Nerve injury classification

Neuropraxia - physiologic block of nerve conduction within an axon without

any anatomical interruption.

● Many infants with birth brachial plexus injury have neuropraxia and
recover spontaneously because neuropraxia tends to disappear
within 4-6 weeks.

Axonotmesis - anatomical interruption of the axon with no or only partial

interruption of the connective tissue framework.

● This type of nerve injury requires regrowth of the axon to the target
muscle, which takes a considerable amount of time. This regrowth
can be inhibited by scar formation. Whether patients with
axonotmesis will require surgical treatment depends on the number
of disrupted axons and the extent of scar formation at the site of
nerve injury.
● When an axon is disrupted, there is a 2-4 week delay before the axon
starts to regenerate. Axons grow in adults at about 1 inch per month,
which means many months will be required for the axon to grow
down to the muscles in the arms. In infants, however, the axon may
regenerate more rapidly, and the distance to be covered is much
less. When a muscle loses its innervation, the nerve receptors will
disappear over a period of 12 to 18 months. This affects the timing of
neurosurgical intervention, because a repair done too late will not
have receptors in the muscles for the growing nerves.

Neurotmesis - complete anatomical disruption of the both the axon and all
of the surrounding connective tissue (rupture of the nerve).

● Birth brachial plexus injury is sometimes associated with

neurotmesis. This is the most severe type of nerve injury and has no
chance of spontaneous recovery. Early surgical treatment is
necessary.