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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

Mixed/grade VI injury. A 34 year old woman with history of prior injury to the wrist presented with ulnar neuropathy clinically and on EMG. Axial T2 SPAIR (A) and axial T1W (B) images show homogeneous hyperintensity, uniform fascicular enlargement, and enlargement of the ulnar nerve. Notice thickened hypointense epineurium with perineural scarring from prior injury (B). MIP reconstruction form sagittal 3D DW PSIF image (C) demonstrates hyperintense enlarged and tortuous ulnar nerve with fascicular continuity at the site of injury (large arrows) with normal nerve distally (small arrow) and denervation edema of hypothenar muscles (double small arrows)
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Figure 10: Mixed/grade VI injury. A 34 year old woman with history of prior injury to the wrist presented with ulnar neuropathy clinically and on EMG. Axial T2 SPAIR (A) and axial T1W (B) images show homogeneous hyperintensity, uniform fascicular enlargement, and enlargement of the ulnar nerve. Notice thickened hypointense epineurium with perineural scarring from prior injury (B). MIP reconstruction form sagittal 3D DW PSIF image (C) demonstrates hyperintense enlarged and tortuous ulnar nerve with fascicular continuity at the site of injury (large arrows) with normal nerve distally (small arrow) and denervation edema of hypothenar muscles (double small arrows)

Mentions: Grade VI injury can demonstrate a combination of findings of above grades; however, the diagnostic clues include epineurial thickening due to direct injury, history or mechanism of external injury, and internal nerve heterogeneity from hemorrhage or fibrosis [Figure 10].


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)

Mixed/grade VI injury. A 34 year old woman with history of prior injury to the wrist presented with ulnar neuropathy clinically and on EMG. Axial T2 SPAIR (A) and axial T1W (B) images show homogeneous hyperintensity, uniform fascicular enlargement, and enlargement of the ulnar nerve. Notice thickened hypointense epineurium with perineural scarring from prior injury (B). MIP reconstruction form sagittal 3D DW PSIF image (C) demonstrates hyperintense enlarged and tortuous ulnar nerve with fascicular continuity at the site of injury (large arrows) with normal nerve distally (small arrow) and denervation edema of hypothenar muscles (double small arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 10: Mixed/grade VI injury. A 34 year old woman with history of prior injury to the wrist presented with ulnar neuropathy clinically and on EMG. Axial T2 SPAIR (A) and axial T1W (B) images show homogeneous hyperintensity, uniform fascicular enlargement, and enlargement of the ulnar nerve. Notice thickened hypointense epineurium with perineural scarring from prior injury (B). MIP reconstruction form sagittal 3D DW PSIF image (C) demonstrates hyperintense enlarged and tortuous ulnar nerve with fascicular continuity at the site of injury (large arrows) with normal nerve distally (small arrow) and denervation edema of hypothenar muscles (double small arrows)
Mentions: Grade VI injury can demonstrate a combination of findings of above grades; however, the diagnostic clues include epineurial thickening due to direct injury, history or mechanism of external injury, and internal nerve heterogeneity from hemorrhage or fibrosis [Figure 10].

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