LEPROSY

BY:-
Sweta upadhyay
Bpt 4th year
 OBJECTIVES
• Introduction
• Mode of spread
• Epidemiology
• Symptoms
• Classification
• Diagnosis
• Treatment
• Prosthosis and orthosis used.
 LEPROSY
• Leprosy disease is a chronic granulomatous
disease caused by Mycobacterium leprae, an
acid and alcohol fast bacillus.
• It is one of the most serious, disabling disease
which attacks nerve  and skin.
• Leprosy which is also called Hansen's Disease is
the commonest cause of peripheral neuritis and
about 20 million of the population is affected by
it.
 MODE OF SPREAD
• The most important mode of spread of Mycobacterium leprae
is by droplets from the sneeze of leprosy patients, whose nasal
mucosa is heavily infected. It is not certain whether the
organism enters by inhalation or through the skin.
• The bacteria responsible for leprosy multiply very slowly. The
disease has an incubation period (the time between infection
and the appearance of the first symptoms) of up to five years.
Symptoms may not appear for as long as 20 years.
 EPIDEMOLOGY
• AGE:-All age from infancy to very old age.
• SEX:- BOTH (Male & Female)
• Males more than females, 2:1
• Global prevalence rate is less than one case
per 10,000 persons.
• Elimination achieved in 2000
 SYMPTOMS(skin)
• The disease can cause skin symptoms such as:
1. A large, discolored lesion on the chest of a person with Hansen’s
disease.
2. Discolored patches of skin, usually flat, that may be numb and look
faded (lighter than the skin around)
Growths (nodules) on the skin
3. Thick, stiff or dry skin

4. Painless ulcers on the soles of feet

5. Painless swelling or lumps on the face or earlobes

Loss of eyebrows or eyelashes.
 SYMPTOMS(Nerve)
Symptoms caused by damage to the nerves are:
 Numbness of affected areas of the skin

 Muscle weakness or paralysis (especially in the hands and feet)

Enlarged nerves (especially those around the elbow and knee and
in the sides of the neck)
 Eye problems that may lead to blindness (when facial nerves are
affected)
 Enlarged nerves below the skin and dark reddish skin patch
overlying the nerves affected by the bacteria on the chest of a
patient with Hansen’s disease. This skin patch was numb when
touched.
 Symptoms (mucous membrane)
 Symptoms caused by the disease in the mucous
membranes are:
 A stuffy nose
 Nosebleeds
Since Hansen’s disease affects the nerves, loss of
feeling or sensation can occur. When loss of sensation
occurs, injuries such as burns may go unnoticed.
Because you may not feel the pain that can warn you
of harm to your body, take extra caution to ensure the
affected parts of your body are not injured.
 CLASSIFICATION
•  It has six classifications based on severity of symptoms. They are:
 1. Intermediate leprosy: a few flat lesions that sometimes heal by themselves and
can progress to a more severe type
 2. Tuberculoid leprosy: a few flat lesions, some large and numb; some nerve
involvement; can heal on its own, persist, or may progress to a more severe form.
 3. Borderline tuberculoid leprosy: lesions similar to tuberculoid but smaller and
more numerous; less nerve enlargement; may persist, revert to tuberculoid, or
advance to another form.
 4. Mid-borderline leprosy: reddish plaques, moderate numbness, swollen lymph
glands; may regress, persist, or progress to other forms.
 5. Borderline lepromatous leprosy: many lesions including flat lesions, raised
bumps, plaques, and nodules, sometimes numb; may persist, regress, or progress.
 6. Lepromatous leprosy: many lesions with bacteria; hair loss; nerve involvement;
limb weakness; disfigurement; doesn’t regress.
 Diagnosis
• Symptoms (such as distinctive rashes that do not
disappear, enlarged nerves, loss of the sense of touch,
and deformities that result from muscle weakness)
provide strong clues to the diagnosis of leprosy.

• Examination of a sample of infected skin tissue under a

microscope (biopsy) confirms the diagnosis.

