2. Objective:
■ By the end of seminar students will have an overview on:
What is Leprosy?, How it spreads?
Widely spread misconception/ Stigma
How to differentiate leprosy with other diseases
What is MDT? Can leprosy be treated completely?
How can physiotherapy treatment help in leprosy
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3. Content
1. Introduction
2. Common misconception
3. Pathophysiology
4. Cardinal signs, Symptoms of leprosy
5. Types of Leprosy/ Classification
6. Differential diagnosis
7. Medical management
8. Surgical management
9. Physiotherapy management
Problems identified
Short term goals
Long term goals
Physiotherapy intervention
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4. INTRODUCTION
■ Leprosy/ “Hansen’s disease” is bacterial infection caused by Mycobacterium
leprae, an acid fast, rod-shaped bacillus. The disease mainly affect the skin,
mucosa of upper respiratory tract , and the eyes.
[WHO, 2019]
■ It’s a chronic granulomatous disease of humans primarily involving the skin,
peripheral nerves and nasal mucosa but capable of affecting any tissue or
organ.
[Ananthanarayan, 2013]
■ A bacterial infection caused by mycobacterium leprae, it’s a progressive
disease affecting the skin, peripheral nerves and limbs. If untreated, causes
permanent tissue damage leading to auto amputations.
[ICD-10, A30]
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5. ■ Prevalence:
Acc. to reports from 138 countries, exclusively human disease and only
source of infection.
In 2015, 1,76,176 cases(0.2 cases per 100 000 people)
In 2017, 1,92,713 cases registered(0.25/10,000)
South east Asia- 119,055
[WHO,2018]
■ Mode of Transmission: Droplet transmission through coughing, sneezing
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6. Wide Misconception/Stigma
It’s a “Curse”
An Untouchable
d/s
Poor man’s d/s
They are
unclean, wear
torn clothes
Hereditary
Highly
Contagious
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8. Cell Mediated Immunity
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TT BT BL
BB LL
6
5
4
3
2
1
0
CMI is a type of immunity produced by direct action of immune cells such as T-lymphocytes,
rather than antibodies. It involves macrophages, NK- cells to release various cytokines in response
antigen.
It is most effective in destroying virus- infected cells, intracellular bacteria and cancers.
9. Cardinal sign’s
Hypo pigmented skin patches with/without
Erythema/redness, with or without
nodules with definite loss of sensation
A thickened or enlarged peripheral nerves
painful or painless
Positive slit skin smear test
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13. Symptomatic Difference
Paucibacillary(PB) Multibacillary(MB)
Skin Lesions 1-5 skin patches
Asymmetrical
Definite loss of sensation
>5 skin patches
Symmetrical
Loss of sensation(may/ may
not be)
Nerve involvement Only 1 nerve is involved >1 nerves involved
Skin smear Negative at all sites Positive at any site
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14. REACTION Phase TYPE I REACTION TYPE II REACTION
SKIN Red and raised patches Nodules, painful with fever &
joint pain
Nerves Painful nerve Painful nerve
TYPES BT, BB, BL LL and BL
Skin smear Can/ cannot be seen Highly positive
Symptoms area Seen only in lesion areas
Other organs not involves
Can be seen anywhere, mainly
extremities
Even organs like Kidney, Liver,
bones, eyes, testes commonly
involved.
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22. Nerve Deformities
Facial Lagopthalmus
Ulnar Claw hand- ulnar side
Z- thumb
Median Ape thumb deformity
Claw fingers- Medial side
Radial Wrist drop
Lateral popliteal Foot drop
Posterior tibial Claw toe
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25. Motor Examination
Muscles ACTION
1. FCU Flexion and Ulnar deviation of wrist
2. FDP Flexion of DIP
3. ADM Abduction of little finger
4. 1st Dorsal interossei Abduction of index finger
5. Intrinsics (Lumbricals and
Interossei)
Flexion at MCP, Extension of IP
6. FCR; PL Flexion of wrist; Cupping of Hand
7. FDS Flexion of PIP joint
8. APB Abduction of thumb
9. OP Opposition of thumb
10. ECRL & ECRB Extension of wrist with radial deviation
11. ECU Extension of wrist in ulnar deviation
12. EDL Extensor digitorum longus
13. EPL Extension of IP joint of thumb
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26. Muscles ACTION
14. TA Dorsiflexion and inversion of foot
15. EHL, EDL Extension of great toe, extension of other toes
16. PL& PB Eversion with plantar flexion
17. Orbicularis occuli Closing of the eye
18. Orbicularis oris Show teeth/ smile/ say “eeeeee”
19. Pronator teres Pronation of semi flexed elbow
20. Tibialis posterior Inversion and plantar flexion of foot
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27. Identification of problems:
■ Loss of sensation over peripheral limbs and body (Anesthetic Limbs)
■ Peripheral muscular weakness
■ Deformities like: Swan neck deformity, Ape thumb deformity etc.
■ Neurologic complications like:
Claw hand: Full, Partial claw hand
Foot drop
Wrist drop
■ Ulceration of foot
■ Upper limb/ Lower limb amputations
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28. Management
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Damage Less than 6 months More than 6 months
Ulnar nerve impairment Claw hand
Z- thumb
Splints: Cylindrical
splint/ Knuckle bender/
Finger loops/ Gutter/
MCP block
Exercises:
1. Stretching of long
flexors
2. Active extension of IP
joints
3. Strengthening of
Intrinsics by exercise
ball, finger springs
Electrical stimulation:
Intrinsics &
RCT:
If no Hyper extension at
PIP & Long flexors FDS
lasso(Half/Full)
1. Ring finger lasso
2. Middle finger lasso
Splints
31. Management
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Damage Less than 6 months More than 6 months
Radial nerve impairment Wrist drop Splints: Cock- up splint/
Radial slab
Exercises:
1. Stretching of wrist
flexors & long flexors
2. Strengthening of
extensor groups
Electrical stimulation:
ECRL, ECRB, EPL, EDC,
EIP, EDM etc.
RCT: Pronator teres
lasso
Splints
Stretching
Stimulation: Pronator
teres, FCR if weakness
33. Management
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Damage Less than 6 months More than 6 months
Median nerve
impairment
Median claw finger
Ape thumb
Splints: Thumb spica/
Opponens loop/ C-
Opponens splint/ Tuck in
splint
Exercises:
1. Stretching of web to
thumb
2. Strengthening of
extensor groups
Electrical stimulation:
ABP, OP
RCT: Opponens
replacement using
Extensor indicis proprius
Splints
Stretching
Stimulation: Pronator
teres, FCR- if weakness
35. Management
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Damage Less than 6 months More than 6 months
Lateral Popliteal nerve
impairment
Foot drop
High stepping gait
Splints: Foot drop
splint/ Spring
Exercises:
1. Stretching of Tendo-
achilles
2. Strengthening of
dorsiflexors- Tibialis
anterior (TA)
Electrical stimulation:
TA, EH, EDL, PL& PB
RCT: PL Lasso
Splints
Stretching- TA
Strengthening of Donor
tendon Tibialis
posterior(TP)
Stimulation: TP
43. References
1. Ananthanarayan & Paniker; Text book of Microbiology; 9th Edition; 2013
2. Thangamani ramalingam; Principles of Physiotherapy in General Medicine and
surgical condition; First edition; 2016
3. https://www.who.int/en/news-room/fact-sheets/details/leprosy
4. www.icd10data.com/A00-B99/A30-A49/A30
5. Handbook from Leprosy mission training school, Naini; 2019
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