The evaluation of nerve damage in leprosy

Abstract

The aim of this paper is to present a protocol with a limited objective, namely to define and describe in detail tests which could be used to evaluate the progress (deterioration or recovery) of damage to the ulnar and median nerves. These tests, performed, recorded, and graded as described, and repeated periodically, will be of value in enabling diferent centres to report the results of their studies in a standard and comparable format. Though planned with particular reference to nerve damage caused by leprosy, it is possible that they will be of use in assessing the treatment of injuries to the median and ulnar nerves. A scoring system has been suggested, so that progress or deterioration of nerve damage can be expressed quantitatively. This system is arbitrary; it has, however, been designed to give appropriate 'weight' to the results of diferent tests. In particular, greater weight is attached to the sensory tests as a whole than to the motor function tests, because the latter may improve due to muscle hypertrophy in the absence of improved nerve function. Also, results of tests (such as nerve tenderness) where there is a large subjective element carry less weight than the more objective tests.