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Cold Intolerance After Median, Ulnar or Radial Nerve Injury
Christine B. Novak, PT, PhD1; Dimitri J. Anastakis, MD1; Dorcas E. Beaton, PhD2; Susan E. Mackinnon, MD3; Joel Katz, PhD4
1Division of Plastic & Reconstructive Surgery, Hand Program, University of Toronto, Toronto, ON, Canada; 2Mobility Program Clinical Research Unit, St Michael's Hospital, University of Toronto, Toronto, ON, Canada; 3Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO; 4Department of Psychology & Department of Anesthesia, York University & University of Toronto, Toronto, ON, Canada

Purpose: Cold intolerance following distal nerve injury may be severe and may contribute to poor outcome. The purpose of this study was to evaluate the factors associated with cold intolerance in patients with long-standing median, ulnar or radial nerve injury.

Methods: Following Research Ethics Board approval and informed consent, adult patients more than six months after a median, ulnar or radial nerve injury were asked to complete these questionnaires: Cold Intolerance Severity Scale (CISS), DASH, SF-36, McGill Pain Questionnaire-Short Form (MPQ), Pain Catastrophizing Scale (PCS) and Post-traumatic Stress Disorder Checklist (PCL-C). Statistical analyses were used to evaluate the relationships among the outcome measures and the independent variables. Multivariable linear regression (backward manual elimination) was used to evaluate the variables that predicted CISS scores.

Results: There were 72 patients (46 men, 26 women) with a mean age 41 14 years and median time from injury 15 months. The mean scores were: CISS 34.5 24.1, DASH 39.5 21.3, PCS 15.4 14.7, PCL-C  33.4 12.9, pain intensity 4.2 2.8, MPQ pain rating index 11.3 9.1, SF-36 mental composite score 47.0 11.2 and SF-36 physical composite score 43.1 7.7. Preliminary analysis revealed a strong correlation between the CISS and the MPQ pain rating index (r = .71), pain intensity (r = .56), PCL-C (r = .50), PCS (r = .49) and DASH (r = .49). The initial regression model (dependent variable CISS scores) included these independent variables: time since injury, DASH, PCS, PCL-C, pain intensity, MPQ pain rating index and SF-36 composite scores. The final regression model explained 53% of the variance and the only significant variable was the MPQ pain rating index (Beta = .677, p < .001). 

Conclusions: High levels of cold intolerance were reported by these patients with long-standing median, ulnar or radial nerve injuries and the significant factor that was associated with cold intolerance was the MPQ pain rating index.


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