Documente Academic
Documente Profesional
Documente Cultură
13.09.2006
INTRODUCTION
IF LEPROSY DID NOT CAUSE DEFORMITIES & DISABILITIES IT WOULD NOT BE A DREADED DISEASE, CONSIDERED AS JUST ANOTHER SKIN DISEASE TO, THE LAY MAN, PATIENTS AND EVEN FOR MANY MEDICAL MEN LEPROSY MEANS DEFORMITY, BUT ONLY 20 25 % SUFFER FROM DISABILITIES
THEREFORE, EVERY PERSON DEALING WITH LEPROSY PT HAS A CLEAR UNDERSTANDING OF THE DEFORMITIES, HOW THERY ARE CAUSED 13.09.2006 HOW FAR THEY MAY BE PREVENTED 2 AND
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IMPAIRMENT
PRIMARY
INVOLVEMENT OF FACIAL OCULAR PERIPHERAL NERVE ACUTE DEPRESSION
SECONDARY
ANESTHETIC DEFORMITY NEGLECTED DEFORMITY
SPECIFIC PARALYTIC
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DISABILITY
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DURATION - LONG ACTIVE DISEASE TYPES IN LL, BORDERLINE INVOLVEMENT OF NERVE TRUNK
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DEFORMITY CLASSIFICATION
ACCORIDNG TO CAUSE
FACE +++ HAND ++ FEET + IMPAIRMENT PRIMARY PRIMARY SECONDARY
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+ +
+++ +
++ +++
STAGES
TISSUE RESPONSE PARASITIZATION CLINICAL INVOLVEMENT NERVE DAMAGE NERVE DESTRUCTION
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NERVE DAMAGE
RELATIVE FREQUENCY BODY PART NERVE
INVOLVEMENT
DAMAGE
FREQUENCY OF RECOVERY
+++ ++ + + +++
+ ++ +++ ++ +10
LOWER LIMB
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TIME FREQUENCY ONE DAY BEFORE Sx 2 WEEKS POST OP FOUR WEEKS 2 MONTHS 3 MONTHS AFTER 6 MONTHS 6 MONTHLY THEREAFTER
RECORD SENSORY, MOTOR, PAIN & TENDERNESS SCORING SYSTEM IS SUGGESTED 12 13.09.2006 NERVE CONDUCTION STUDY & EMG
SENSORY TESTING
METHODS
MOTOR TESTING
VOLUNTARY MUSCLE TEST
ULNAR ULNAR
ABDUCTOR
DIGITI
MINIMI
1ST
DORSAL INTEROSSEOUS
ABDUCTOR
MEDIAN
POLLICIS
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BREVIS
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MUSCLE PARALYSIS
DRY SKIN
REACTION HAND
3.
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REACTION HAND
REACTION HAND
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ANKYLOSIS OF ELBOW
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AIMS
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4. ELEVATION OF HAND
5. APPLICATION OF HEAT WAX BATH 6. CPM AFTER INFLAMMATION SUBSIDES
7. ACTIVE MOVEMENTS
8. RADIOGRAPHY BONE STATUS ASSESSMENT
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ASSESSMENT OF HAND
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ANESTHETIC DEFORMITIES
SCAR CONTRACTURE STIFFNESS & SHORTENING OF FINGERS MUTILATION OF FINGERS OM OF PHALANX # OF CARPAL & METACARPAL NEUROPATHIC DISORGANISATION OF WRIST JOINT
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ANTICIPATE, AVOID & ATTEND INJURY INJURY CONSCIOUSNESS TO REALISE THE SERIOUSNESS OF INJURY PREVENTIVE PRECAUTIONS
FOR DAILY ACTIVITIES COOKING, EATING, HANDLING KNIVES, WORK TOOLS, etc
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HIGH PALSY > LOW PARALYSIS DEFORMITY & DISABILITY REMAINS SAME IN BOTH MUSCLES PARALYSED ARE
ALL INTEROSSEI LUMBRICALS III & IV HYPOTHENAR MUSCLES ADDUCTOR POLLICIS FLEXOR POLLICIS BREVIS ( 30 % Pts)
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DEFORMITY
CLAWING OF LITTLE & RING FINGER (+/- INDEX & MIDDLE) Z DEFORMITY OF THUMB (HYPER EXT OF MCP JOINT, FLEXION OF IP JOINT)
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DISABILITY
INABILITY TO HOLD OBJECT, INABILITY TO SPREAD THE FINGERS & BRING THEM TOGETHER FINGER SPAN REDUCED ACTIVITY LIKE TYPING NOT POSSIBLE SMALL OBJECTS (eg; COINS, EATING RICE) FALL OUT GRIP POWER BECOMES WEAK
