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The Classification of Nerve Injury Revisited: Sunderland 0-VI
Stahs Pripotnev1, Noah S Llaneras2, Bob Teixeira2
1Plastic and Reconstructive Surgery, Western University, Roth McFarlane Hand and Upper Limb Centre, London, ON, Canada.
Plastic Surgery (Oakville, Ont.)
|October 27, 2025
Summary
This study revisits nerve injury classification systems, adding grades 0 and VI to the existing framework. The updated classification aids clinicians in assessing, predicting, and managing nerve injury patients more effectively.
Area of Science:
- Neurology
- Neurosurgery
- Regenerative Medicine
Background:
- Established nerve injury classifications by Seddon and Sunderland have been used for 70 years.
- Advances in nerve pathophysiology, healing, electrodiagnostics, and surgical options necessitate an updated classification.
Purpose of the Study:
- To revisit and enhance existing nerve injury classification systems.
- To incorporate modern knowledge into a framework for the current era of nerve surgery.
Main Methods:
- A comprehensive review of existing nerve injury classification systems.
- Expansion of Sunderland's framework with new grades and a simplified approach.
Main Results:
- Addition of Grade 0 (no injury) and Grade VI (complete transaction) to the classification.
- Development of a simplified, patient- and physician-oriented classification reflecting prognosis, recovery time, and degree of recovery.
Conclusions:
- The proposed enhanced nerve injury classification provides a more comprehensive and practical tool.
- This framework assists clinicians in improved patient assessment, prognostication, and management strategies for nerve injuries.
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