The Combination Therapy of Oral Steroids and Nerve Decompression for Ulnar Neuritis in Leprosy - Usefulness in Prevention of Progression of Hand Deformities

Hand, being an important functional part of the body, needs healthy complementing motor and sensory nerve supply. Both these functions get compromised following involvement of ulnar nerve in leprosy, which is the commonest nerve involved in Hansen’s disease. It is commonly involved at the elbow level and results in clawing of the hand. There are two routine management protocols viz medical and surgical to manage ulnar nerve damage in leprosy. Steroid therapy along with anti-leprosy regimen is the common medical approach for treatment for ulnar neuritis. Patients not improving with medical management are taken up for surgical decompression. However, when to switch from medical to surgical intervention is topic of debate. In this study we have given steroid therapy in early (4-6 weeks) duration of ulnar neuritis along with anti-leprosy drugs and attempted to determine an appropriate period of medical treatment, beyond which there is no significant benefit in continuing sole medical management if no response is seen. Of the 247 eligible patients, 210 did not respond to 12 months of steroid therapy – the results 193 such patients, treated with steroids and nerve decompression and which were available for follow up were analysed. A total 158/193 (81.8%) cases showed the sensory recovery for touch within 4-6 weeks, deep sensation of pin prick returned in 117/193 (60.62%) cases in 6-8 weeks. Motor recovery was slow, it took 24 to 54 weeks. While 117/193 (60.62%) cases showed improved motor function, in 58/193(30%) cases there was no change and only 18/193(9.3%) cases deteriorated. It appears that period of 12 weeks is an ample time for medical treatment to start showing any form of improvement (motor or sensory) and if there is no improvement, patient should be considered for surgical decompression along with continuation of medical management (Steroid therapy). Our study shows that cases who failed to respond to exclusive medical steroid therapy by 12 weeks responded to combined medical plus surgical treatment as surgical decompression helps in the release of pressure on nerve tissue and improves the functional status.