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DUE TO COMBINED PARALYSIS OF HIGH ULNAR & LOW MEDIAN Nr PARALYSIS OF ALL SMALL MUSCLES OF HAND (INTRINSIC ZERO HAND)
DEFORMITY
CLAWING OF ALL 5 DIGITS DEROTATION OF THUMB
HAND INSENSITIVE
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THUMB DROP
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EARLY STAGE
1. ANTILEPROSY DRUGS 2. STEROIDS
LATE STAGE AIM : TO RESTORE BALANCE OF FORCE OF MOVEMENT ACTING ON THE FINGER JOINT SYSTEM
SPLINT TEMPORARY
Sx - PREFERRED
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2. EXERCISE
3. WAX BATH
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4. SPLINT
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TIME OF SURGERY
1. AFTER ATLEAST 6 MONTHS OF ANTILEPROSY Rx WITH GOOD CLINICAL RESPONSE 2. SHOULD NOT HAVE ANY REACTION / ACUTE EXACERBATION 3. MUSCLE PARALYSIS > 1 YR DURATION (STABLE / IRREVERSIBLE)
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4. EXTENSOR INDICISION
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ANTIA PROCEDURE
PL MOTOR TENDON
BUNNELS OPERATION
FDS TO RING FINGER DEINSERTED- SPLIT INTO 2 STRIPS & INSERTED INTO EXTENSOR EXPANSION OF RING & LITTLE FINGER
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PRE OP
POST OP
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ADVANTAGES
GRIP, PINCH STRENGTH 90 % SUCCESS RATE LUMBRICAL POSITION POSSIBLE RESTORATION OF MAXIMUM WORK
DISADVANTAGES
INDIVIDUAL FINGER CONTROL NOT POSSIBLE
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GRIP & PINCH STRENGTH NOT AFFECTED LUMBRICAL POSITION NOT POSSIBLE INDIVIDUAL FINGER CONTROL POSSIBLE NOT USEFUL IN HYPERMOBILE FINGERS
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POP IN FUNCTIONAL POSITION IP JT. ARE LEFT FREE POP IN FUNCTIONAL POSITION FOR 3 WEEKS INTERMITTENT MCP JT. FLEXION & EXTENSION EXERCISES GREATLY IMPROVE MOTOR FN BUT NOT SENSIBILITY SO INJURIES COMMON
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ARTHRODESIS OF MCP JT. JT. INSTABILITY + ARTHRODESIS OF IP JT. FLEXOR ADDUCTOR REPLACEMENT FPL TENODESIS
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OF TRANSPLANT
RESTORATION OF WRIST EXTENSION BY TRANSFORMING PT TO ECRB FOR FINGER EXTENSOR FCR ARE USED REPLACEMENT OF INTRINSICS BY THE FDS OPPONENS REPLACEMENT BY THE RING FDS ARTHRODESIS OF WRIST
IF AS WITH HIGH MEDIAN NR. PALSY WRIST INSTABILITY, SUBLUXATION, NEUROPATHIC DISORGANISATION OR PAIN
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SPECIFIC DEFORMITIES
REACTION FOOT & TWISTED TOES
PARALYTIC DEFORMITIES
CLAW TOES & FOOT DROP
ANESTHETIC DEFORMITIES
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TWISTED TOES
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DISABILITY
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SITES
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PLANTAR ULCER
STAGES
COMPLICATIONS
THREATENED
CONCEALED
OPEN
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SEPTICEMIA
TETANUS OM
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Rx REST, ELEVATION & WOUND CARE WOUND CARE & POP CAST, PROTECTIVE FOOT WEAR SCAR REVISION, FOOT WEAR MODIFICATION, CORRECTIVE Sx, INFECTION 63 ERADICATION
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OF RECURRENCE
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FOOT WEAR
SENSORY LOSS WITHOUT INTRINSIC MUSCLE PARALYSIS - TOUGH OUTER SOLE SENSORY LOSS WITH INTRINSIC MUSCLE PARALYSIS
MCR 10 15 DEG SHORE FOR SOLE RESILIENT, NON COLLAPSING, SHOCK ABSORBING INSOLE
