Classification of Nerve Injuries

What is the classification of nerve injuries and what are the typical findings?

Seddon was the first to classify nerve injuries into three categories based on the presence of demyelination and the extent of damage to the axons and other connective tissues. This classification was expanded by Sunderland. The mildest form of damage, neurapraxia, can occur from mild compression or from mild traction to the nerve. This can result in conduction slowing and “gain of function” symptoms. If the compression continues or the traction injury is more severe, axonotmesis may occur. This will result in “loss of function” symptoms. If the injury is severe enough, neurotmesis may occur.

NeurapraxiaGrade IFocal, segmental demyelination resulting in conduction slowing
AxonotmesisGrade IIAxon is damaged, but endoneurium is intact
AxonotmesisGrade IIIAxon and endoneurium are damaged, but epineurium is intact
AxonotmesisGrade IVAxon, endoneurium, and epineurium are damaged, but the epineurium is intact
NeurotmesisGrade VThe nerve is transecte

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