Leprosy Mailing List – January 11, 2015
Ref.: (LML) BT Hansen's Disease and nerve abscesses - surgical intervention or MDT alone?
From: Dinkar Palande, Pondicherry, India
Dear Pieter,
I have the following comments, suggestions - with ref. to the information that is made available: Please pass them on soon.
- It is not clear if the person is on prednisolon. He should be. I suggest 5mgms tds 5 days and then taper monitoring the sensory/motor assessments using graded nylons. Unless graded nylons are used one would not know if there is early nerve function deficit.
- Is there pain in the ulnar nerve above the elbow on flexion of the elbow? With or without pronation of the forearm and closed fist? In any case please splint the elbow in a comfortable position.
- The abscess in the ulnar nerve above the elbow is very likely to be in the dorsal cutaneous branch of the nerve which often joins the ulnar above the elbow.
- No need to drain the abcesses for the present. Go on observing with very frequent monitoring - Pain, tenderness, stretch sign, sensory motor evaluation etc.
- In case abscess evacuation (s) is decided on, mainly because of any signs of early or increasing nerve deficit. PLEASE ensure that the surgery is done under magnification and by a surgeon USED to doing these nerve surgeries. It is not difficult to damage a nerve.
best wishes
dinkar d Palande
from dinkar d. palande
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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