Nerve decompression for leprous neuropathy: A prospective study from Ecuador

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.