be safe and effective neuroprotective agents, possibly because of their antioxidant properties. The ratio of the genes for cell death to those for regeneration is what ultimately determines the fate of the nerve cell. Annual meeting of the American society for the surgery of the hand. Mechanisms of Traumatic Nerve Injury Nerve injury can result from one or more of the following: J Hand Surg Eur Vol. Soon after nerve injury, degeneration of myofibers occurs and 18—24 months after the injury muscle fibers are replaced by fat and fibrous connective tissue, which makes the muscle progressively refractory to reinnervation 4.

In this type of lesion, also named neuroma in continuity, it is difficult to define the extent of internal nerve damage by macroscopic inspection only. Effective neuroprotective growth factors have been developed, but their use is not without limitations.

Management of Nerve Injuries

The nerve injury may involve various lengths of one or more regional nerves, and furthermore, the degree of injury may vary along the length of a particular nerve or along its cross section. Neuroma-in-continuity shows heterogeneous signal abnormality due to internal hemorrhage and fibrosis [ Figure 7 ].

Original Editor – Tomer Yona.