Abstract
Leprosy is a stigmatizing and neglected tropical disease still prevalent in various countries of the world. According to WHO reports from 159 countries, 208,619 new leprosy cases were reported globally in 2018, of which Brazil, India, and Indonesia accounted for 79.6%. With the preference of M. leprae for cooler areas, peripheral nephropathy of the hand and feet are commonly seen in leprosy patients. Peripheral nerve involvement may result in the development of deformities. The ulnar nerve is commonly involved followed by median nerve, common peroneal nerve, facial nerve and the radial nerve in descending order. High doses of steroids are commonly given in peripheral neuropathies, but 70–75% cases still develop deformity with this treatment. Surgical decompression of involved nerves, though not so common, is another modality attempted for nerve damage prevention. In the present study, we compared steroid therapy alone with steroids plus surgical decompression, for carpal tunnel syndrome in leprosy cases. Methods 52 patients with involvement of 70 median nerves (18 bilateral) were enrolled. They had palpable median nerves, along with sensory and motor loss. 16 patients were lost to follow up by 2 years, so that 36 patients with 50 median nerves (14 bilateral) remained for review. These cases were randomly divided into two groups: one group was given steroids while the second group was given steroids along with surgical nerve decompression. The results were evaluated for improvement or deterioration of the sensory and motor symptoms, along with pain. Conclusion The results support the proposition that surgical decompression of the nerve together with steroid treatment, is a better option to prevent the progression of deformities due to median nerve involvement, than steroids alone.
Highlights
The median nerve is the second most common nerve to be affected in leprosy
The results support the proposition that surgical decompression of the nerve together with steroid treatment, is a better option to prevent the progression of deformities due to median nerve involvement, than steroids alone
It clinically presents as the carpal tunnel syndrome, the wrist being the usual site of its involvement in leprosy
Summary
The median nerve is the second most common nerve to be affected in leprosy. It clinically presents as the carpal tunnel syndrome, the wrist being the usual site of its involvement in leprosy. When the median nerve is involved, the inflammation builds up in the nerve tissue causing its entrapment internally due to oedema and externally due to its anatomical position, resulting in nerve tissue compression This process of inflammation clinically manifests in symptoms like paresthesia, sensory loss, motor damage (in the form of paralysis of abductor pollicis and opponens pollicis, leading to loss of abduction and opposition of the thumb) along with thenar muscle wasting. This presents as functional loss affecting the pinch and grasp functions. One of the early signs often noted is tenderness when pressed on the inflamed nerve
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
