Cold sensitivity, functional disability and predicting factors after a repaired digital nerve injury

Abstract

To investigate self-reported cold sensitivity and functional disability after a repaired digital nerve injury. We identified 3204 individuals operated with digital nerve repair in the Swedish national quality registry for hand surgery (HAKIR). Patient-reported symptoms, including cold sensitivity and perceived disability, were examined using two questionnaires (HQ-8 and QuickDASH), three and 12 months postoperatively. Patients with diabetes (n = 48; 3%) were identified in the Swedish National Diabetes Register (NDR). Cold sensitivity (scored 0–100) was the most prominent symptom among 1553 included individuals (998 men, 555 women; median age 41 [IQR 27–54] years). In the regression analysis, flexor tendon injury, hand fracture and injury to multiple structures predicted worsened cold sensitivity (6.9, 15.5 and 25.0 points; p = 0.005, 0.046 and < 0.001) at 12 months. Individuals with moderate (30–70) and severe (> 70) cold sensitivity had higher QuickDASH scores at three and 12 months postoperatively than individuals with mild cold sensitivity (6.0 and 5.5; 19.8 and 21.0 points; p = 0.001). Flexor tendon injury, injuries to multiple structures and diabetes had significant effect on QuickDASH scores at three, but not at 12, months postoperatively. Cold sensitivity is common after a digital nerve repair and impacts self-reported disability. A concomitant injury, particularly multiple injuries, predicts postoperative cold sensitivity.

Cold sensitivity and its association to functional disability following a major nerve trunk injury in the upper extremity—A national registry-based study

“…Neither age, nor sex, affected QuickDASH scores at 12 months, which also has been reported among individuals with a single digital nerve injury [ 20 ]. This is in contrast to previous studies, where lower age has been reported as a significant predictor of successful motor recovery [ 32 , 37 ].…”

“…We found no differences in occurrence of concomitant injuries between men and women, which is in contrast to individuals with a single injury to a digital nerve, where men tend to suffer from more severe and multiple injuries [ 20 ]. This could be explained by the position of the major nerve trunks, which commonly lie deep to the flexor tendons on the volar aspect, depending on the level, where an injury to the median or the ulnar nerves needs to be deep enough to perch the nerve and therefore often involves a more extensive and complex injury regardless of sex.…”

“…However, the present individuals with a major nerve trunk injury showed 4–16 points higher QuickDASH score at 12 months postoperatively when the self-reported cold sensitivity was judged as severe (i.e. >70) compared to individuals with a single digital nerve injury [ 20 ], indicating the impact of particularly the median and ulnar nerves on hand function. The present QuickDASH scores for individuals with a median and an ulnar nerve injury (i.e.…”

“…Interestingly, no difference was seen in cold sensitivity scores, nor QuickDASH scores, at 12 months between individuals with or without concomitant flexor tendon injury. Furthermore, individuals with a median or an ulnar nerve injury, who reported severe cold sensitivity at 12 months, did not more commonly have concomitant flexor tendon injury, which is in contrast to individuals with a digital nerve injury [ 20 ]. The location of the injury at the wrist/forearm level might play a role concerning the start of rehabilitation, since such a program may be initiated earlier concerning mobilisation of the fingers and the postoperative range of motion is not affected as much as compared to an injury at the digital level.…”

“…In the Swedish National Quality Register for Hand Surgery (HAKIR), symptoms and disability are evaluated pre- and postoperatively by QuickDASH and a specific hand surgery questionnaire (HQ-8), focusing on pain, cold sensitivity and related symptoms with subsequent ability to perform daily activities [ 5 ]. Data from HAKIR indicates problems with cold sensitivity even after treated single digital nerve injuries [ 20 ]. However, the presence of cold sensitivity after surgically treated major nerve trunks has not been sufficiently highlighted, nor how it is affected by concomitant injuries.…”