The predictive value of sensation testing in the development of neuropathic ulceration on the hands of leprosy patients.
The early detection of the loss of protective sensation in leprosy patients is vital if neuropathic ulceration and subsequent disabilities are to be avoided. The aim of this study was to find protective value of sensory thresholds in the hands of leprosy patients. Thresholds for touch-pressure, vibration and temperature were assessed in areas on leprosy-affected hands near ulcers or ulcer scars (LU-group), in areas without lesions (LN-group), and in controls (N-group). Semmes-Weinstein monofilaments were used for testing the touch-pressure threshold (PST), a biothesiometer for the vibration threshold (VST) and a Thermo Sensation Tester for the temperature threshold (TST). The distribution of ulcers was about equal on palmar and dorsal aspects of the hands. In the LU-group there was a negative response to SWF of 2.0 g in all patients, while 74% could feel the 2.0 g in LN-areas and in N-areas 100% could detect the 2.0 g SWF. In the LU-group about 11% felt 8 V VST, in the LN-group about 60% and in the N-group 89%. Testing temperature sensation was given up prematurely because the results in controls were unsatisfactory. Both palmar and dorsal sides of the hands should be tested for sensation. The thresholds for protective sensation are 2.0 g SWF and 8 V for vibration sense. It is recommended that Semmes-Weinstein monofilaments should always be used for early detection of loss of protective sensation.
Kuipers
M
M
University of Utrecht Medical School, The Netherlands.
Schreuders
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006225:Hand; D006801:Humans; D007918:Leprosy / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012678:Sensation Disorders / Q000150:complications* / Q000503:physiopathology; D012684:Sensory Thresholds; D017678:Sex Distribution; D012883:Skin Ulcer / Q000150:complications* / Q000503:physiopathology