FORE FOOT ( MC )METATARSO PHALANGEAL REGION HIND & MID FOOT CAUSE SERIOUS DISABILITY TYPES SEPTIC - MC ACUTE OM & ARTHRITIS OF INTER TARSAL & ANKLE JT. DESTRUCTION OF TALUS & CUBOID GOOD PROGNOSIS TRAUMATIC OSTEOPOROSIS:TALUS, NAVICULAR DESTRUCTION Rx IMMOBILISATION POP STABILISING Sx 13.09.2006 68 ORTHOSIS WT. RELIEVING
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FOOT DROP
LOSS OF FOOT DORSIFLEXION 7& EVERSION + DROOPING OF TOES DAMAGE - COMMON PERONEAL IN POPLITEAL REGION MUSCLES PARALYSED TA, EHL, EDL, PERONEUS LONGUS & BREVIS
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CONSEQUENCES
FOOT, TOES DROP HIGH STEPPING GAIT
EVERSION FAILURE OVERLOADING OF OUTER PART OF FOOT ULCER ON FIFTH METATARSAL BASE & HEAD DESTRUCTION OF OUTER PART OF THE FOOT
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Rx OF FOOT DROP
EARLY CASES (INCOMPLETE PARALYSIS) RECOVERY CHANCES 1 YR Rx
ANTILEPROSY STEROIDS FOOT DROP SLING / STRAPPING WITH FOOT WEAR DAILY ELECTRICAL STIMULATION Sx DECOMPRESSION OF THE NERVE (IF SYMPTOMS PERSIST)
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CLAW TOES
DEGREE I
DEFORMITY
II
JT ARTHRODESIS
SOFT MTP
III
PLANTAR ULCERATION
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TISSUE RELEASE MTP CAPSULOPLASTY RESECTION OF METATARSAL HEAD INTERPHALANGEAL ARTHRODESIS CONDYLECTOMY OF 75 METATARSAL HEAD
OF TOE IS OBVIOUS (HOOK LIKE APPERANCE) NO HYPER EXTENSION OF THE MTP JT Rx - ARTHRODESIS OF IP JT.
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EARLY ULCER
MODERATELY SCARRED FOOT MARKED SCARRING FOOT DROP TARSAL DISORGANISATION SHORT FOOT SYMES AMPUTATION BK AMPUTATION SHORT BK AMPUTATION AK AMPUTATION
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MCR CHAPPALS
ARCH SUPPORT + METATARSAL PAD MCR
FOOT WEAR
LOW MOULDED SHOE
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PHYSIOTHERAPY
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PHYSIOTHERAPY
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EXERCISES
ACTIVE
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EXERCISES
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SPLINTING
USES
1. 2. 3. 4. 5. 6. REST IMMOBILISE SPECIFIC MOVEMENT RESTRICTION CONTINUOUS TRACTION STABILISE JT RELEASE OF CONTRACTURE SERIAL SPLINTING
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SPLINTING
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SPLINTING
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OCCUPATIONAL Rx IN LEPROSY
METHODS
AIDS TO ACTIVITIES OF DAILY LIVING & AGRICULTURE
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FUNCTIONAL ASSESMENT PSYCHOLOGICAL ASSESMENT TEACHING PT TO CARRY OUT THEIR WORK SAFELY
SUPERVISION
OCCUPATIONAL THERAPY IS A TEAM WORK
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PROGNOSIS
FACTORS
TYPE OF DISEASE AVAIALBILITY OF ADEQUATE Rx, BOTH MEDICAL & SURGICAL EXTENT OF CARE OF THE AFFECTED PART
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REHABILITATION
PERIOD
EARLY
REHABILITATION
FAMILY COUNSELLING OCCUPTION CERTIFICATION PHYSIOTHERAPY CORRECTION RECONSTRUCTIVE Sx OF DEFORMITY OCCUPATIONAL Rx REEMPLOYMENT SHELTERED INDUSTRY DOMICIALLARY REHABILITATION
MIDDLE
LATE
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PSYCHOLOGICAL REHABILITATION
MEASURES
EARLY RECOGNITION & Rx TRAINING THE AFFECTED , FAMILY & SOCIETY HAND & FOOT CARE MEASURES EARLY Rx OF ULCER RECONSTRUCTIVE Sx PSYCHOLOGICAL OCCUPATIONAL RESTORATION OF HUMAN 97 DIGNITY TO DESTITUTE
I II
SECONDARY IMPAIRMENT
III IV V
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DISABILITY PREVENTION
HANDICAP PREVENTION
REHABILITATION
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