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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2014; 24(03): 217-224
DOI: 10.4103/0971-3026.137025
Recent Advances in MSK

Peripheral nerve injury grading simplified on MR neurography: As referenced to Seddon and Sunderland classifications

Avneesh Chhabra
Department of Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, Baltimore, MD, USA
,
Shivani Ahlawat
Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
,
Allan Belzberg
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
,
Gustav Andreseik
Department of Radiology, University Hospital Zürich, Zürich, Switzerland
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Abstract

The Seddon and Sunderland classifications have been used by physicians for peripheral nerve injury grading and treatment. While Seddon classification is simpler to follow and more relevant to electrophysiologists, the Sunderland grading is more often used by surgeons to decide when and how to intervene. With increasing availability of high-resolution and high soft-tissue contrast imaging provided by MR neurography, the surgical treatment can be guided following the above-described grading systems. The article discusses peripheral nerve anatomy, pathophysiology of nerve injury, traditional grading systems for classifying the severity of nerve injury, and the role of MR neurography in this domain, with respective clinical and surgical correlations, as one follows the anatomic paths of various nerve injury grading systems.

Keywords

Axonotmesis - injury - MR neurography - neuroma‑in‑continuity - neurotmesis - peripheral nerve - Seddon - Sunderland


Publication History

Article published online:
02 August 2021

© 2014. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Martyn CN, Hughes RA. Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry 1997;62:310-8.
  • 2 Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma 1998;45:116-22.
  • 3 Siemionow M, Brzezicki G. Chapter 8: Current techniques and concepts in peripheral nerve repair. Int Rev Neurobiol 2009;87:141-72.
  • 4 Seddon HJ. Three types of nerve injuries. Brain 1943;66:237.
  • 5 Seddon HJ, Medawar PB, Smith H. Rate of regeneration of peripheral nerves in man. J Physiol 1943;102:191-215.
  • 6 Seddon HJ. A review of work on peripheral nerve injuries in Great Britain during World War II. J Nerv Ment Dis 1948;108:160-8.
  • 7 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951;74:491-516.
  • 8 Chhabra A, Andreisek G. Magnetic Resonance Neurography. 1 st ed. Delhi, India: Jaypee Publishers; 2012. pp 1-8.
  • 9 Filler AG, Maravilla KR, Tsuruda JS. MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin 2004;22:643-82.
  • 10 Chhabra A, Williams EH, Wang KC, Dellon AL, Carrino JA. MR neurography of neuromas related to nerve injury and entrapment with surgical correlation. AJNR Am J Neuroradiol 2010;31:1363-8.
  • 11 Glaus SW, Johnson PJ, Mackinnon SE. Clinical strategies to enhance nerve regeneration in composite tissue allotransplantation. Hand Clin 2011;27:495-509.
  • 12 Zhang H, Xiao B, Zou T. Clinical application of magnetic resonance neurography in peripheral nerve disorders. Neurosci Bull 2006;22:361-7.
  • 13 Yan Y, Johnson PJ, Glaus SW, Hunter DA, Mackinnon SE, Tung TH. A novel model for evaluating nerve regeneration in the composite tissue transplant: The murine heterotopic limb transplant. Hand (N Y) 2011;6:304-12.
  • 14 Morisaki S, Kawai Y, Umeda M, Nishi M, Oda R, Fujiwara H, et al. In vivo assessment of peripheral nerve regeneration by diffusion tensor imaging. J Magn Reson Imaging 2011;33:535-42.
