Cold Sensitivity and Its Association to Functional Disability Following a Major Nerve Trunk Injury in the Upper Extremity-A National Registry-based Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2022 Jul 12

PMID 35819958

Authors

Drifa Frostadottir

Linnea Ekman

Malin Zimmerman

Lars B Dahlin

Affiliations

Soon will be listed here.

Abstract

Aims: To investigate self-reported cold sensitivity and functional disability after a repaired major nerve trunk injury in the upper extremity.

Methods: We identified 735 individuals with a major nerve trunk injury in the upper extremity, surgically treated with direct nerve repair or reconstructed with nerve autografts, in the Swedish national quality registry for hand surgery (HAKIR). Patient-reported symptoms, including cold sensitivity, and perceived disability were collected using two questionnaires (HQ-8 and QuickDASH) preoperatively, and at three and 12 months postoperatively.

Results: We included 281 individuals, who had responded the questionnaires, where 197 (70%) were men (median age 34 [interquartile range 25-52] years) and 84 (30%) were women (median age 41 [25-55]). Cold sensitivity (scored 0-100) was the most prominent symptom 12 months postoperatively after an injured and repaired/reconstructed median (p<0.001) or ulnar (p<0.001) nerve, while individuals with a radial nerve injury showed milder symptoms. Concomitant injuries did not affect cold sensitivity scores. Individuals with ulnar nerve injuries scored higher in stiffness (p = 0.019), weakness (p<0.001) and ability to perform daily activities (p = 0.003) at 12 months postoperatively than median nerve injuries. Individuals with a median, ulnar or radial nerve injury with severe (>70) cold sensitivity had 25, 37 and 30 points higher QuickDASH scores, respectively (p<0.001), at 12 months postoperatively than individuals with mild (<30) cold sensitivity. There were no differences in QuickDASH score or cold sensitivity score at 12 months postoperatively between direct nerve repair or nerve reconstruction with nerve autografts. Neither age, nor sex, affected QuickDASH score at 12 months postoperatively.

Conclusion: Cold sensitivity after surgery for a major nerve trunk injury in the upper extremity can be substantial with impaired ability to perform daily activities, where an ulnar nerve injury may have a worse outcome.

Citing Articles

Risk of hand and forearm conditions due to vibrating hand-held tools exposure: a retrospective cohort study from Sweden.

Zimmerman M, Nilsson P, Rydberg M, Dahlin L BMJ Open. 2024; 14(6):e080777.

PMID: 38890140 PMC: 11191761. DOI: 10.1136/bmjopen-2023-080777.

Socioeconomic factors and outcome after repair and reconstruction of digital and major nerve trunk injuries in the upper limb.

Frostadottir D, Perez R, Dahlin L Sci Rep. 2024; 14(1):7242.

PMID: 38538697 PMC: 10973527. DOI: 10.1038/s41598-024-57757-w.

Patient reported symptoms and disabilities before and after neuroma surgery: a register-based study.

Dahlin E, Zimmerman M, Nyman E Sci Rep. 2023; 13(1):17226.

PMID: 37821445 PMC: 10567846. DOI: 10.1038/s41598-023-44027-4.

Neuromas cause severe residual problems at long-term despite surgery.

Dahlin E, Gudinge H, Dahlin L, Nyman E Sci Rep. 2023; 13(1):15693.

PMID: 37735475 PMC: 10514298. DOI: 10.1038/s41598-023-42245-4.

Benign nerve tumours in the upper limb: a registry-based study of symptoms and surgical outcome.

Istefan E, Zimmerman M, Dahlin L, Nyman E Sci Rep. 2023; 13(1):11500.

PMID: 37460574 PMC: 10352292. DOI: 10.1038/s41598-023-38184-9.

References

Rosen B, Lundborg G . The long term recovery curve in adults after median or ulnar nerve repair: a reference interval. J Hand Surg Br. 2001; 26(3):196-200. DOI: 10.1054/jhsb.2001.0567. View

Ruijs A, Jaquet J, van Riel W, Daanen H, Hovius S . Cold intolerance following median and ulnar nerve injuries: prognosis and predictors. J Hand Surg Eur Vol. 2007; 32(4):434-9. DOI: 10.1016/J.JHSB.2007.02.012. View

Nyman E, Dahlin E, Gudinge H, Dahlin L . Surgically Treated Neuroma in Upper Extremity: Patient Characteristics and Factors Influencing Outcome of Surgery. Plast Reconstr Surg Glob Open. 2022; 10(1):e4076. PMC: 8849272. DOI: 10.1097/GOX.0000000000004076. View

