Neurosensory sequelae assessed by thermal and vibrotactile perception thresholds after local cold injury

Abstract

BackgroundLocal freezing cold injuries are common in the north and sequelae to cold injury can persist many years. Quantitative sensory testing (QST) can be used to assess neurosensory symptoms but has previously not been used on cold injury patients.ObjectiveTo evaluate neurosensory sequelae after local freezing cold injury by thermal and vibrotactile perception thresholds and by symptom descriptions.DesignFifteen patients with a local freezing cold injury in the hands or feet, acquired during military training, were studied with QST by assessment of vibrotactile (VPT), warmth (WPT) and cold (CPT) perception thresholds 4 months post-injury. In addition, a follow-up questionnaire, focusing on neurovascular symptoms, was completed 4 months and 4 years post-injury.ResultsQST demonstrated abnormal findings in one or both affected hands for VPT in 6 patients, for WPT in 4 patients and for CPT in 1 patient. In the feet, QST was abnormal for VPT in one or both affected feet in 8 patients, for WPT in 6 patients and for CPT in 4 patients. Freezing cold injury related symptoms, e.g. pain/discomfort when exposed to cold, cold sensation and white fingers were common at 4 months and persisted 4 years after the initial injury.ConclusionsNeurosensory sequelae after local freezing cold injury, in terms of abnormal thermal and/or vibration perception thresholds, may last at least 4 months after the initial injury. Symptoms such as pain/discomfort at cold exposure, cold sensations and white fingers may persist at least 4 years after the initial injury.

Neurosensory and vascular function after 14 months of military training comprising cold winter conditions

“…There is however congruence between QST findings and subjective symptom descriptions in this study, which supports the idea that our QST findings are of clinical value. In a previous study, we observed a similar QST pattern among military conscripts who suffered from cold injuries and were enrolled in the same type of training as the current study population (8).…”

“…This has been shown among cold injury victims (8) and since our subjects are exposed to similar repeated tissue cooling and local ischemia (10) similar symptoms could be expected.…”

“…To our knowledge this is the first prospective study investigating the effects of winter-time cold exposure on neurosensory and vascular function in hands and feet. Previous studies have either studied sequelae after cold injury (4)(5)(6)(7)(8) or rewarming responses and heart rate variability after cold exposure (18,19). Most comparisons to other studies in this section will therefore be made to studies on cold injuries and not cold exposure.…”

“…Previous studies have focused on cold injuries and found an increasing vasospastic reaction and prevalence of white fingers (4,8). A possible explanation is that one winter of cold exposure might not be sufficient Sensibility Index ** *** *** *** *** Figure 3.…”

“…Local cold injuries are categorized into freezing cold injuries, occurring at temperatures <0 °C, and non-freezing cold injuries which occur after prolonged exposure to temperatures >0 °C together with wet conditions and local pressure (3). Previous studies have described both short-and long-term sequelae after local cold injury (4)(5)(6)(7)(8), the majority of the studies involved military personnel. Remaining sequelae entails neurosensory (cold sensitivity, hypoesthesia, local pain etc), vascular (exaggerated vasospastic reaction to cold stimulus, abnormal skin color etc) (4,6,7), musculoskeletal (stiff and painful joints) (7) or most often a combination of the symptoms stated above.…”