Complications of the extremities in leprosy
patients are primarily a consequence of neuropathy leading to insensitivity and
myopathy. Insensitivity affects fine touch, pain, and heat receptors but
generally spares position and vibration appreciation. The most commonly
affected nerve trunk is the ulnar nerve at the elbow, whose involvement results
in clawing of the fourth and fifth fingers, loss of dorsal interosseous
musculature in the affected hand, and loss of sensation in these distributions.
Median nerve involvement in leprosy impairs thumb opposition and grasp, while
radial nerve dysfunction, though rare in leprosy, leads to wristdrop. Tendon
transfers can restore hand function but should not be performed until 6 months
after the initiation of antimicrobial therapy and the conclusion of episodes of
acute neuritis. Plantar ulceration, particularly at the metatarsal heads, is
probably the most frequent complication of leprous neuropathy. Therapy requires
careful debridement; administration of appropriate antibiotics; avoidance of
weight-bearing until ulcerations are healed, with slowly progressive ambulation
thereafter; and wearing of specialized shoes to prevent recurrence. Footdrop as
a result of peroneal nerve palsy should be treated with a simple nonmetallic
brace within the shoe or surgical correction attained by tendon transfers.
Although uncommon, Charcot’s joints, particularly of the foot and ankle, may
result from leprosy. The loss of distal digits in leprosy is a consequence of
insensitivity, trauma, secondary infection, and—in lepromatous patients—a
poorly understood and sometimes profound osteolytic process. Conscientious protection
of the extremities during cooking and work and the early institution of therapy
have substantially reduced the frequency and severity of distal digit loss in
recent times.
Source:
Harrison_s_Principles_of_Internal_Medicine_16th_Edition
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