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Classification of Nerve Injuries

Last updated on: January 5, 2024

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Nerve injury can result from compression, gun shoot, stapping injuries or iatrogenic injuries. The most widely used classification of Nerve Injuries are Seddon and Sunderland Classification.

What is the classification of Nerve Injuries?

Seddon classification of nerve injuries (in 1941):

In Seddon classification, there are 3 types of nerve injury:

Type	Description	Recovery
Neurapraxia	Paralysis in the absence of peripheral degeneration.	The delay in recovery may be long, but recovery will be complete.
Axonotmesis	Damage to nerve fibers with complete peripheral degeneration but with intact of the Schwann sheath which provide support for accurate spontaneous regeneration.	Good recovery is anticipated, and no intervention can improve the outcome. Complete recovery depends on a number of factors, including timely removal of the compression and axon regeneration.
Neurotmesis	All essential structures, both neural and supporting tissues, have been disrupted. This category includes neuroma in continuity, division of nerves, and anatomic disruption.	Recovery rarely is complete, and the amount of loss can only be determined over time.

See Also: Brachial Plexus Palsy

Signs and Symptoms

Neuropraxia

Pain
No or minimal muscle wasting
Muscle weakness
Numbness
Proprioception affected
Recovery time: minutes to days

Axonotmesis

Pain
Muscle wasting evident
Complete motor, sensory and sympathetic functions lost
Recovery time: months (axon regenerates at rate of 1 inch/month, or 1 mm/day)
Sensation is restored before motor function

Neurotmesis

No pain (anesthesia)
Muscle wasting
Complete motor, sensory, and sympathetic functions lost
Recovery time: months and only with surgery

See Also: Median Nerve Palsy Tests

Sunderland Nerve Injuries Classification (in 1978):

Sunderland classification is based on an anatomical description of the lesion, rendering it a retrospective diagnosis with less clinical relevance.

Degree	Description
I	In this injury all structures are preserves, but conduction is temporarily blocked.
II	In this injury, wallerian degeneration occurs, but endoneurial integrity is maintained and recovery is complete.
III	This Injury adds endoneurial destruction and internal fascicular disorganization . recovery is poorer, with possible cross-regeneration.
IV	This injury characterized by complete internal disorganization, but some continuity of external structure remains.
V	This injury involves complete disruption of all nerve structures.

Correlation of Seddon and Sunderland Classification of Nerve Injuries

Thomas and Ochoa’s Nerve Injuries Classification

Thomas and Ochoa’s nerve injuries classification system divides injuries into those resulting in neuronal degeneration and those that do not.

I	Transient conduction block (non-degenerative)
II	Prolonged conduction block (non-degenerative)
III	Degenerative

Distinguishing between degenerative and non-degenerative lesions on clinical grounds is therefore possible. A degenerative lesion manifests as a progressive loss of all peripheral function. This includes peripheral autonomic function (sudomotor and vasomotor) due to interruption of postganglionic sympathetic fibres.

A non-degenerative lesion comprising a block of nerve transmission preserves some elements of peripheral function, such as the sympathetic fibres and deep-pressure sensation.

classification of Nerve Injuries comparison

References & More

Millers Review of Orthopaedics -7th Edition Book.
Basic Orthopaedic Sciences: The Stanmore Guide Book by Manoj Ramachandran
Bhandari PS. Management of peripheral nerve injury. J Clin Orthop Trauma. 2019 Sep-Oct;10(5):862-866. doi: 10.1016/j.jcot.2019.08.003. Epub 2019 Aug 13. PMID: 31528058; PMCID: PMC6739245.
Althagafi A, Nadi M. Acute Nerve Injury. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549848/
Morrey BF, editor: The elbow and its disorders, ed 2, Philadelphia, 1993, WB Saunders, p 814.