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Nerve Injury

This document discusses the classification of peripheral nerve injuries. It begins with introducing the anatomy and physiology of peripheral nerves and nerve conduction. It then discusses the injury response and etiology of nerve injuries. The major classifications of nerve injuries are the Seddon and Sunderland classifications, which categorize injuries based on the extent of damage to the nerve fibers and layers. The document concludes with sections on clinically assessing nerve injuries, investigating them through electrodiagnostic tests and examinations, and considering implications for management.

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Pasupathy Palaniappan
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168 views16 pages

Nerve Injury

This document discusses the classification of peripheral nerve injuries. It begins with introducing the anatomy and physiology of peripheral nerves and nerve conduction. It then discusses the injury response and etiology of nerve injuries. The major classifications of nerve injuries are the Seddon and Sunderland classifications, which categorize injuries based on the extent of damage to the nerve fibers and layers. The document concludes with sections on clinically assessing nerve injuries, investigating them through electrodiagnostic tests and examinations, and considering implications for management.

Uploaded by

Pasupathy Palaniappan
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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CLASSIFICATION OF PERIPHERAL NERVE INJURIES

- PASUPATHY.P Intern, Batch of 2005

Anatomy of peripheral nerves Physiology of nerve conduction Injury response Etiology of nerve injuries

Classification of nerve injuries


Clinical assessment Investigation Implications on management

ANATOMY OF PERIPHERAL NERVES

PHYSIOLOGY OF NERVE CONDUCTION

Nerve Action Potential

INJURY RESPONSE

ETIOLOGY OF NERVE INJURIES Mechanical trauma (laceration, contusion, stretch/traction, compression) Thermal & chemical injuries

Metabolic
Malignant Endogenous/exogenous toxins Malignancies

CLASSIFICATION OF NERVE INJURIES


1.SEDDON CLASSIFICATION - 1943 2. SUNDERLAND CLASSIFICATION 1951 (1910-1993)

Australian anatomist extensive research in human neuroanatomy

SEDDON CLASSIFICATION

Neurapraxia
Axonotmesis Neurotmesis

SUNDERLAND CLASSIFICATION
HISTOPATH CHANGES Sunderland Myelin Axon Endone Perineu urium rium TINEL SIGN Distal progress Epineuri Present um

I
II III IV V

+/+ + + + + + + + + + + + + +

+ + + +

+ + -

CLINICAL ASSESSMENT Testing of muscles innervated by the nerve. testing of all sensory modalities, especially in the zone autonomous innervation. Simple tests to detect nerve injuries

eg. Loss pain at the tip of index finger- median nerve injury

INVESTIGATION
1. Electro diagnostic procedures : - Nerve conduction study (by proximal & distal stimulation) - Electromyography (Denervation potentials) 2. Others : - Tinel sign - Sweat test(Starch iodine test) - Skin resistance test - Galvanic current stimulation

IMPLICATIONS ON MANAGEMENT

SUMMARY
Anatomy & physiology Injury response etiology of nerve injuries Seddon & Sunderland classification Clinical assessment Investigation Management principles

REFERENCE : Snell`s neuro anatomy Ganong`s review of physiology Campbell textbook of orthopedics Youman`s neurosurgery Principles of neurosurgery- Setti.c.Rangachary Richard.G.Ellenbogan

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