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Effect of Forearm Warming Compared to Hand Warming for Cold Intolerance Following Upper Extremity Trauma
Christine B Novak, PT, PhD; Yue Li, PhD; Herbert P. von Schroeder, MD, MSc; Dimitri J Anastakis, MD; Steven J. McCabe, MD
University of Toronto, Toronto, ON, Canada

Purpose: The purpose of this study was to evaluate the effect of forearm versus hand warming and control conditions to improve symptoms of cold intolerance in hand trauma patients compared to age/sex matched controls.
Material & Methods: Adults at least 3 months following hand trauma with cold intolerance and age/sex matched controls were included. Testing sessions (forearm warming, hand warming, control) were completed in a climate laboratory with continuous temperature monitoring at baseline (22 C), cold exposure (1 C) and recovery (22 C). Outcome measures included physical (skin temperature, sensation, strength, dexterity) self-report (cold intolerance, pain) and psychosocial factors (pain catastrophizing). Statistical analyses were performed to evaluate the relationships between the dependent and independent variables.
Results: Hand trauma patients (n = 9; mean age 34 12yrs) and age-and sex-matched controls were included. With bare hands (patients and controls), the mean skin temperature changed significantly (p < .001) from baseline (31.8 2.6C), cold exposure (15.2 3.3C) and rewarming (30.1 3.4C). In the patient group, the minimum cold temperature was lower in the injured digits (14.3 3.5C) compared to uninjured (16.9 4.1C) digits but not statistically significant (p = 0.09). Skin temperatures had a significant main effect treatment difference (p< 0.001); compared to bare hands, glove warming significantly (p < 0.05) increased the minimum temperature during cold exposure in patients (bare 14.3 3.5C; gloves 20.8 4.2C) and controls (bare 15.0 2.6C; gloves 19.3 1.9C) and the maximum rewarming temperature (bare 30.1 3.4C; gloves 32.4 2.2C) and controls (bare 30.4 3.3C; gloves 32.7 1.9C) and forearm warmers (injured vs. uninjured digits) significantly (p = 0.03) increased the baseline temperatures. Wearing gloves significantly (p < .05) decreased grip strength and pegboard performance in patients. Significant improvement in thermal sensation was reported with forearm and hand warming and injured vs non-injured digits. Patients reported higher pain levels with cold exposure but there was no significant treatment effect.
Conclusion: There was variability in the cold air responses following hand trauma and in healthy controls. Hand trauma patients had a greater temperature change from baseline to minimum cold temperature. Significant decreases in skin temperature during cold exposure in both groups improved with glove warming. Cold air exposure with continuous temperature monitoring may identify subtle physiologic changes associated with cold-induced pain and potential warming interventions.


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