title: Voluntary muscle testing and dynamometry in diagnosis of motor impairment in leprosy: a comparative study within the INFIR Cohort Study.
abstract: OBJECTIVE
  To evaluate hand muscle weakness detected through dynamometry as an indicator for change in motor nerve function detected by Voluntary Muscle Testing (VMT) of ulnar and median nerves.
  
  
  METHODS
  The research was carried out as part of the INFIR Cohort Study among 303 subjects newly diagnosed with MB leprosy in two centres in UP state, northern India.
  
  
  METHODS
  To assess grip strength, key pinch and pulp-to-pulp pinch we adapted the cuffs of adult and neonatal sphygmomanometers. The testing was carried out at diagnosis and at each visit during a 2-year follow-up.
  
  
  RESULTS
  303 subjects with newly diagnosed MB leprosy were included in the study. We found statistically significant differences in grip strength, key pinch and pulp-to-pulp pinch between groups defined by ulnar VMT grades at time of diagnosis. There was also a statistically significant difference in hand grip between groups defined by median VMT at diagnosis. In each case, strength tended to reduce with increasing motor involvement. We explored reduction in grip strength, key pinch or pulp-to-pulp pinch as indicators of change in ulnar VMT during follow-up. A 25% reduction over two visits was the most effective indicator. Changes were also associated with marginal changes in motor and sensory nerve function, most commonly associated with Type I reactions.
  
  
  CONCLUSIONS
  Dynamometry is recommended as an additional method that may be used to monitor changes in nerve function in leprosy, particularly in subjects with early motor impairment of the ulnar nerve.
authors.affiliation: The Leprosy Mission Hospital, Purulia, West Bengal, India.
authors.forename: M
authors.initials: M
authors.lastname: Suresh
authors.forename: Peter G
authors.initials: PG
authors.lastname: Nicholls
authors.forename: Loretta
authors.initials: L
authors.lastname: Das
authors.forename: Wim H
authors.initials: WH
authors.lastname: Van Brakel
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D004594:Electrophysiology / Q000379:methods; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007194:India; D007918:Leprosy / Q000150:complications*; D008297:Male; D008475:Median Nerve / Q000293:injuries / Q000503:physiopathology; D020423:Median Neuropathy / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D053581:Muscle Strength Dynamometer; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology*; D052581:Pinch Strength; D011237:Predictive Value of Tests; D014459:Ulnar Nerve / Q000293:injuries / Q000503:physiopathology; D020424:Ulnar Neuropathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult