This site is intended for healthcare professionals
General Practice Notebook
Medical search

Sunderland classification of nerve injuries

FREE subscriptions for doctors and students... click here
You have 3 open access pages.

Sunderland described a classification of nerve injuries in 1951 that correlates pathological changes with prognosis. The grades are:

  • first degree injury:
    • demyelinated nerve
    • a physiological local conduction block
    • neuropraxia in the Seddon scheme
    • conservative management
    • recovery expected over weeks to months
  • second-degree injury:
    • some axons disrupted
    • endoneurial sheaths and surrounding connective tissue layers remain intact
    • Wallerian degeneraiton distally
    • equivalent to axonotmesis in Seddon scheme
    • treatment is conservative
    • regeneration of axons can be followed clinically by an advancing Tinel's sign
    • complete recovery can be expected over months
  • third-degree injury:
    • axons and endoneurial sheaths disrupted
    • scarring replaces existing structures
    • perineurium and connective tissue layers outside of this remains
    • most of these injuries will recover spontaneously but partially
  • fourth-degree injury:
    • axon, endoneurium and perineurium disrupted
    • scarring replaces existing structures
    • epineurium remains
    • scar blocks all neuronal regeneration
    • no recovery likely without operative management
  • fifth-degree injury:
    • nerve transection
    • all structures including epineurium divided
    • no recovery expected without operative management

Sixth-degree injury was subsequently added to the scheme by Susan Mackinnon. This describes a nerve injury with features of two or more of the above categories.


General Practice Notebook
General Practice Notebook
The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2016 Oxbridge Solutions LtdĀ®. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions LtdĀ® receives funding from advertising but maintains editorial independence. GPnotebook stores small data files on your computer called cookies so that we can recognise you and provide you with the best service. If you do not want to receive cookies please do not use GPnotebook.