• If a laboratory is available, skin smears may be

obtained for a more definitive diagnosis
 Conservative Treatment
• Multibacillary: The standard combination of drugs is dapsone, rifampin
and clofazimine. People take rifampin and clofazimine once a month under
a health care practitioner's supervision. They take dapsone plus clofazimine
once a day on their own. This regimen is continued for 12 to 24 months,
depending on the severity of the disease.
• Paucibacillary: People take rifampin once a month with supervision and
dapsone once a day without supervision for 6 months. People who have
only a single affected skin area are given a single dose of rifampin,
ofloxacin, and minocycline.
• Because the bacteria are difficult to eradicate, antibiotics must be
continued for a long time. Depending on the severity of the infection and
the doctor's judgment, treatment continues from 6 months to many years.
Some doctors recommend lifelong treatment with dapsone for people with
lepromatous leprosy.
 Surgical Treatment
• Tendon Transfer: Moving the distal end of the tendon to a new place so that
contraction of muscle belly will produce a needed movements used to
replace paralysed muscles. Example- Transfer of fore-arm muscle to make
finger movements.
• Tendon Lengthening: Lengthening the tendon of a muscle to permit more
movement and reduce contracture. Example- Tendo Calcaneus lengthening.
• Capsulotomy: To loosen tight joint capsule often done with tendon
lengthening and tendon transfer to improve range of motions. Tighten the
loose joint capsule using suture.
• Arthrodesis: Elimination of unstable and deformed joints.
• Tenodesis: Attach a piece of tendon across the joint to reduce the
movement. The tendon then act as ligament. Example- Tenodesis of MCP
joint to prevent hyperextension.
 PT. Management
AIM:-
• To increase and regain range of motion.
• Improve muscle strength particularly in muscles to be
transferred.
• Clean supple skin in areas of surgery.
• Teach home self care.
• Protect tissue during wearing.
• Prevent/reduce swelling.
• Muscle re-education after tendon transfer.
• Safe use of any new restored skill in work.
 Pt. management cont.
• For increasing/regaining ROM: ROM can be increased by soaking the skin or part
in warm water and then performing passive movement to the part affected.
• To improve strength specially in tendon transfer: Active exercise in all part in
which surgery is performed.
• Clean supple skin: It is provided by soaking the part in soap water, rubbing off
thick skin, oiling, self massage and protecting the part from infection.
• Home care: teaching skin, hand, foot and eye care to groups and individuals and
teaching the patients actual home care.
• Protect tissue during healing: Rest, body position and POP cast.
• Prevent/Reduce swelling: Elevation, active and passive exercise.
• Muscle Re-education after tendon transfer: Teaching new restored skills in
movements provided by tendon transfer.
• Self restored skills in daily work: Teaching patient ot use any new skill safely in
specific task. Providing hand, eye and foot protection.
 Clawing of finger
• Clawing of Fingers. NFI of the ulnar nerve
leads to paralysis of the third and fourth
lumbricals.
• All of the interossei muscles are also
paralyzed. The paralysis causes the little and
ring fingers to claw.
• Clawing of the medial two fingers is referred
to as an “ulnar claw”.
 APE THUMB
• Ape thumb deformity. the median nerve leads
to thenar muscle paralysis.
• abduction movement of the thumb are lost,
leading to the characteristic ‘ape thumb
deformity’
• ulnar-median paralysis and is commonly seen
in leprosy-affected patients
 WRIST DROP
• Wrist drop:-
• Neuro Fibro matosis of the radial nerve rarely occurs in
isolation.
• the radial nerve is usually damaged along with the median
and ulnar nerves, leading to triple nerve paralysis. The clawing
of fingers is not significantly visible in a triple nerve paralysis,
as the extensors are not capable of hyperextending the MCP
joints. The power grip is usually lost in radial nerve palsy.
• This loss occurs because the flexors of the fingers work in a
shortened position and the grasp functions are restricted by
the loss of the finger extensors
 FOOT DROP
• Foot drop. NFI of the deep branch of the
lateral popliteal (common peroneal) nerve
leads to paralysis of the tibialis anterior,
extensor hallucis longus, extensor digitorum
longus, and peroneusterrus muscles. The
peroneus longus and brevis are affected if the
superficial branch is affected, leading to the
loss of ankle dorsiflexion, foot eversion, and
toe extension. An inability to dorsiflex
 CLAW TOES
• Claw toes. NFI of the posterior tibial nerve
causes the intrinsic muscles of the foot to be
para-lyzed. The extensors of the
metatarsophalangeal joint pull the joint into
extension which, coupled with the flexion of
the toes, leads to clawing of the toes
Orthosis for little finger
 Orthotic Management
• Orthotic management:-
Ulnar nerve:- Partial Claw Hand-Knuckle Bender
Splints
 Median Nerve
• Median Nerve :- Ape Thumb Deformity- Short
Openness Splint
• Immobilization of fingers , provide support
and stabilize the wrist in extension
 Cock up splint
• Immobilizes, or stabilize the wrist in
dorsiflexion with dorsal support.
 ORTHOTIC MANAGMENT
Ankle Foot Orthosis:-
• For Muscle weakness affecting the ankle and
sub talar joints
• Prevention and correction of deformities of
the foot and ankle,
 KNEE ANKLE FOOT ORTHOSIS
• IT provides stability to knee, ankle and foot
 HIP KNEE ANKLE FOOT ORTHOSIS
• IT provides support and correction to
the hip, knee, ankle and foot. An HKAFO
improves body alignment and posture,
increases bone and muscle strength, and
enhances independence and self-esteem
PROSTHESIS (Above Elbow and Below Elbow
Prosthesis(Above knee and below knee)