Many clinicians are not taught to really examine the nerves

Leprosy Mailing List – November 12th, 2011 

Ref.:   Many clinicians are not taught to really examine the nerves.
From: G. Warren, Sydney, Australia

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Dear Dr  Noto,

Thank you very much for publishing the photos and thank you Dr Barreto for sending them in (LML Nov. 7^th, 2011). 

It is so good to see good photos of typical cases and, I especially appreciate the photos of the nerves.  Many clinicians are not taught to really examine the nerves and I frequently have been able to make a final diagnosis by finding an altered radial or ulnar nerve on the back of a hand.  One horse jockey had no feeling in some toes and no one could diagnose till I showed them the large superficial peroneal nerve!

One teenager, in Asia, complained of numbness and parasthesia, of index and long fingers and had no other obvious symptoms or signs so the general doctor, to whom he went, sent him  to a psychiatric hospital for many months.  Eventually they got him out and when I saw him he had a very large hard radial nerve on the back of that hand and large lymph nodes in neck and groin.  A Biopsy of one of them showed classical leprosy that even the  experienced professor was thrilled at finding- he was not often sent biopsies of lymph nodes!  Poor boy fortunately he did not develop any further major deformity.  Certainly not the classical case- but something to be aware of.

Thank you for the picture of the sural nerve abscess.  I must confess that although I have felt many nerve abscesses and seen many large sural nerves I have never seen one abscess in that manner in the middle of the calf.  It all goes to show that what we do not look for we will never see!  I wonder what I have missed?  Thank you for that.

Grace Warren.

Castle Hill, Sydney Aust.

Prev.  Advisor for Leprosy for the Leprosy Mission in Asia 1975-1995.