Cold Intolerance Following Peripheral Nerve Injury

Abstract

Cold intolerance can be severe and debilitating following injury to the hand. Little is known about its natural history and factors predicting symptom severity. We looked retrospectively at upper limb peripheral nerve injuries over a 12-year period. Information was obtained using a patient questionnaire and patient records. The incidence of cold intolerance was 83%. In 48% the onset of symptoms was within 1 month of the initial injury. At a mean follow-up of 51 months improved symptoms were reported by 21%, while 18% deteriorated. Patients were more likely to develop cold intolerance if they smoked and less likely if they suffered a sharp injury. A score defining the severity of cold induced symptoms, based on the information collected, was calculated for each patient. Significantly increased severity was associated with complete nerve division, median and ulnar nerve division and an associated vessel injury. Symptom improvement was significantly more likely in non-smokers and a deterioration most likely with a high severity score.

Cold sensitivity and associated factors: a nested case–control study performed in Northern Sweden

“…Cold sensitivity is an elusive condition that has previously been defined as an exaggerated or abnormal reaction to cold exposure, causing discomfort or the avoidance of cold (Kay 1985 ). It can be accompanied by pain, numbness, stiffness, weakness, swelling and skin color changes in the affected body part, most often the hands (Irwin et al 1997 ). However, there is no universally accepted symptom-based definition of cold sensitivity, although attempts have been made (Lithell et al 1997 ).…”

“…However, there is no universally accepted symptom-based definition of cold sensitivity, although attempts have been made (Lithell et al 1997 ). The pathophysiological mechanisms are not fully elucidated, but seem to involve a multifactorial etiology, including neural (Irwin et al 1997 ), vascular (Hope et al 2014 ), as well as humoral (Koman et al 1998 ) aspects. Cold sensitivity has previously been studied as a sequela to upper extremity injuries, such as digital and hand amputation (Lithell et al 1997 ; Tark et al 1989 ), hand fracture (Nijhuis et al 2010 ), peripheral nerve and brachial plexus injury (Novak et al 2012 ; Ruijs et al 2007 ), upper extremity arterial injury (Klocker et al 2012 ), flexor tendon repair (Riaz et al 1999 ), corrective surgery for Dupuytren’s disease (McKirdy 2007 ), carpal tunnel syndrome (Thomsen et al 2009 ), freezing cold injury (Carlsson et al 2014 ), and hand–arm vibration (HAV) syndrome (Carlsson et al 2010c ; Necking et al 2002 ).…”

Immersion in Cold-Water Evaluation (ICE) and Self-reported Cold Intolerance are Reliable but Unrelated Measures

“…It has been argued that cold intolerance is not significantly correlated with age [25], smoking history [5], or mechanism of peripheral nerve injury [3]. However, other studies have found that younger subjects are less affected [27], smokers are more affected, and subjects with crushed nerve injuries are more likely to develop cold intolerance [10], further exemplifying the diversity and disagreement surrounding this issue. By creating valid and reliable measurement tools, both for subjective observations and objective physiological responses, the disagreement surrounding this highly prevalent issue may be settled.…”

Assessment of Functional Outcome After Nerve Repair in a Longitudinal Cohort

“…Apart from "weakness'' of the instrument, this might be because these phenomena, especially cold intolerance, can fluctuate over time. There are also studies that report minimal or no change of cold intolerance over time (8,12).…”