  • 15 Lehmann HC, Zhang J, Mori S, Sheikh KA. Diffusion tensor imaging to assess axonal regeneration in peripheral nerves. Exp Neurol 2010;223:238-44.
  • 16 Belzberg AJ. Acute nerve injuries. In: Rengachary SS, Ellenbogen RG, editors. Principles of Neurosurgery. 2 nd ed. Philadelphia: Elsevier Mosby; 2005. p. 387-95.
  • 17 Mackinnon S, Dellon AL. Diagnosis of nerve injury. Surgery of the peripheral nerve. NY: Thieme;.1988. p. 74-8.
  • 18 Mackinnon S. Reconstruction using distal sensory and motor nerve transfers. Instructional course 25. Annual meeting of the American society for the surgery of the hand. Chicago, Illinois, Sept. 2008.
  • 19 Bowen JM. Peripheral nerve electrodiagnostics, electromyography and nerve conduction velocity. In: Hoerlein BF, editor. Canine Neurology. Philadelphia: WB Saunders; 1978. p 254.
  • 20 Dyck PJ. Invited review: Limitations in predicting pathologic abnormality of nerves from the EMG examination. Muscle Nerve 1990;13:371-5.
  • 21 Chuang TY, Chiu FY, Tsai YA, Chiang SC, Yen DJ, Cheng H. The comparison of electrophysiologic findings of traumatic brachial plexopathies in a tertiary care center. Injury. 2002;33:591-5.
  • 22 Viallon M, Vargas MI, Jlassi H, Lövblad KO, Delavelle J. High-resolution and functional magnetic resonance imaging of the brachial plexus using an isotropic 3D T2 STIR (Short Term Inversion Recovery) SPACE sequence and diffusion tensor imaging. Eur Radiol 2008;18:1018-23.
  • 23 Vargas MI, Viallon M, Nguyen D, Beaulieu JY, Delavelle J, Becker M. New approaches in imaging of the brachial plexus. Eur J Radiol 2010;74:403-10.
  • 24 Eppenberger P, Chhabra A, Andreisek G. MR Neurography - Imaging of the peripheral nervous system [German]. Radiologie up2date 2012;12:339-55.
  • 25 Lee PP, Chalian M, Bizzell C, Williams EH, Rosson GD, Belzberg AJ, et al. Magnetic resonance neurography of common peroneal (fibular) neuropathy. J Comput Assist Tomogr 2012;36:455-61.
  • 26 Petchprapa CN, Rosenberg ZS, Sconfienza LM, Cavalcanti CF, Vieira RL, Zember JS. MR imaging of entrapment neuropathies of the lower extremity. Part 1. The pelvis and hip. Radiographics 2010;30:983-1000.
  • 27 Keen NN, Chin CT, Engstrom JW, Saloner D, Steinbach LS. Diagnosing ulnar neuropathy at the elbow using magnetic resonance neurography. Skeletal Radiol 2012;41:401-7.
  • 28 Bäumer P, Dombert T, Staub F, Kaestel T, Bartsch AJ, Heiland S, et al. Ulnar neuropathy at the elbow: MR neurography--nerve T2 signal increase and caliber. Radiology. 2011;260:199-206.
  • 29 Du R, Auguste KI, Chin CT, Engstrom JW, Weinstein PR. Magnetic resonance neurography for the evaluation of peripheral nerve, brachial plexus, and nerve root disorders. J Neurosurg 2010;112:362-71.
  • 30 Aagaard BD, Maravilla KR, Kliot M. MR neurography. MR imaging of peripheral nerves. Magn Reson Imaging Clin N Am 1998;6:179-94.
  • 31 Terzis JK, Novikov ML. Radiological and electrophysiological detection of nerve roots avulsion in patients with birth related brachial plexus paralysis. Semin Plast Surg 2005;19:24-41.
  • 32 Thakkar RS, Del Grande F, Thawait GK, Andreisek G, Carrino JA, Chhabra A. Spectrum of high-resolution MRI findings in diabetic neuropathy. AJR Am J Roentgenol 2012;199:407-12.
  • 33 Chhabra A, Thakkar RS, Andreisek G, Chalian M, Belzberg AJ, Blakeley J, et al. Anatomic MR imaging and functional diffusion tensor imaging of peripheral nerve tumors and tumorlike conditions. AJNR Am J Neuroradiol 2013;34:802-7.
  • 34 Nielsen YW, Thomsen HS. Contrast-enhanced peripheral MRA: Technique and contrast agents. Acta Radiol 2012;53:769-77.