Nerve injuries: Sunderland grade IV: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Nerve injuries: Sunderland grade IV

Sample item

After a traction injury to the median nerve, there is loss of axons, endoneurium and perineurium, but the epineurium is intact, and a neuroma in continuity forms. Which grade is this and what is the usual outcome?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Sunderland grade IV; spontaneous recovery is poor and surgical repair is usually needed

In Sunderland grade IV only the epineurium remains, so regenerating axons are blocked by scar and a neuroma in continuity forms. The nerve will not recover satisfactorily without excision of the damaged segment and repair or grafting. Grades I and II recover spontaneously because the connective tissue framework is preserved.

Option by option

  • A. Sunderland grade IV; spontaneous recovery is poor and surgical repair is usually needed (correct)

    Correct. Grade IV leaves only epineurium intact, with scar blocking recovery.

  • B. Sunderland grade II; full recovery at 1 mm per day

    Grade II keeps all connective tissue layers and therefore recovers well.

  • C. Sunderland grade V; the nerve is transected and graft is impossible

    Grade V is complete transection, and grafting remains possible.

  • D. Sunderland grade I; complete recovery in weeks

    Grade I has intact axons and recovers quickly.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Sunderland grade IV; spontaneous recovery is poor and surgical repair is usually needed. In Sunderland grade IV only the epineurium remains, so regenerating axons are blocked by scar and a neuroma in continuity forms.

Why is "Sunderland grade II; full recovery at 1 mm per day" not the answer?

Grade II keeps all connective tissue layers and therefore recovers well.

Why is "Sunderland grade V; the nerve is transected and graft is impossible" not the answer?

Grade V is complete transection, and grafting remains possible.

Why is "Sunderland grade I; complete recovery in weeks" not the answer?

Grade I has intact axons and recovers quickly.

What concept does this question test?

It tests Nerve injuries: Sunderland grade IV in Orthopaedics. The nerve will not recover satisfactorily without excision of the damaged segment and repair or grafting. Grades I and II recover spontaneously because the connective tissue framework is preserved.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nerve injuries: Sunderland grade IV?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.