Sensory deficit in median nerve distribution Signs of atrophic ulcers No motor deficit No deficit in other region
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WHO leprosy peripheral neuropathy sensory loss trophic ulcer median nerve diagnosis
This pattern is most suggestive of pure neuritic leprosy (Hansen neuropathy) involving the median nerve, presenting as a sensory mononeuropathy.
- Loss of sensation limited to the median-nerve territory
- Trophic/atrophic ulcers from loss of protective sensation and repeated unnoticed trauma
- No motor weakness, suggesting motor fascicles are not yet significantly affected
- No other nerve-region deficit, suggesting single-nerve involvement
Leprosy is clinically supported when an enlarged peripheral nerve is associated with sensory loss and/or weakness in its distribution, as described in the WHO diagnostic criteria. Examine specifically for a thickened/tender median nerve, skin lesions with sensory loss, and consider nerve conduction studies, slit-skin smear, or nerve/skin biopsy where diagnosis is uncertain.
Because trophic ulcers can become infected and lead to tissue loss, this needs prompt in-person evaluation, wound care, protective splinting/foot-or-hand protection as appropriate, and assessment for multidrug therapy if leprosy is confirmed.
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