Clinical Study on Sensibility Disturbance of the Hand in Leprory
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概要
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In this study, the specific pattern was found on the degeneration and/or regeneration of peripheral nerve in the hand of leprosy patient. The series of test to evaluate sensibility was done on 52 hands of leprosy patients, 28 of were of male and the others were of female. The mean age was 50.7 years.As shown in Figure 1, the dorsal and palmer surfaces of the hand were divided into 30 regions each, including horizontal zoning into 7 sections starting from the fingertip toward the wrist. Evaluation of the sensibility was performed by the comprehensive tests on the sense of pain with needle, cold (10°C) and heat (50°C) perception, touch and pressure with Semmes-Weinstein monofilaments, vibration with 30 and 256cps tuning fork, position with passive movement against each finger joints, static and moving two-point descrimination and sweating by Ninhydrin printing method. Table 1 shows the test scores totalled for each of the seven horizontal zones of the dorsal and palmer surfaces.The specific patterns found in this study were as follows:1) As far as the entire region of the hand is concerned, disturbance in the sense of touch occurred in the widest ares, and the disturbances of the sense of heat, pain, cold, pressure and vibration appeared within the affected zone, each area being smaller than the others in the order named. Moreover, in the hand in which the sences of pressure and vibration were disturbed, the sence of joint was also affected. This observation suggests that sensibility disturbances progress individually, firstly in the sense of touch, followed by those of heat, pain or cold, pressure, vibration and joint, in this order.2) Judging from the spreading of sensibility disturbances, appearance of the disturbances in the dorsal region always precedes that in the palmer region, with the affected area progresses from the hand to finger on the dorsal side and from the proximal and/or middle phalanges regions to distal region on the palmer side. However, the disturbances tend to be less severe in the distal region.3) The modality of disturbances was also evaluated. It was found that a specific and limited region with the sensibility threshold lower than the surrounding areas appears particularly in the inner surfaces of the fingertips, and such areas were often seen also at the thenar and hypothenar eminences.4) The recoveries from sensibility disturbances following neurolysis were observed on perception of the vibration with 30cps and 256cps, then pressure followed by the sense of pain considerably later.It is very difficult to find the report on the pattern and orderly sequence of recovery following peripheral neuropathy in leprosy.As the above, this report has valuable suggestions for the possibility of sensory recovery following peripheral neuropathy.
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