The validity and reproducibility of the skin vasomotor test—studies in normal subjects, after spinal anaesthesia, and in diabetes mellitus

Abstract

Skin sympathetic vasomotor control can be examined in the extremities by the skin vasomotor test. In this test the change in skin blood flow and skin temperature in the hand and foot in response to a cold stimulus is utilized as an index of distal sympathetic nerve fibre integrity. This is of importance in conditions such as diabetes mellitus as peripheral autonomic neuropathy is associated with orthostatic hypotension and diabetic foot complications. The validity and reproducibility of the test as a marker of distal sympathetic nerve function has been studied. The test was performed in nine healthy control subjects and in nine subjects (undergoing minor surgery) after a sympathetic nerve conduction block (L2-L3) was achieved in the lower extremities by spinal analgesia. Changes in skin temperature (p < 0.001) and skin blood flow (p < 0.005) in responses to cooling were significantly larger in the control group than in the group with spinal analgesia. Repeated skin temperature measurements on 42 occasions (test-retest period of 4 weeks) in eight healthy and 34 diabetic subjects indicated a reliability coefficient of 80%. We conclude, therefore, that the skin vasomotor test provides a valid and reproducible quantitative assessment of skin sympathetic nerve function in upper and lower extremities.

Effect of Korean red ginseng on cold hypersensitivity in the hands and feet: study protocol for a randomized controlled trial

“…Among other methods, the measurement of skin temperature with the CST has been reported to be a good indicator of sympathetic responses [36], and has been used to evaluate central autonomic and peripheral vascular responses [37]. Cold stimulation increases sympathetic activity and the removal of the extremities from a cool environment results in prompt rewarming in the healthy subjects, with an RR of over 80% at five minutes.…”

The relationship between pressure ulcers and skin blood flow response after a local cold provocation

“…Because damage of (peripheral) autonomic nerve fibers occurs in several diseases, widespread use has been made of temperature provocation tests to detect and assess the extent of this damage, and also to evaluate the effect of therapies on, for instance, diabetes mellitus, Raynaud's disease, and anorexia nervosa. [10][11][12][13][14][15][16] In these tests, local temperature stimuli (mainly cold) are applied locally, and local vascular responses are studied, usually by monitoring the local temperature course. The stimuli are usually applied to an extremity.…”

Reproducibility of Skin Temperature Response after Cold Stress Test Using the Game Ready System: Preliminary Study

“…Although there is a high intersubject variability response to CST [18], good reproducibility of skin temperature after CST has been observed by different studies due to a lower within-subject variability [8,15,19]. However, this reproducibility is not generalizable to all the body regions [20].…”

“…For example, O'Brien [15] observed reproducible finger skin temperatures in the nail bed, but not in the pad. These studies assessed hands and foot, being the most used method the immersion of these extremities in cold water [8,15,19]. Therefore, it is necessary to determine the reproducibility for specific regions with new methodologies of CST.…”