Fw: Ref.: (LML) Median nerve damage in leprosy

 

Leprosy Mailing List – January 10,  2022

 

Ref.:  (LML) Median nerve damage in leprosy

 

From:  Michel-Yves Grauwin, Lille, France

Dear Pieter, dear colleagues,

Thanks to Doctor NOTO (LML January 7) for his observation of the tenderness in the median nerve territory.

If we look closely at the image, there does not seem to be any muscular involvement of the median nerve yet, the volume of the thenar eminence appears to be preserved.

And then, on the other side, the volume of the hypothenar eminence, ulnar side seems a little reduced and the 3 middle fingers are slightly clawed, even if there is not the classic hyperextension of the MCP joints, we could perhaps- be suspected of a beginner medio-ulnar involvement. The involvement is undoubtedly recent and in this case the MDT, whether PB or MB, does not change much in the nerve involvement of this hand (LML doctor de LAQUICHE - January 8).

If this is confirmed that it is recent, an accurate baseline neurological workup should be done and traced and treated with prednisolone.

Nerve decompression is only indicated in the event of failure of this well-conducted and protocolized cortisone treatment (LML doctor THEUVENET 9 January).

This is what we are doing in Francophone West Africa in support of ministries of health and national leprosy control programs with the FOLLEREAU Foundation.

This disability prevention program has been in place in many countries for a long time with interesting and encouraging results when diagnoses of nerve damage are made early enough, taken care of and followed up. We also have results with systematic management of all WHO grade I, early impairment of the sensitivity and trophicity of the skin before muscle involvement as I was able to observe recently during supervisions with the national program doctors in Senegal in October and in Guinea in December.

 

Cordial greetings

Dr Michel-Yves GRAUWIN

Neuro-orthopedic surgeon

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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