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

Chhabra A, Ahlawat S, Belzberg A, Andreseik G - Indian J Radiol Imaging (2014)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, Baltimore, MD, USA.

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.

No MeSH data available.


Related in: MedlinePlus

Moderate to severe stretch injury (Sunderland grade III). A 51 year old male, status post motor vehicle accident, ankle fixation, and knee arthroscopy developed left sciatic distribution weakness over the course of treatment. The patient continued to have weakness for 6 months from the original injury and severe left sciatic neuropathy on EMG. Axial T2 SPAIR image (A) demonstrates moderate left sciatic hyperintensity with homogeneous signal intensity and preserved fascicular appearance (arrow). Maximum Intensity Projection (MIP) reconstruction from coronal 3D STIR SPACE (B) confirms asymmetric hyperintensity of the left sciatic nerve (arrows). Coronal fat-suppressed proton density image of the lower extremities (C) shows subacute denervation of the left thigh muscles. Notice the abnormal left sciatic nerve (arrow) hyperintensity. Findings are in keeping with moderate to severe stretch injury (Sunderland grade III injury), which was managed conservatively resulting in slow and incomplete recovery
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Figure 6: Moderate to severe stretch injury (Sunderland grade III). A 51 year old male, status post motor vehicle accident, ankle fixation, and knee arthroscopy developed left sciatic distribution weakness over the course of treatment. The patient continued to have weakness for 6 months from the original injury and severe left sciatic neuropathy on EMG. Axial T2 SPAIR image (A) demonstrates moderate left sciatic hyperintensity with homogeneous signal intensity and preserved fascicular appearance (arrow). Maximum Intensity Projection (MIP) reconstruction from coronal 3D STIR SPACE (B) confirms asymmetric hyperintensity of the left sciatic nerve (arrows). Coronal fat-suppressed proton density image of the lower extremities (C) shows subacute denervation of the left thigh muscles. Notice the abnormal left sciatic nerve (arrow) hyperintensity. Findings are in keeping with moderate to severe stretch injury (Sunderland grade III injury), which was managed conservatively resulting in slow and incomplete recovery

Mentions: Type I-III injuries [Figures 2–6], which are commonly treated medically, may cause diffuse nerve swelling, but there is no focal nerve enlargement or heterogeneous signal alteration in the enlarged nerve. Regional muscle denervation change is absent in neurapraxia. Endoneurium is not visible with current magnetic resonance imaging (MRI) techniques; therefore, differentiation of grade II and III injuries is not possible on MRN. However, in most instances, both conditions are treated medically. Regional muscle denervation changes cannot be used to distinguish Sunderland grade III from grade IV injury and direct assessment of peripheral nerve is essential to embark upon accurate diagnosis.


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

Chhabra A, Ahlawat S, Belzberg A, Andreseik G - Indian J Radiol Imaging (2014)

Moderate to severe stretch injury (Sunderland grade III). A 51 year old male, status post motor vehicle accident, ankle fixation, and knee arthroscopy developed left sciatic distribution weakness over the course of treatment. The patient continued to have weakness for 6 months from the original injury and severe left sciatic neuropathy on EMG. Axial T2 SPAIR image (A) demonstrates moderate left sciatic hyperintensity with homogeneous signal intensity and preserved fascicular appearance (arrow). Maximum Intensity Projection (MIP) reconstruction from coronal 3D STIR SPACE (B) confirms asymmetric hyperintensity of the left sciatic nerve (arrows). Coronal fat-suppressed proton density image of the lower extremities (C) shows subacute denervation of the left thigh muscles. Notice the abnormal left sciatic nerve (arrow) hyperintensity. Findings are in keeping with moderate to severe stretch injury (Sunderland grade III injury), which was managed conservatively resulting in slow and incomplete recovery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126136&req=5

Figure 6: Moderate to severe stretch injury (Sunderland grade III). A 51 year old male, status post motor vehicle accident, ankle fixation, and knee arthroscopy developed left sciatic distribution weakness over the course of treatment. The patient continued to have weakness for 6 months from the original injury and severe left sciatic neuropathy on EMG. Axial T2 SPAIR image (A) demonstrates moderate left sciatic hyperintensity with homogeneous signal intensity and preserved fascicular appearance (arrow). Maximum Intensity Projection (MIP) reconstruction from coronal 3D STIR SPACE (B) confirms asymmetric hyperintensity of the left sciatic nerve (arrows). Coronal fat-suppressed proton density image of the lower extremities (C) shows subacute denervation of the left thigh muscles. Notice the abnormal left sciatic nerve (arrow) hyperintensity. Findings are in keeping with moderate to severe stretch injury (Sunderland grade III injury), which was managed conservatively resulting in slow and incomplete recovery
Mentions: Type I-III injuries [Figures 2–6], which are commonly treated medically, may cause diffuse nerve swelling, but there is no focal nerve enlargement or heterogeneous signal alteration in the enlarged nerve. Regional muscle denervation change is absent in neurapraxia. Endoneurium is not visible with current magnetic resonance imaging (MRI) techniques; therefore, differentiation of grade II and III injuries is not possible on MRN. However, in most instances, both conditions are treated medically. Regional muscle denervation changes cannot be used to distinguish Sunderland grade III from grade IV injury and direct assessment of peripheral nerve is essential to embark upon accurate diagnosis.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, Baltimore, MD, USA.

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.

No MeSH data available.


Related in: MedlinePlus