Nagappa Madhu, Pujar Guruprasad S, Keshavan Anuradha H, Bathala Lokesh, Jain Richa D, Das Abhijit, Mehndiratta Man Mohan, Visser Leo H, Kumar Himanshu Mohan
Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
Department of Neurology, Aster CMI Hospital, Bangalore, India.
Acta Neurol Scand. 2021 Aug;144(2):155-160. doi: 10.1111/ane.13432. Epub 2021 Apr 26.
Median nerve enlargement in leprosy seems to be more proximal than in carpal tunnel syndrome (CTS), but this feature has not been studied systematically. The aim of the study was to compare the sites of median nerve enlargement in patients with leprosy with that of patients with CTS.
Transverse sections of the median nerve were recorded from wrist to the mid-forearm (at distal wrist crease and at 2-cm: M1, 4-cm: M2, 6-cm: M3, 8-cm: M4 and 10-cm: M5, proximal to the distal wrist crease in the forearm) in patients with leprosy, CTS and healthy subjects using high-resolution ultrasound.
Twenty-six patients each with leprosy and CTS were compared with healthy controls. Patients with leprosy included 6 (23.1%), 7 (26.9%), 7 (26.9%) and 6 (23.1%) patients with borderline tuberculoid, borderline-borderline, borderline lepromatous and lepromatous leprosy, respectively. Cross-sectional area (CSA) of median nerve was increased in all patients with leprosy as compared to healthy controls at all points of measurement. CSA was higher among patients with leprosy as compared to CTS at all points except at the wrist. In patients with leprosy, the maximal enlargement was noted 2-cm (M1) proximal to the wrist crease with gradual tapering of the CSA proximally (p < .05). In contrast, in patients with CTS the median nerve was maximally enlarged at the distal wrist crease (p<.05).
Median nerve enlargement 2-cm proximal to the distal wrist crease distinguishes leprosy from CTS. This important discriminating sign can be used at point-of-care to identify patients with leprosy.
麻风病患者的正中神经增粗似乎比腕管综合征（CTS）患者更靠近近端，但这一特征尚未得到系统研究。本研究的目的是比较麻风病患者与CTS患者正中神经增粗的部位。
使用高分辨率超声记录麻风病患者、CTS患者和健康受试者从腕部到前臂中部（腕部远侧横纹处以及距离腕部远侧横纹近端2 cm：M1、4 cm：M2、6 cm：M3、8 cm：M4和10 cm：M5）的正中神经横切面。
将26例麻风病患者和26例CTS患者与健康对照进行比较。麻风病患者中，分别有6例（23.1%）、7例（26.9%）、7例（26.9%）和6例（23.1%）为界线类偏结核型、中间界线类、界线类偏瘤型和瘤型麻风。与健康对照相比，所有测量点的麻风病患者正中神经横截面积（CSA）均增加。除腕部外，所有测量点的麻风病患者CSA均高于CTS患者。在麻风病患者中，最大增粗出现在腕横纹近端2 cm（M1）处，CSA向近端逐渐变细（p < 0.05）。相比之下，CTS患者正中神经在腕部远侧横纹处增粗最大（p < 0.05）。
腕部远侧横纹近端2 cm处的正中神经增粗可将麻风病与CTS区分开来。这一重要的鉴别体征可在床边用于识别麻风病患者。