Magistroni E, Parodi G, Fop F, Battiston B, Dahlin L . Cold intolerance and neuropathic pain after peripheral nerve injury in upper extremity. J Peripher Nerv Syst. 2020; 25(2):184-190. DOI: 10.1111/jns.12376. View

Collins E, Novak C, Mackinnon S, Weisenborn S . Long-term follow-up evaluation of cold sensitivity following nerve injury. J Hand Surg Am. 1996; 21(6):1078-85. DOI: 10.1016/S0363-5023(96)80319-4. View

Stjernbrandt A, Pettersson H, Liljelind I, Nilsson T, Wahlstrom J . Raynaud's phenomenon in Northern Sweden: a population-based nested case-control study. Rheumatol Int. 2018; 39(2):265-275. DOI: 10.1007/s00296-018-4133-y. View

Stjernbrandt A, Liljelind I, Nilsson T, Wahlstrom J . Defining abnormal cold sensitivity using the Cold Intolerance Symptom Severity questionnaire: a population study. J Hand Surg Eur Vol. 2021; 46(7):731-737. PMC: 8377284. DOI: 10.1177/1753193421996221. View

Rosen B, Dahlin L, Lundborg G . Assessment of functional outcome after nerve repair in a longitudinal cohort. Scand J Plast Reconstr Surg Hand Surg. 2000; 34(1):71-8. DOI: 10.1080/02844310050160204. View

Hundepool C, Ultee J, Nijhuis T, Houpt P, Hovius S . Prognostic factors for outcome after median, ulnar, and combined median-ulnar nerve injuries: a prospective study. J Plast Reconstr Aesthet Surg. 2014; 68(1):1-8. DOI: 10.1016/j.bjps.2014.09.043. View

10.

Ruijs A, Jaquet J, Kalmijn S, Giele H, Hovius S . Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg. 2005; 116(2):484-94. DOI: 10.1097/01.prs.0000172896.86594.07. View

11.

Jongen S, Van Twisk R . Results of primary repair of ulnar and median nerve injuries at the wrist: an evaluation of sensibility and motor recovery. Neth J Surg. 1988; 40(3):86-9. View

12.

Nylander G, Nylander E, Lassvik C . Cold sensitivity after replantation in relation to arterial circulation and vasoregulation. J Hand Surg Br. 1987; 12(1):78-81. DOI: 10.1016/0266-7681_87_90064-7. View

13.

Simesen K, Haase J, Bjerre P . Interfascicular transplantation in median nerve injuries. Acta Orthop Scand. 1980; 51(2):243-8. DOI: 10.3109/17453678008990793. View

14.

Carlsson I, Ekstrand E, Astrom M, Stihl K, Arner M . Construct validity, floor and ceiling effects, data completeness and magnitude of change for the eight-item HAKIR questionnaire: a patient-reported outcome in the Swedish National Healthcare Quality Registry for hand surgery. Hand Ther. 2023; 26(1):3-16. PMC: 10584055. DOI: 10.1177/1758998320966018. View

15.

Ozaksar K, Gunay H, Kucuk L, Coskunol E . Long-term results of primary repair of combined cuts on the median and ulnar nerves in the forearm. Ulus Travma Acil Cerrahi Derg. 2017; 23(5):410-414. DOI: 10.5505/tjtes.2017.92744. View

16.

Lenoble E, Dumontier C, Meriaux J, Mitz V, Sokolow C, Lemerle J . [Cold sensitivity after median or ulnar nerve injury based on a series of 82 cases]. Ann Chir Main Memb Super. 1990; 9(1):9-14. DOI: 10.1016/s0753-9053(05)80430-2. View

17.

Carlsson I, Cederlund R, Hoglund P, Lundborg G, Rosen B . Hand injuries and cold sensitivity: reliability and validity of cold sensitivity questionnaires. Disabil Rehabil. 2008; 30(25):1920-8. DOI: 10.1080/09638280701679705. View

18.

Fonseca M, Elui V, Lalone E, da Silva N, Barbosa R, Marcolino A . Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties. Syst Rev. 2018; 7(1):175. PMC: 6204279. DOI: 10.1186/s13643-018-0836-0. View

19.

Kilinc A, Ben Slama S, Dubert T, Dinh A, Osman N, Valenti P . [Results of primary repair of injuries to the median and ulnar nerves at the wrist]. Chir Main. 2009; 28(2):87-92. DOI: 10.1016/j.main.2009.01.001. View

20.

Lundborg G, Rosen B, Dahlin L, Danielsen N, Holmberg J . Tubular versus conventional repair of median and ulnar nerves in the human forearm: early results from a prospective, randomized, clinical study. J Hand Surg Am. 1997; 22(1):99-106. DOI: 10.1016/S0363-5023(05)80188-1. View