Abstract
Cold sensitivity, an abnormal response to exposure to cold, is debilitating. It often affects people with nerve injuries and diabetes. Knowledge about the occurrence and prognostic impact of cold sensitivity in people with ulnar neuropathy at the elbow (UNE) is limited. We aimed to investigate the occurrence of cold sensitivity in UNE in relation to disability, the influence of diabetes and impact on surgical outcome. Data concerning 1270 persons operated on for UNE from 2010-2016 from the Swedish National Register for Hand Surgery (HAKIR) were matched with data from the Swedish National Diabetes Register (NDR). Disability and symptoms were assessed preoperatively, and at three and 12 months postoperatively using QuickDASH and a symptom-specific survey (HQ-8) containing one item regarding cold sensitivity. Differences regarding grade of cold sensitivity, occurrence of diabetes, QuickDASH scores and HQ-8 scores were studied. A linear regression analysis was performed to predict surgical outcome based on preoperative cold sensitivity. The mean age of the cases was 52 ± SD 14 years and 48% were women. Preoperatively, 427 answered the questionnaire. Severe cold sensitivity was present in 140/427 (33%) cases, moderate in 164/427 (38%) and mild in 123/427 (29%) cases. Cases with severe preoperative cold sensitivity reported higher QuickDASH scores at all times compared to cases with mild cold sensitivity. Relative change in QuickDASH scores over time did not differ between the groups. Cases with diabetes reported worse cold sensitivity preoperatively, but not postoperatively. All HQ-8 items improved with surgery, but cases with severe cold sensitivity reported worse persisting symptoms. Cold sensitivity is a major problem among those with UNE and an even greater preoperative problem among people with diabetes. It is associated with more symptoms and disability pre- and post-operatively. All cases, regardless of preoperative degree of cold sensitivity improve with surgery.
Highlights
Cold sensitivity, an abnormal painful response to cold exposure, is a debilitating condition, which often occurs after hand trauma, as a result of peripheral nerve injuries, and in carpal tunnel syndrome (CTS) (1)
As 76 persons were operated on bilaterally, our study included 1346 cases, from 1270 people, where the ulnar nerve was subjected to surgery at the elbow
We found no differences in HbA1c values, retinopathy frequency, BMI or duration of diabetes between persons with diabetes and moderate or severe cold sensitivity compared to those with diabetes and mild cold sensitivity
Summary
An abnormal painful response to cold exposure, is a debilitating condition, which often occurs after hand trauma, as a result of peripheral nerve injuries, and in carpal tunnel syndrome (CTS) (1). UNE has an incidence rate of 21-30/100 000 person-years (3, 4) It occurs when the ulnar nerve becomes compressed at elbow level for example beneath the Osborne’s ligament. Cold sensitivity is more common in people with diabetes, BMI >25, rheumatic diseases and in women (2, 7). It is associated with reduced quality of life and characterized by pain, stiffness, weakness, numbness and colour changes in the affected body part (8, 9). The aim of this study was to investigate the presence of cold sensitivity in those with UNE at the elbow requiring surgical treatment, its relation to other symptoms and disability, the influence of gender and diabetes, as well as the effects of surgical treatment
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