SURGERY IN LEPROSY.
DEFINITION
Leprosy is a Chronic granulomatus inflammatory disease caused due to infection by mycobacterium leprae .
– There are 3 types
√ Tuberculoid
√ Borderlined
√ Lepromatous
• Deformities in Leprosy
1) Primary :
* Hand :
✓ Total claw hand
✓ Banana fingers ( swelling on back of hand and finger )
✓ Ulnar claw hand
✓ Ape thumb deformity.
* Foot
✓ Foot drop plantar ulcers
* Face
✓ Collapse of bridge of nose
✓ Madarosis ( Loss of lateral portion of eyebrows )
✓ Fascial palsy
✓ Leonine face ( multiple nodules )
✓ corneal ulcer.
2) Secondary
– Due to paralysis of muscles and anesthesia
– Trophic ulcers
• Defomity
– Deform means out of shape
– Deformation or deviation of body parts or segments from normal anatomical alignment is deformity.
* Type of deformity
– Congenital : CTEV
– Acquired : Degenerative conditions, trauma / injury , muscular imbalances.
* Grading of deformity
– There are three grades
Grade 1 : tightness
Grade 2 : varying from tightness to contracture.
Grade 3 : Bony deformity with contracture.
(1) Foot drop
– Foot drop is a deformity seen in leprosy results in paralysis of muscles supplied by common peroneal nerve ( superficial and deep )
– Muscles supplied by these nerves are peroneus longus and brevis ( superficial ) and tibialis anterior ( deep branch or anterior tibial nerve )
* Clinical features
– Loss of Dorsiflexion of foot
– Diminision in sensation
– Gait : high stepping gait
– plantar ulcers
* Tendon transfer in foot drop
– Tibialis posterior muscle is transferred to dorsum of foot either by subcutaneous tissue or interossei membrane.
– And is inserted at base of 2 nd or 3 rd metatarsals.
* Splinting
– dynamic foot drop splint
– Static foot drop splint
(2) Ulnar claw hand ( C8 – T1 )
* Muscles paralyzed ;
√ Palmaris brevis
√ 2 lumbricals from medial side
√ Hypothenar muscles : flexor digiti minimi , abductor digiti minimi , opponence digiti minimi , palmar and dorsal interossei , adductor pollicis, flexor carli ulnaris.
* Clinical features
– Sensory loss ( medial 1/2 fingers)
– Hyperextension of MCP , Flexion of DIP , PIP of 4 th and 5 th finger
– Paralysis of lumbricals
– wasting of hypothenar and interossei muscles
* Clinical tests
– Forments test
– Card test
– Egawas test
* Tendon transfer (Bunnell’s operation)
– Flexor digitorum sublimis is detached and split into 2 slips and is inserted to extensor aspect of little and ring finger
(3) Total claw hand ( True claw hand )
– Both ulnar and median nerve are injured .
* Muscles supplied by median nerve ( C6, C7, C8, T1 )
– Thenar muscles
– abductor pollicis brevis
– flexor pollicis brevis
– opponence pollicis
– 2 Lumbricals ( from lateral side )
– Palmaris longus
– flexor digitorum profundus and superficialis
– flexor pollicis longus
– pronator teres
– flexor carpi radialis
* Clinical features
– sensory loss in medial 1 – 1/2 fingers due to ulnar nerve and lateral 3-1/2 fingers due to median nerve
– Hyperextension of metacarpophalangeal joints of all 4 fingers
– labourer’s nerve
– ape thumb deformity
* Clinical tests
– pen test
– pointing index or oschner’s clasp test
– benediction test
– test for ulnar nerve injury
* Tendon transfer
1) brands many tailed tendon transfer
– Extensor carpi radialis longus tendon is detached and lengthened
– Palmaris longus tendon is split longitudinally into 4 slips and is then attaches to extensor expansion of fingers
2) Bunnell’s opponence palsy
– For restoration of thumb opposition and abduction
– Transfer of flexor digitorum sublimis of little finger to the base of thumb
* Splinting
– Knuckle bender splint
– Median nerve splint
– Static 2 dynamic splinting.
