CIRCULATION AND SENSATION AT THE FINGERTIPS OF CLAW HANDS

Measurements of skin blood flow (by laser Doppler flowmetry) and tempe rature were made under environmental conditions promoting peripheral v asodilatation at the fingertips of a disfigured 'clawed' hand in 12 le prosy patients long-resident at Baba Baghi Leprosy Hospital, Tabriz, I ran. Sensory function was assessed by measuring the responses to light touch, pain and temperature of each finger, and peripheral autonomic function was gauged by estimating palmer sweating and by measuring ski n vasomotor reflexes in response to inspiratory gasp. In 2 patients al l measured fingers had laser Dopper flux (LDFlux) values and skin temp eratures lower than the 95% confidence limits for the mean of 20 healt hy controls, i.e. were impaired; in 2 patients all fingers had normal values for LDFlux and temperature; and in 8 patients there was a combi nation of impairment with most fingers normal for these parameters but with the small finger most commonly impaired. There were 10 (67%) fin gers with impaired LDFlux and temperature values who had significant s ensory impairment, whereas only 5 (18%) of the fingers with normal LDF lux values and temperatures had a similar sensory deficit. Overall, th e fingers with the most impaired sensation had significantly (P < 0.05 ) lower LDFlux and temperature values than those with no sensory defic it. Microcirculatory impairment was not related to disordered skin vas ometer reflexes or dysfunction of sweating. We concluded that the rela tionship between motor (skeletal muscle) nerve paralysis and any subse quent sensory neuropathy and/or microcirculatory impairment is more co mplex than might be expected from previous understanding of the diseas e.