Prevalence of leprous neuropathy determined by neurosensory testing in an endemic zone in Ecuador: Development of an algorithm to identify patients benefiting from early neurolysis.

The success of a microneurosurgical intervention in leprous neuropathy (LN) depends on the diagnosis of chronic compression before irreversible paralysis and digital loss occurs. In order to determine the effectiveness of a different approach for early identification of LN, neurosensory testing with the Pressure-Specified Sensory Device™ (PSSD), a validated and sensitive test, was performed in an endemic zone for leprosy. A cross-sectional study was conducted to analyze a patient sample meeting the World Health Organization (WHO) criteria for Hansen's disease. The prevalence of LN was based on the presence of ≥1 abnormal PSSD pressure threshold for a two-point static touch. A total of 312 upper and lower extremity nerves were evaluated in 39 patients. The PSSD found a 97.4% prevalence of LN. Tinel's sign was identified in 60% of these patients. An algorithm for early identification of patients with LN was proposed using PSSD testing based on the unilateral screening of the ulnar and deep peroneal nerves.

Peripheral neuropathy of the upper extremity: medical comorbidity that confounds common orthopedic pathology.

In the orthopedic patient, the diagnosis of a compression neuropathy may be straightforward. However, various medical comorbidities can obscure this diagnosis. It is paramount for the practicing orthopedic surgeon to have an appreciation for the medical pathology of common axonal neuropathies to properly diagnose, treat, and refer a patient with altered sensation in the upper extremity. The prevalence of diabetes in the United States is 10%, and roughly 20% of diabetic patients have peripheral neuropathy. In addition to diabetes, 32% of heavy alcohol users present with polyneuropathy. With advancements in the treatment of human immunodeficiency virus/acquired immunodeficiency syndrome clinicians may see the long-term effects of the virus manifested as axonal neuropathies and extreme allodynia. In some regions of the world, Hansen's disease usurps diabetes as the most common cause of polyneuropathy. Based on patient demographics and social habits, Lyme disease, multiple sclerosis, and syphilis can all manifest as polyneuropathies. Understanding the common medical causes of neuropathy will aid the orthopedic surgeon in differentiating simple compression neuropathies from diseases mimicking or confounding them.

Flexor carpi ulnaris transfer successfully used to gain strengthening of flexor digitorum superficialis tendons.

Transfer of the flexor carpi ulnaris (FCU) to replace the power of the paralysed extensor digitorum communis and extensor pollicies longus has been described in the literature. However the use of FCU for strengthening flexor digitorum superficialis (FDS) is relatively not widely known. In this report the use of the technique is dicussed to successfully restore the strength of the fingers of a leprosy patient with considerable partial high median palsy to this patient's urgent need and at his request. This surgical procedure and results of a single case are shown as a preliminary report.

Restoration of plantar sweat secretion in the feet of leprosy patients.

As part of the studies on nerve damage and its consequences in leprosy, the status of sweat gland function in the anaesthetic sole of the feet of leprosy patients was investigated qualitatively and semi-quantitatively, before and after surgical decompression of the posterior tibial neurovascular bundle. Sweat prints of the feet of the patients were obtained pre-operatively and postoperatively on Whatman's No. 1 filter paper. The paper was treated with one percent Ninhydrin and the intensities of the Ninhydrin positive areas were quantitated. Forty one feet of thirty six patients have been studied in this manner. Sweat print analysis of twenty normal people have also been done, and included for comparison. This operative procedure has been found to effect an improvement in the sweat gland function in the feet of more than fifty percent of leprosy patients studied so far.

Surgical decompression of nerves in leprosy. An attempt at prevention of deformities. A clinical, electrophysiologic, histopathologic and surgical study.

Forty-five leprosy patients were electively subjected to extraneural decompression and medial longitudinal epineurotomy in anticipation that relief from compression may favorably alter the course of the disease by retrieving reversibly damaged nerve bundles and preventing further progression of disease. Neurolysis was performed in 69 nerves, including the ulnar, median, lateral popliteal and posterior tibial. The period of follow-up was up to three years. Excellent sensory recovery was seen in most patients while motor recovery was less predictable. The recovery seen was better in those patients taking treatment early and also at the age the surgery was carried out. Motor damage appeared more severe in the 10-20 year age group. Most of the beneficial effects can be explained on the basis of increased vascularity due to relief from extraneural and intraneural compression.