Orthonotes
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Peripheral Nerve Injury — Sunderland Classification

Seddon: neuropraxia, axonotmesis, neurotmesis; Sunderland expands to 5 degrees based on structural disruption. Degree I: conduction block; II: axonal disruption intact endoneurium; III: endoneurial disruption; IV: perineurial disruption intact epineurium; V: complete transection. Prognosis worsens with increasing degree; surgical exploration/grafting typically for IV–V. EMG/NCS guide prognosis and timing; Tinel’s progression marks regeneration (~1–3 mm/day).

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Seddon: neuropraxia, axonotmesis, neurotmesis; Sunderland expands to 5 degrees based on structural disruption. Degree I: conduction block; II: axonal disruption intact endoneurium; III: endoneurial disruption; IV: perineurial disruption intact epineurium; V: complete transection. Prognosis worsens with increasing degree; surgical exploration/grafting typically for IV–V. EMG/NCS guide prognosis and timing; Tinel’s progression marks regeneration (~1–3 mm/day).
MCQs

High-yield practice questions

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Question 1

What is the primary structural disruption in Sunderland Grade I nerve injury?

Question 2

In Sunderland Grade II nerve injury, which structure remains intact?

Question 3

Which Sunderland grade corresponds to complete transection of the nerve?

Question 4

What is the expected recovery time for a Sunderland Grade I injury?

Question 5

Which type of nerve injury is characterized by misdirection of regenerating axons?

Question 6

What is the primary mechanism of recovery in Sunderland Grade II injuries?

Question 7

What is the main prognostic factor in Sunderland Grade IV injuries?

Question 8

What is the typical rate of axonal regeneration following a peripheral nerve injury?

Question 9

What is the significance of Tinel's sign in the context of peripheral nerve injury?

Question 10

Which Sunderland grade is characterized by intact endoneurium but disrupted perineurium?