OSCR

Diagnostic performance of peripheral nerve palpation compared with ultrasonography in leprosy neuropathy: A prospective real-world clinical evaluation.

Overview

Authors: Jaqueline da Silva Mendes1,2, Thiago Montenegro da Silva1,2, Patricia Tavares Cruz1, Amanda Gabrielle dos Santos Cordeiro1, Raquel da Mata Serique1, Marcelo Ribeiro Alves3, Flavio Alves Lara4, Carolina Talhari1,2, Hélio Amante Miot5, Sinésio Talhari1,2
ORCID iDs: Carolina Talhari
  1. Programa de Pós-Graduação em Ciências Aplicadas à Dermatologia, Universidade do Estado do Amazonas, Manaus, Brazil
  2. Fundação Hospitalar Alfredo da Matta, Manaus, Brazil
  3. Instituto Nacional de Infectologia (IPEC) Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
  4. Lab. de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
  5. Departamento de Dermatologia e Radioterapia da FMB-UNESP, Botucatu, Brazil
Journal: PLoS neglected tropical diseases, volume 20, issue 4, article e0014234
Dates: received 13 November 2025; accepted 8 April 2026; published online 21 April 2026
Type: Research article · Language: English
License: CC BY
Identifiers: DOI 10.1371/journal.pntd.0014234 · PMID 42013148 · PMCID PMC13143118 · OpenAlex W7155074368
Open access: gold, a free copy (OpenAlex)
Status: data only
Categories: other (modality), human (organism), other condition (population), clinical / translational (subfield)
Methods: Statistics, Connectivity
MeSH: Leprosy*, Palpation*, Peripheral Nerves*, Peripheral Nervous System Diseases*, Adult, Aged, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Ultrasonography, Young Adult (* major topic)
Journal subjects: Medicine and Health Sciences, Diagnostic Medicine, Diagnostic Radiology, Ultrasound Imaging, Research and Analysis Methods, Imaging Techniques, Radiology and Imaging, Medical Conditions, Infectious Diseases, Bacterial Diseases, Leprosy, Tropical Diseases, Neglected Tropical Diseases, Biology and Life Sciences, Anatomy, Nervous System, Nerves, Neuropathy, Neurology, Neuroscience, Cognitive Science, Cognitive Psychology, Perception, Sensory Perception, Psychology, Social Sciences, Clinical Medicine, Signs and Symptoms, Lesions, People and places, Geographical locations, South America, Brazil
Topic: Leprosy Research and Treatment (Infectious Diseases, Medicine), according to OpenAlex
Citations: not cited yet (Europe PMC); 44 references in the paper

Abstract

Background: Leprosy frequently causes peripheral neuropathy, and nerve palpation remains a cornerstone of diagnosis in many endemic settings despite its subjectivity and limited reproducibility. High-resolution ultrasonography has emerged as a sensitive, low-cost imaging tool to detect peripheral nerve involvement. We aimed to compare the diagnostic performance and interobserver agreement of peripheral nerve palpation versus ultrasonography for detecting leprosy neuropathy, with particular focus on pure neural forms.

Methodology/Principal findings: In this cross-sectional study, 29 newly diagnosed, treatment-naïve patients with clinical neuropathy underwent standardized palpation of the radial, ulnar, fibular, and posterior tibial nerves by three experienced examiners (dermatologist, orthopedist, physiotherapist). Ultrasonographic cross-sectional area was used as a comparative reference method. Overall, 232 nerves were evaluated, and ultrasonography identified nerve thickening in 26%. Interobserver agreement for nerve thickening on palpation was 60% (95% CI: 54–65%). Using ultrasonography as reference, palpation sensitivity ranged from 26% to 34%, specificity from 68% to 81%, and accuracy from 56% to 67%. Among individual nerves, the posterior tibial nerve showed the highest palpation sensitivity (44%), whereas thickening of the radial nerve was rarely detected (3%). Bilateral asymmetry (>2.5 mm²) was observed in 13% of nerves that were considered clinically normal on examination, and median nerve enlargement (at ultrasonography) was present in 45% of the participants. In patients with pure neural leprosy (62% of the sample), palpation sensitivity was 43%, resulting in frequent misclassification of operational forms.

Conclusions/Significance: Peripheral nerve palpation showed low sensitivity and only moderate specificity when compared with ultrasonography, with poor interobserver agreement even among experienced clinicians. These findings support the consideration of high-resolution ultrasonography as a complementary tool in diagnostic algorithms, particularly in pure neural cases, where reliance on palpation alone may lead to underdiagnosis and misclassification.

Reproduced under the paper's license (CC BY), from the paper cited above.

Code

The paper links to its data, not to its authors' code: see the Data section.

Tracing map

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Data

Datasets cited

Data Availability

Raw data of this study are available at https://doi.org/10.17632/9mpwgnw523.1.

Reproduced under the paper's license (CC BY), from the paper cited above.

Versions

The history of this record: each version stored by the harvester or made by a correction of its authors or of the maintainers of its code, and what changed in its facts. The texts of the paper (its abstract, its availability statements) are not part of it; versions that changed only those are not listed.

Version 1, 29 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 10 authors, 15 MeSH terms, 1 funder, 36 references.

Cite

This paper

da Silva Mendes, J., Montenegro da Silva, T., Tavares Cruz, P., dos Santos Cordeiro, A. G., da Mata Serique, R., Alves, M. R., Alves Lara, F., Talhari, C., Amante Miot, H., & Talhari, S. (2026). Diagnostic performance of peripheral nerve palpation compared with ultrasonography in leprosy neuropathy: A prospective real-world clinical evaluation. PLoS neglected tropical diseases, 20(4), e0014234. https://doi.org/10.1371/journal.pntd.0014234

BibTeX

@article{dasilvamendes2026diagnostic,
author = {da Silva Mendes, Jaqueline and Montenegro da Silva, Thiago and Tavares Cruz, Patricia and dos Santos Cordeiro, Amanda Gabrielle and da Mata Serique, Raquel and Alves, Marcelo Ribeiro and Alves Lara, Flavio and Talhari, Carolina and Amante Miot, Hélio and Talhari, Sinésio},
title = {{Diagnostic performance of peripheral nerve palpation compared with ultrasonography in leprosy neuropathy: A prospective real-world clinical evaluation}},
journal = {PLoS neglected tropical diseases},
year = {2026},
month = apr,
volume = {20},
number = {4},
pages = {e0014234},
publisher = {PLOS},
issn = {1935-2727},
doi = {10.1371/journal.pntd.0014234},
url = {https://doi.org/10.1371/journal.pntd.0014234},
pmid = {42013148},
pmcid = {PMC13143118}
}

RIS

TY - JOUR
AU - da Silva Mendes, Jaqueline
AU - Montenegro da Silva, Thiago
AU - Tavares Cruz, Patricia
AU - dos Santos Cordeiro, Amanda Gabrielle
AU - da Mata Serique, Raquel
AU - Alves, Marcelo Ribeiro
AU - Alves Lara, Flavio
AU - Talhari, Carolina
AU - Amante Miot, Hélio
AU - Talhari, Sinésio
TI - Diagnostic performance of peripheral nerve palpation compared with ultrasonography in leprosy neuropathy: A prospective real-world clinical evaluation
T2 - PLoS neglected tropical diseases
J2 - PLoS Negl Trop Dis
PY - 2026
DA - 2026/04/21
VL - 20
IS - 4
SP - e0014234
SN - 1935-2727
PB - PLOS
DO - 10.1371/journal.pntd.0014234
UR - https://doi.org/10.1371/journal.pntd.0014234
LA - en
ER -

CSL-JSON

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