A Classification of Peripheral Nerve Injuries Producing Loss of Function

Sunderland, Sydney

doi:10.1093/brain/74.4.491

Cited by 1,253 publications

(611 citation statements)

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“…In acute stretch injury, peripheral nerves are viscoelastic, and are prone to rupture when the limit of elasticity is exceeded [10,28]. On the other hand, stress-relaxation phenomena can decrease tensile stress if rupture does not occur [16].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, stress-relaxation phenomena can decrease tensile stress if rupture does not occur [16]. Acute stretch beyond 6-8% causes ischemia [ 15,17,3 11 or axonal injury, and may result in Wallerian degeneration [28]. Indeed, even intermediate-rate nerve elongation (more than 1 mm/day) causes more severe demyelination, axonal degeneration, and electrophysiologic disturbance, which require a longer period for repair [ 1, 2,20].…”

Section: Discussionmentioning

confidence: 99%

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Internodes can nearly double in length with gradual elongation of the adult rat sciatic nerve

Abe

Ochiai

Ichimura

et al. 2004

Journal Orthopaedic Research

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Leg lengthening procedure is used increasingly to treat leg length discrepancy and some forms of dwarfism. We investigated adaptation in rat sciatic nerve to the gradual nerve elongation that occurs with leg lengthening. Indirect nerve elongation was produced by leg lengthening by a total of 15, 30, 45, or 70 mm at a rate of 1 m d d a y . One day after leg lengthening completion, transverse semithin sections of sciatic nerve were prepared and examined; a teased-fiber study also was performed. Elongation decreased axon diameter, but not significantly. In teased-fiber preparations, internodal length was increased by 93%, and the longest internode measured 3000 pm after leg lengthening by 70 mm. Slopes of fiber diameter-internodal length regression lines increased with increasing elongation. Paranodal demyelination caused by nerve elongation worsened as elongation increased, stimulating remyelination (i.e., intercalation of a segment). Only 0.8% of axons showed degeneration in the group with 70 mm of elongation. We concluded that adult rat sciatic nerve can adapt itself to leg lengthening procedure with even doubling internodal length.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Internodes can nearly double in length with gradual elongation of the adult rat sciatic nerve

Abe

Ochiai

Ichimura

et al. 2004

Journal Orthopaedic Research

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“…Epineurium, a layer of dense connective tissue, covers and holds together these bundles to create the outer surface of nerves ( Figure 1). published a 3-point nerve injury scale in 1943 [4], and in 1951, Sir Sydney Sunderland published a 5-point scale which gave more resolution to Seddon's scale (Table 1) [5]. These scales classify nerve injury as a function of temperature [6,7]:…”

Section: Nerve Anatomymentioning

confidence: 99%

“…Studies have shown axon regeneration will deviate from the disrupted endoneurial tube and into the intrafasicular structure, which could lead to a potential neuroma formation [8]. Functional, but not complete, reinnervation of the target site can occur over a period of months to year(s) [5,6,8].…”

Section: Nerve Anatomymentioning

confidence: 99%

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Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

Ilfeld

Preciado

Trescot

2016

Expert Review of Medical Devices

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Introduction: Cryoneurolysis is the direct application of low temperatures to reversibly ablate peripheral nerves to provide pain relief. Recent development of a handheld cryoneurolysis device with small gauge probes and an integrated skin warmer broadens the clinical applications to include treatment of superficial nerves, further enabling treatments for pre-operative pain, post-surgical pain, chronic pain, and muscle movement disorders. Areas covered: Cryoneurolysis is the direct application of cold temperatures to a peripheral nerve, resulting in reversible ablation due to Wallerian degeneration and nerve regeneration. Use over the last 50 years attests to a very low incidence of complications and adverse effects. Cryoprobes have traditionally been applied through a surgical incision; but, recent technical advances allow percutaneous administration. A new hand-held device is now approved for use within the United States. Cryoneurolysis has been used to treat postoperative and chronic pain states as well as spasticity. Expert commentary: Changes in the US healthcare system such as a push for the reduction of opioid use and the incorporation of Diagnostic Related Group codes, as well as recent technological advances including a handheld unit that allows for treatment of superficial nerves while protecting the skin from damage, may contribute to the resurgence of cryoneurolysis for the treatment of peripheral nerves. ARTICLE HISTORY

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