LEPROSY PHYSICAL EXAM

NERVE FUNCTION TEST(VMT/ST)

• Sensory nerve fibers: are involved early and most
severely affected. Cause anesthesia which is the
most important cause of disability.
• Motor nerve fibers: paralysis, joint stiffness,
clawing.
• Autonomic nerve fibers: sweating impaired (skin
dryness, skin fissures, ulceration, scaring).
 2. Nerve Function Test (NFT)…contd

Test the following peripheral nerve fibers.

a) Sensory Nerve fibers by Sensory Testing (ST)
b) Motor nerve fibers by Voluntary Muscle Testing
(VMT)
c) Autonomic nerve fibers by Checking Palms and
Soles for Dryness.

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 2.1 Sensation Test (ST)
Test sensation of eyes, hands and feet
2.1.1 Sensation of the eyes (Cornea)
• Observe the patient’s blink ( open & close
the eye) as you talk to him/here.
• Normal blink = Normal Corneal Sensation =
No need for testing sensation by cotton
wool.
• No blink = Eye at risk = Do corneal
Sensation Test.
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 2.1 Sensation Test (ST)…contd

• Wash hands well; make a cotton wisp; explain test to

the patient.
• While patient is looking upward to the opposite side,
touch the edge of the cornea and observe reaction.
• Record result in the Patient Record Card.
– If sensation is normal, patient blinks eyes

– If sensation is absent, there is no blink. 5

 2.1 Sensation Test (ST)…contd
2.1.2 Testing sensation of palms & soles
• Test sensation on palms and soles with a
ball-point pen

• Sensation should be tested on 10 standard

points
• Absence of senasation on 2 or more points
shows presence of aneasthesia
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2.1 Sensation Test (ST)…contd

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 2.2 Voluntary Muscle Testing (VMT)

 Muscle strength of the eyes, hands and feet is

measured by VMT
Strength is graded as
1. Strong- S
2. Weak- W
3. Paralyzed- P
VMT
4. Eye closure
5. Strength (resistance) of the hands & feet
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 2.2 Voluntary Muscle Testing (VMT)…contd

2.2.1 VMT of the EYE

Eye closure:-
 Ask the patient to close his eyes lightly as in sleep.
 Look for completeness of eye lid closure,
 Lagophthalmos (inability to fully close the eye);
 If there is Lagophthalmos measure the lid gap in mm.
 If pt is able to fully close his eyes (no Lagophthalmos), ask pt
to close the eyes firmly , and gently check for strength
(resistance) of eye lid muscles.
 Grade the strength as weak (W) or strong (S)
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 2.2 Voluntary Muscle Testing (VMT)…contd

Testing the eyelid muscles

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 2.2 Voluntary Muscle Testing (VMT)…contd

Lagophthalmos

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 2.2 Voluntary Muscle Testing (VMT)…contd

2.2.2 VMT of hands and feet

• Check range of movement:-
• Is movement normal, reduced or absent because of
muscle paralysis.
• If movement is normal > test for resistance > press
gently while asking the patient to maintain the
position by resisting the pressure as strongly as
possible.
• Is the resistance (S), (W) or absent (P)
• Compare the right hand or foot with the left. 12
 2.2 Voluntary Muscle Testing (VMT)…contd

2.2.2.1 Thumb up test

Tests the Median nerve:-
– Ask the person to put out his/her hand, and palm
up
– Support his/her hand in your hand
– Ask him/her to point the thumb towards their
own nose
– Test the strength of the thumb to stay in that
position
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 2.2 Voluntary Muscle Testing (VMT)…contd

Thumb up test

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 2.2 Voluntary Muscle Testing (VMT)…contd

2.2.2.2 Little finger out test

Tests the Ulnar nerve:-
• Ask the person to put out his/her hand, palm up

• Support his/her hand in your hand

• Ask him/her to move the little finger out

• Test the strength of the little finger to stay in that
position. 15
 2.2 Voluntary Muscle Testing (VMT)…contd

Little finger out test

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 2.2 Voluntary Muscle Testing (VMT)…contd

2.2.2.3 Foot up test

Tests the Peroneal nerve:-
• Ask the person to sit down

• Support the person’s lower leg in your hand

• Ask the person to point the foot up to the roof
• Test the strength of the foot to stay in that position.

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 2.2 Voluntary Muscle Testing (VMT)…contd

Foot up test

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 2.2 Voluntary Muscle Testing (VMT)…contd
2.2.2.4 Wrist up test
Tests the Radial Cutaneous nerve:-

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 Examination of eyes for
disability
Visual acuity (for both eyes)
 Test vision with good light falling on the assessor
 Ask the pt to cover one eye and count the fingers
of the assessor at 6 meters
 If the patient cannot see at 6 meters, re-test at 3
meters.
Other eye problems/complications
 Injury of the cornea
 Loss of vision due to incomplete blink and or eye
closure
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 Examination of hands/feet for
disability
 Examine complication due to nerve damage
which are usually combined with loss of
sensation, dryness of the skin & muscle weakness.
 Skin cracks with loss of sensation
 Wounds with loss of sensation
 Clawed fingers and toes
 Dropped foot
 Dropped wrist
 Shortening and scarring with loss of sensation 21