Leprosy
mailing list – June 9th, 2005
Ccn:
all.
Ref.: Reactions
and their management.
From: R Jerskey, Los Angeles and San
Diego, California, USA.
Dear Dr. Noto,
I would like to comment re: Reactions and their management ---the
first of the two interesting articles submitted to the LML on May 21st
by Dr. Ganapati and Dr. Pai.
Specifically, I would like to address one small component of the well
detailed article: the clinical manifestation of "stasis
hand" or "reactional hand" and what was written: -
"this usually leads to the flexion of distal inter-phalangeal
joints and hyper-extension of meta-carpo-phalangeal and proximal
inter-phalangeal joints ("intrinsic plus" deformity)."
There may have been a simple mix up of words, but
if not, for clarification: an "intrinsic plus" deformity
consists of flexion, not extension or hyper-extension, at the
metacarpo phalangeal [MP] joints and extension at the inter-phalangeal
[IP] joints. And in some pathologies, it can also include some
"swanning" at the IP joints, whether resulting from a
rheumatological condition, or from an over-corrected surgical
procedure [one can view a photo on pg 320 from R. Schwarz and W.
Brandsma's Surgical Reconstruction & Rehabilitation in Leprosy],
or other cause.
On the other hand (no pun intended),
the "intrinsic minus" deformity, or "claw hand"
deformity, consists of hyperextension of the MP joints and
flexion of the IP joints----seen in leprosy patients whose intrinsic
muscles are significantly impaired by ulnar and median nerve
involvement. In other words, the hand becomes one which is
"minus" the integral intrinsic muscle apparatus that is
essential for much functional grasp and pinch.
I believe the Stasis Hand falls in
neither of these two opposing categories. And I believe that the fine
graphic photo that Dr. Ganapati and Dr. Pai included in their article
illustrates that.
If I may also add here, treatment for
the stasis hand would include positioning it in a resting splint such
that the MP joints are flexed at about 60 degrees and the IP joints
are in extension in order to prevent collateral ligament contractures
which could otherwise result in further impaired hand function and
deformity down the line. And,
depending on the acuity, gentle, therapeutic exercises at periodic
intervals would also be in order for such a hand. I do not have a published
protocol re: treatment of such a hand, but this has been my
experience.
I greatly appreciate the
opportunity to be a part of this forum and to respond to a part of
this series on Reactions prepared by these two eminent leprologists.
With warm regards,
Robert Jerskey
LOTR,
prevention of impairment and disability consultant,
National
Hansen's Disease Program,
Los Angeles
and
San Diego
,
California
,
USA
rjerskey@lacusc.org
robjerskey@yahoo.com
