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 pat ients is vital if neuropathic ulceration and subsequent disabilities a re to be avoided. The aim of this study was to find protective value o f sensory thresholds in the hands of leprosy patients. Thresholds for touch-pressure, vibration and temperature were assessed in areas on le prosy-affected hands near ulcers or ulcer scars (LU-group), in areas w ithout 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 Sen sation 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 pati ents, while 74% could feel the 2.0 g in LN-areas and in N-areas 100% c ould 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 sen sation was given up prematurely because the results in controls were u nsatisfactory. Both palmar and dorsal sides of the hands should be tes ted for sensation. The thresholds for protective sensation are 2.0 g S WF and 8 V for vibration sense. It is recommended that Semmes-Weinstei n monofilaments should always be used for early detection of loss of p rotective sensation.