Functional evaluation of the hand after ulnar claw correction in patients with leprosy
Purpose: To evaluate hand function in leprosy patients after reconstructive surgery for claw hand.
Methods: Patients who had completed multidrug therapy (MDT) and who had undergone tendon transfer surgery for ulnar claw correction at either of two reference centres for leprosy in Brazil between 2010 and 2014, were included. Clinical evaluations, Screening of Activity Limitation and Safety Awareness (SALSA) Scale, Disabilities of the Arm, Shoulder, and Hand Score (DASH) Questionnaire and the Jebsen Taylor Test (JTT) were used to measure arm/hand function recovery after surgery. Data were analyzed with the one sample t-test ( p , 0·05).
Results: Twenty-three patients participated in the study, with 13 males (57%), a mean age of 49·5 years and an average of 6·3 years post-surgery. On the SALSA Scale total score, 59% of the individuals had mild or no limitation of activity. On the specific score for the hand domain, 91% had mild or no limitation. The mean score of the DASH Questionnaire was 24·45. On the JTT, when comparing individuals who had surgery on the right hand with normative values for the dominant hand, matched for mean age and gender, there was a significant difference for all six tasks. When comparing individuals who had surgery on the left hand with normative values for the non-dominant hand, there was greater proximity between the means, although still significantly different.
Conclusions: The SALSA, DASH and JTT were easily applicable and useful to measure the functional limitation of the leprosy hand. The data demonstrated that the patients had a good impression of their hand’s improved functionality after surgery. Patients exhibited mild to no disability. These results reinforce the importance of early diagnosis of neuritis and immediate therapeutic interventions to prevent physical disability.