Abstract
Background:Peripheral nerve involvement results in deformities in leprosy. High doses (40-60 mg) of steroids along with anti-leprosy drugs is the preferred treatment, even though 70-75% cases still develop deformity. Early surgical decompression of nerves gives better chances of preventing deformity. We have analyzed the role of early surgical decompression in such cases.Materials and Methods:Five hundred nerves (386 ulnar, 60 median and 54 posterior tibial) not responding to the medical treatment in 12 weeks, were undertaken for external and internal nerve trunk decompression. These cases were followed up for five to 20 years at various intervals.Results:The pain in nerve (neuralgia) recovered in all cases of ulnar, median and posterior tibial nerves. Full sensory recovery to pinprick and feather or cotton wool touch was seen in 50% cases of all the three nerves. Twenty percent cases maintained the preoperative levels of sensory status. Plantar ulcers healed within six months after decompression of posterior tibial nerve but six cases showed recurrence. Overall motor recovery in ulnar nerve was 89% and 70% in median nerve.Conclusions:The sensory recovery restores protective sensation which prevents secondary injuries. The improvement of motor power gives better function and improves the appearance, which in the absence of surgical intervention was not possible.
Highlights
Leprosy is a disease of nerve and is known for its deformities
The peripheral nerve involvement in leprosy is common and results in damage leading to various deformities
The ulnar nerve can be entrapped by medial intramuscular septum under deep fascia of anterior medial compartment of upper arm, in the distal fibro-osseous tunnel, and between the tendinous fibers of origin of two heads of flexor carpi ulnaris
Summary
Leprosy is a disease of nerve and is known for its deformities. The peripheral nerve involvement in leprosy is common and results in damage leading to various deformities. Involved nerves in upper limb are ulnar and median and in lower limbs are posterior tibial and lateral poplitial in that order (Cochrane and Davey 1964). It is known that even in non leprosy situations and conditions, nerves are known to get entrapped at various anatomical sites clinically manifesting in paresthesia and paresis. It is known that inflamed swollen nerves due to any cause are more prone to entrapment (Husain et al 1998, Husain et al 1997, Husain et al 1998, Pandya 1978, Parikh et al 1968). Swollen edematous nerves passing through tunnel-like structures suffer by getting compressed (entrapment neuropathy).
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