Occurrence of cold sensitivity in carpal tunnel syndrome and its effects on surgical outcome following open carpal tunnel release

Abstract

Cold sensitivity is common following nerve injuries in the upper extremity, but is less well studied in carpal tunnel syndrome (CTS). We investigated cold sensitivity in CTS and its effects on surgical outcome. A search of the Swedish National Registry for Hand Surgery (HAKIR) for open carpal tunnel releases (OCTR) from 2010-2016 identified 10,746 cases. Symptom severity questionnaires (HQ-8; HAKIR questionnaire 8, eight Likert-scale items scored 0-100, one item on cold sensitivity) and QuickDASH scores before and after surgery were collected. Patient mean age was 56 ± SD 16 years, and 7,150/10,746 (67%) were women. Patients with severe cold sensitivity (defined as cold intolerance symptom severity score > 70; n = 951), scored significantly higher on QuickDASH at all time points compared to those with mild cold sensitivity (cold intolerance symptom severity scores ≤ 30, n = 1,532); preoperatively 64 [50-75] vs. 40 [25-55], at three months 32 [14-52] vs. 18 [9-32] and at 12 months 25 [7-50] vs. 9 [2-23]; all p < 0.0001. Severe cold sensitivity predicted higher postoperative QuickDASH scores at three [12.9 points (95% CI 10.2-15.6; p < 0.0001)] and at 12 months [14.8 points (11.3-18.4; p < 0.0001)] compared to mild cold sensitivity, and adjustment for a concomitant condition in the hand/arm, including ulnar nerve compression, did not influence the results. Cold sensitivity improves after OCTR. A higher preoperative degree of cold sensitivity is associated with more preoperative and postoperative disability and symptoms than a lower degree of cold sensitivity, but with the same improvement in QuickDASH score. Cold sensitivity is a disabling symptom that often presents after hand injuries, particularly those involving peripheral nerves in the upper extremity. It is also common, but often overlooked, in nerve compression syndromes. Cold sensitivity is defined as an abnormal response to cold, with symptoms such as numbness, pain, stiffness, weakness, and sometimes changes in colour 1. Cold sensitivity has also been associated with poorer sensory function following nerve compression 2 , and with reduced quality of life 3. In cases of nerve compression syndromes in the upper extremity, earlier studies have described cold sensitivity as occurring more commonly in patients with diabetes and in women 4. Cold sensitivity largely resolves following open carpal tunnel release (OCTR), but may persist longer in patients with diabetes than in those without 5. The population numbers in previous studies on cold sensitivity in nerve compression syndromes were limited. The impact of cold sensitivity on surgical outcome has not yet been completely clarified 5,6. Hence, our aim was to investigate the occurrence of cold sensitivity in carpal tunnel syndrome (CTS) both pre-and post-operatively, and its effects on the surgical outcome of OCTR.

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

“…There is also the possibility that symptomatic subjects might be more prone to respond to a questionnaire of this kind, which may lead to an overestimation, rather than an underestimation, of symptoms, such as cold sensitivity. In accordance with other register studies, women responded more often to the questionnaires than men and responders were also older than non-responders, indicating that the present data are comparable with other studies and valid 39 , 49 . Another limitation was the low number of same responders to all three questionnaires.…”

“…In addition, a nerve compression lesion, such as carpal tunnel syndrome, induces cold sensitivity, which disappears after surgery with decompression of the nerve. Altogether, this indicates that it is the nerve injury that is causing symptoms such as cold sensitivity 18 , 38 , 39 .…”

“…Previous studies have reported occurrence of cold sensitivity after a peripheral nerve injury, as well as in individuals with other nerve conditions, such as carpal tunnel syndrome, and its association with pain on motion without load, pain on load, stiffness, weakness and numbness/tingling 39 . These symptoms correlated moderately to each other, as well as with activities and disability, and are debilitating symptoms that should be considered when deciding on treatment for nerve injuries 1 , 17 , 39 . In the present study, individuals with severe cold sensitivity scored high on all other HQ-8 items.…”

“…Furthermore, when the national quality register HAKIR was started in 2010, the ICHOM recommendations for regular and extended evaluation of outcome after nerve injuries were not available 48 . We classified individuals into three categories according to the severity of cold severity agreeing to a previously published study 39 . Mild cold sensitivity was defined as a HQ-8 score of ≤ 30, moderate cold severity as a score of 30–70 and severe cold severity as a score of > 70.…”

Manual Therapy With Rest as a Treatment for Established Inflammation and Fibrosis in a Rat Model of Repetitive Strain Injury

“…TASK rats that performed the repetitive work for 14weeks showed progressive sensory and motor declines, and multiple neuromuscular pathologies that resemble many of those seen in humans with upper extremity repetitive strain injuries or median mononeuropathy ( Borg and Lindblom, 1988 ; Carp et al, 2007 ; Fernández-De-Las-Peñas et al, 2016 ; Wolny et al, 2017 ; Wendt et al, 2018 ; Singh and Srivastava, 2020 ; Zimmerman et al, 2020 ). Specifically, TASK rats showed enhanced mechanical sensitivity of the forepaw, greater sensitivity of a noxious cold temperature, declines in reflexive grip strength and forelimb/forepaw agility, and reduced median NCV.…”