This study set out to compare high-resolution ultrasonography (HRUS) to clinical examination in order to determine how useful HRUS was in determining peripheral nerve involvement in leprosy. Methods: The study comprised a total of 25 leprosy-positive individuals. The research population's demographic and clinical traits were noted. Clinical grading and nerve thickness as determined by HRUS were associated. Additionally assessed was the consistency in recognising nerve involvement between HRUS and clinical evaluation. Results: 60% of the patients were men and 40% were women, with a mean age of 42.8 years. Eighty percent of the patients (80%) had multibacillary leprosy (MB). The median nerve (32%) and peroneal nerve (12%), as well as the ulnar nerve (56%) were the most frequently impacted nerves. The clinical grade and nerve thickness had a very good positive connection (r=0.85, p<0.001). When compared to patients with lower clinical grades, participants with higher clinical grades had considerably thicker mean nerves on the HRUS (p <0.001). With a kappa value of 0.78, HRUS showed excellent agreement with clinical examination. Conclusion: HRUS has the potential to be a useful tool for determining peripheral nerve involvement in leprosy. It offers precise measurements of nerve thickness and has a good clinical grading correlation. High agreement between HRUS and clinical examination is another sign of HRUS's potential as a trustworthy diagnostic tool. The early identification and precise assessment of nerve disease in leprosy patients should benefit from the integration of HRUS into standard clinical practise.