Nerve decompression for leprous neuropathy

A prospective study from Ecuador

Eric L. Wan, Jonathan Noboa, Pablo A. Baltodano, Renato Martinez Jousin, William B. Ericson, James P. Wilton, Gedge David Rosson, A. Lee Dellon

Research output: Contribution to journalArticle

Abstract

Objectives: Since the mid-1950s retrospective studies in leprosy have reported outcomes following decompression of single anatomic sites of compression (e.g., ulnar nerve at elbow). The purpose of this prospective study is to apply concepts developed from the successful treatment of diabetics, who have neuropathy and multiple sites of chronic nerve compression, to patients with leprous neuropathy (e.g., neurolysis of the ulnar nerve at the elbow and at the wrist). Results: Eighteen of 19 patients returned for post-operative evaluation. There were no post-operative complications. At 2 years follow-up, 13/15 (87%) patients have sensory improvement as demonstrated by the Pressure-Specified Sensory Device (PSSD). Thirteen of 13 (100%) patients reported motor improvement and could demonstrate a voluntary muscle testing score of 4/5 or 5/5 on their most recent follow-up. Post-operatively, we observed significantly improved quality of life by RAND-36, (P = 0.03) and significantly increased upper-extremity function by Q-DASH (P = 0.02). Among patients with severe pain, there was a significant decrease in pain by an average of 5.6 points (P = .005). Conclusions: Application of the double crush concept to decompression of multiple peripheral nerves is feasible in the population with leprous neuropathy. In our cohort, neurolysis of the median nerve at the wrist and forearm, of the ulnar nerve at the wrist and elbow, of the tibial nerve in 4 medial ankle tunnels, and of the peroneal nerve at the knee, leg and foot gave increased quality of life, decreased disability, improved pain, and improved sensory and motor function in the majority of patients.

Original languageEnglish (US)
Pages (from-to)95-108
Number of pages14
JournalLeprosy Review
Volume88
Issue number1
StatePublished - Mar 1 2017

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Ecuador
Decompression
Prospective Studies
Elbow
Wrist
Ulnar Nerve
Pain
Ulnar Nerve Compression Syndromes
Quality of Life
Tibial Nerve
Peroneal Nerve
Median Nerve
Leprosy
Peripheral Nerves
Forearm
Ankle
Upper Extremity
Foot
Leg
Knee

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wan, E. L., Noboa, J., Baltodano, P. A., Jousin, R. M., Ericson, W. B., Wilton, J. P., ... Dellon, A. L. (2017). Nerve decompression for leprous neuropathy: A prospective study from Ecuador. Leprosy Review, 88(1), 95-108.

Nerve decompression for leprous neuropathy : A prospective study from Ecuador. / Wan, Eric L.; Noboa, Jonathan; Baltodano, Pablo A.; Jousin, Renato Martinez; Ericson, William B.; Wilton, James P.; Rosson, Gedge David; Dellon, A. Lee.

In: Leprosy Review, Vol. 88, No. 1, 01.03.2017, p. 95-108.

Research output: Contribution to journalArticle

Wan, EL, Noboa, J, Baltodano, PA, Jousin, RM, Ericson, WB, Wilton, JP, Rosson, GD & Dellon, AL 2017, 'Nerve decompression for leprous neuropathy: A prospective study from Ecuador', Leprosy Review, vol. 88, no. 1, pp. 95-108.
Wan EL, Noboa J, Baltodano PA, Jousin RM, Ericson WB, Wilton JP et al. Nerve decompression for leprous neuropathy: A prospective study from Ecuador. Leprosy Review. 2017 Mar 1;88(1):95-108.
Wan, Eric L. ; Noboa, Jonathan ; Baltodano, Pablo A. ; Jousin, Renato Martinez ; Ericson, William B. ; Wilton, James P. ; Rosson, Gedge David ; Dellon, A. Lee. / Nerve decompression for leprous neuropathy : A prospective study from Ecuador. In: Leprosy Review. 2017 ; Vol. 88, No. 1. pp. 95-108.
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