Injury to Nerves

2BPT Lecture
October 2008
 A nerve consists of a mixture of myelinated and unmyelinated
nerve fibers that are grouped into fascicles by connective
tissue sheaths- the endoneurium, perineurium and epineurium
Traumatic nerve injuries may be classified according to the
degree of severity of the injury:
 Nerve Injury Classification

Nerve Injury Classification

Sunderland Seddon Injury Recovery Potential

Ionic block;
I Neuropraxia possible segmental Full
demyelinization

Axon severed;
II Endoneurial tube Full
intact

III Axonotmesis Endoneurial tube torn Slow; incomplete

Neuroma-in-
IV Only epineurium intact
continuity

V Loss of Continuity None

Neurotmesis
VI Combination of above Unpredictable
Traumatic Neuropathies

1.  Compression neuropathy is associated with

neuropraxia e.g. Saturday night palsy, carpal
tunnel syndrome, metatarsalgia
2.  Crush injuries are more severe and result in
axonotmesis.
3.  Cut injuries as in lacerations and avulsions of
nerves result in neurotmesis
Two types of reactions are seen in peripheral nerve injury

 Injury of the Schwann cell

leads to a loss of myelin,
referred to as segmental
demyelination.
 The loss of the myelin
sheath causes failure of
nerve impulse conduction
Injury of the neuron and its axon leads to
Wallerian degeneration.

 Skeletal muscles undergo

denervation atrophy
following loss of axons
 may be followed by
axonal regeneration
and reinnervation of
muscle.
 Wallerian degeneration

Within a day, the

axon begins to break
down, and the
affected Schwann
cells begin to
catabolize myelin and
later engulf axon
fragments, forming
small oval
compartments (myelin
ovoids).
 Axonal regeneration

Later macrophages are

recruited into the area
and participate in the
phagocytosis of axonal
and myelin-derived
debris.
The regrowth of axons is a
slow process on the
order of 1 mm per day.
Traumatic neuromas develop as a result of sprouting of a tangled
mass of axonal processes between badly aligned nerve ends
 Entrapment and compression of nerves is commonly seen in
several sites:

 Nerve roots are

compressed in
intervertebral
foramina by
prolapsed
intervertebral discs
or osteophytes due
to osteoarthritis of
the spine
Sciatca
Carpal tunnel syndrome

 The median nerve is

compressed by
swellings in the
carpal tunnel at the
wrist
 Carpal tunnel Syndrome

 Computer work often

involves at least one of
the following factors that
predispose someone to
injury:
 Working in an awkward
position for long periods
of time pinches nerve
groups.

Repetitive stress injury

Stretch injury to brachial plexus
Stretch injury
Peroneal Nerve Palsy

 Injury to the peroneal

nerve results in significant
disability.  There is loss of
capacity to lift the foot
and toes (dorsiflexion), as
well as loss of the ability
to evert the foot. 
 The patient finds it
difficult to walk and when
attempting to do so, drags
the foot on the ground
when bringing it forward. 
The patient senses a loss
of control of the foot.