Short-term outcomes of ulnar, median, tibial, and common fibular neurolysis in leprosy neuropathy: A prospective study of pain, sensory function, and muscle strength

BACKGROUND: Leprosy neuropathy is a major cause of persistent pain and functional impairment. When neuritis does not respond adequately to medical management, open neurolysis is often used to decompress inflamed peripheral nerves, yet short-term outcomes across different nerve groups remain incompletely characterized. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a prospective cohort study including 65 patients with clinically diagnosed leprosy neuropathy who underwent open neurolysis of the ulnar, median, tibial, or common fibular nerves. Sensory function, motor strength, and neuropathic pain were evaluated preoperatively and at 30 and 60 days postoperatively using Semmes-Weinstein monofilaments, the Medical Research Council scale, and a visual analog scale, respectively. Changes over time were estimated using mixed-effects cumulative link models for ordinal outcomes, adjusted for age, operated side, and nerve group, with patient ID as a random effect. The contralateral limb was assessed at the same time points as a within-patient comparator. Pain decreased significantly at the group level in all operated nerve groups at 30 days (p < 0.001), and this reduction was maintained at 60 days under routine postoperative care, although individual responses varied. Sensory improvement was observed only after common fibular neurolysis at 30 days and was not sustained at 60 days. No measurable motor improvement was detected during this early 60-day follow-up period. Pain reduction did not differ significantly between patients operated more than three years after completion of multidrug therapy and those operated earlier, although pain worsening was observed only in the < 3-year group. CONCLUSIONS/SIGNIFICANCE: Overall, these findings support neurolysis primarily as a short-term analgesic procedure within the early postoperative period, while the absence of measurable motor improvement should be interpreted as a preliminary short-term observation. Longer-term controlled studies are needed to refine surgical indications and determine whether delayed sensory or motor recovery occurs after neurolysis.