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Classification of nerve injury and potential recovery

Sunderland (1990)	Seddon (1943)	Grade of lesion	Pathology	Electro-diagnostic studies	Prognosis*
I	Neurapraxia	Mild	Demyelination	Conduction block	Excellent (up to 3 months)
II	Axonotmesis	Mild-moderate	Demyelination and axon loss	Axon loss^¶	Good, limited by "time-distance" factor
III	Neurotmesis	Moderate	II + involvement of endoneurium	Axon loss^¶	Good-fair
IV	Neurotmesis	Severe	III + involvement of perineurium	Axon loss^¶	Poor-nil
V	Neurotmesis	Severe	IV + involvement of epineurium	Axon loss^¶	Nil

* As the lesion is commonly mixed (demyelinating and axonal) the recovery is usually biphasic: the neurapraxic component resolves quickly, followed by a slower recovery of the axonal component, which is dependent upon distal axonal sprouting, axonal regeneration, and the level of injury (proximal versus distal).
¶ Most nerve lesions are mixed, consisting of a combination of neurapraxia and axonotmesis/neurotmesis, and therefore presenting as a mix of conduction block and partial axonal loss.

Original figure modified for this publication. Sunderland S. Nerve Injuries and their Repair: a Critical Appraisal. Churchill Livingstone, Edinburgh 1991. Table used with the permission of Elsevier Inc. All rights reserved.

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