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Seddons Classification For Nerve Injury

Basic structure of Nerve

(In increasing order of severity of damage:)

  1. Neurapraxia
    1. Reversible physiological nerve conduction block
    2. It is seen in crutchpalsy, tourniquet palsy and Saturday night palsy.
    3. Recovery is complete and it is in one go, that is complete recovery occurs once for all, there is no staged recovery.
  2. Axonotmesis
    1. There is loss of conduction due to axonal interruption but the nerve is in continuity and the neural tubes are intact.
    2. Seen in closed fractures and dislocations
    3. Recovery is staged and many a times some residual deficit is there.
  3. Neurotmesis
    1. There is complete division of nerve (i.e. epineurium, perineurium, endo neurium, & axon all have lost their continuity)
    2. Seen in open wounds
    3. There is no recovery without surgery.
Sunderland classification:
  1. Prognostic Factors in Nerve Injury
    (Mnemonic: GOOD NERVE)
    1. Growing age (Children)
    2. Only motor
    3. Only sensory
    4. Distal lesion
    5. Neurapraxia
    6. Early repair
    7. Radial nerve
    8. Vascularity Intact
    9. End to end anastomosis
      1. Type of lesion: Neuropraxia always recovers fully, axonotmesis may or may not; neurotmesis will not unless nerve is repaired.
      2. Level of lesion: Distal lesions have better prognosis
      3. Type of nerve: Pure motor or pure sensory nerves recover better than mixed, because there is less likehood of axonal confusion.
      4. Age: Children do better than adults
      5. Size of gap: Gaps of more than 1-2 cm usually requre grafting. However gaps of 2 cm in median nerve, 4-5 cm in ulnar nerve, and 6-8 cm in sciatic nerve can usually be closed by mobilizing & transposing the nerve and flexing the joint.
      6. Delay in suture: This is most important adverse factor. The best results are obtained with early nerve repair
      7. Associated lesions of vessels, tendons etc make recovery difficult.
      8. Tinel’s sign indicate regeneration of nerve
      9. Rate of regeneration of nerve is 1 mm/day
      10. The denervated target organs motor end plates and sensory receptors, gradually atrophy, if they are not reinervated within 2 years they will never recover.
  2. Prognosis After Nerve Suturing
    Radial nerve (best) >median nerve > ulnar nerve > Peroneal nerve > Sciatic (worst prognosis).

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