Early Active Mobilization of Tendon Transfers

Leprosy, also known as Hansen's Disease, has been known since biblical times. The causative organism Mycobacterium leprae is unique among bacteria in that it has an affinity to involve, infect and destroy peripheral nerves, especially those of the limbs. The disability problems in Leprosy are mainly due to the nerve trunks affected by the disease resulting in diminution or loss of sensation, paralysis of muscles producing deformities and autonomic nerve function impairment leading to loss of sweating, dryness and cracks in the hands and feet. The affected nerve from the initial stage of involvement advances to the stage of damage and finally to a stage of destruction. In the stage of initial involvement, the nerves are thickened, tender, and painful but have no loss of function. In the subsequent stage of damage there is loss of sweating and sensibility, muscle weakness or complete paralysis. These two stages of nerve involvement and damage are amenable to prompt and adequate treatment by multi drug therapy (MDT) and steroids and recovery of lost nerve functions in possible. In the subsequent stage of nerve destruction, the involved nerve is completely damaged and cannot recover function to any useful level with all available treatment. This stage is diagnosed when the nerve has been completely paralyzed for at least one year. Leprosy involves three kinds of peripheral nerves. They are (1) dermal nerves, which are fine nerves in the skin; (2) cutaneous nerves, which are thicker nerves that are palpable under the skin and (3) major nerve trunk, which are large nerves of the limbs.

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