Grading Systems for Peripheral Nerve Disorders
Pathophysiological basis for peripheral nerve grading scale :
Degree of severity: Pathophysiology: Clinical:
Mild Blood-nerve barrier breakdown Symptoms, no signs
Moderate Demyelination Symptoms, signs of abnormal threshold
Severe Axonal loss Symptoms, signs of decreased innervation density
‘British’ System :
Sensory recovery within the autonomous zone of the nerve:
S0 absence of sensibility
S1 recovery of deep cutaneous pain sensibility
S1+ recovery of superficial pain sensibility
S2 return of some degree of superficial pain and tactile sensibility
S2+ as in S2 but with an over response
S3 return of superficial pain and tactile sensitivity with no over response
S3+ As in S3 but good stimulus localisation and some two-point discrimination
S4 complete recovery
Motor recovery of muscles innervated by this nerve
M0 no contraction of any muscle
M1 perceptible contraction in proximal muscles
M2 perceptible contraction in proximal and distal muscle
M3 M2 plus all muscles can act against resistance
M4 M3 plus synergistic and isolated movements are possible
M5 complete recovery
Numerical Grading Scale for the Posterior Tibial Nerve at the Ankle* :
Sensory Score: Motor Score: Description of impairment:
1 Paraesthesia, intermittent
2 Abnormal pressure threshold (Pressure Specified Sensory Device):
<45 yrs old – <6.3mm at 6.8-30g/mm2
>45 yrs old – <8.3mm at 25-40g/ mm2
3 Weakness
4 Abnormal pressure threshold (Pressure Specified Sensory Device):
<45 yrs old – <6.3mm at >30g/mm2
>45 yrs old – <8.3mm at >40g/ mm2
5 Paraesthesia, persistent
6 Abnormal pressure threshold (Pressure Specified Sensory Device):
<45 yrs old – <6.3mm at <10/mm2
>45 yrs old – <8.3mm at <11/ mm2
7 Muscle wasting (1-2/4)
8 Abnormal pressure threshold (Pressure Specified Sensory Device):
<45 yrs old – <10.1mm at any g/mm2
>45 yrs old – <11.1mm at any g/ mm2
9 Anaesthesia
10 Muscle wasting (3-4/4)
*Pressure Specifying Sensory Device – an electromechanical computer assisted device
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