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Table 1 Seddon's and Sunderland's classifications of nerve injuries

From: Intraoperative brachial plexus injury during emergence following movement with arms restrained: a preventable complication?

Injury Pathophysiology Exam Findings Nerve Studies Prognosis
Neurapraxia (Seddon)
First Degree (Sunderland)
Reversible conduction block. Local compression with ischemia; selective demyelination of the axon sheath possible. Motor paralysis: complete
Muscle atrophy: minimal
Sensory alteration: minimal, often with sparing
Distal nerve conduction: present.
Motor unit action potential: absent.
Fibrillation: occasionally detectable.
Good prognosis. Full recovery usually within days to 2–3 weeks
Axonotmesis (Seddon)
Second Degree (Sunderland)
More severe injury with disruption of the axon and myelin sheath. Motor paralysis: complete
Muscle atrophy: progressive
Sensory alteration: complete
Distal nerve conduction: absent.
Motor unit action potential: absent.
Fibrillation: present.
Fair prognosis. Full recovery possible without surgery; recovery at 1 mm/day
Third Degree (Sunderland) Endoneurium disrupted; epineurium and perineurium intact. Same Same Same
Fourth Degree (Sunderland) Endoneurium and perineurium disrupted; epineurium intact. Same Same Same
Neurotmesis (Seddon)
Fifth Degree (Sunderland)
Complete nerve division with disruption of the endoneurium, perineurium, and epineurium. Same Same Poor prognosis. Requires surgery with varying degrees of impairment present even after surgery