Cold Sensitivity Test Research Articles

Ultrasound-guided selective glossopharyngeal nerve block: posterior mandibular ramus approach.

Glossopharyngeal nerve block is a useful interventional technique for pain management of the head and neck. It is performed with landmark techniques or ultrasound guidance. We propose a novel ultrasound-guided glossopharyngeal nerve block technique. This new approach was performed in 3 patients in their twenties and thirties. A needle was inserted deeply under the stylohyoid muscle through the sternocleidomastoid muscle. Subsequently, an ultrasound-guided nerve block was performed with 1 mL of 1% xylocaine. The performance of our technique was evaluated with 2 tests: a cold sensitivity test and a gag reflex test. The effect of the nerve block was observed in the posterior third of the tongue on both sides, the tonsils, and the pharyngeal region. The effect lasted for approximately 1.5 hour. Motor efferent block was not observed. We designated the technique as ultrasound-guided selective glossopharyngeal nerve block: posterior mandibular ramus approach. No complications occurred during the bilateral application. This novel approach can be performed at a very shallow position, compared with conventional methods. There is no damage to tissues other than the muscles, which reduces postoperative complications and patient distress. Although our technique requires further safety assessments and technical refinements, it could represent a simpler alternative to conventional methods in daily clinical practice.

Clinical Characteristics and Results of Transungual Excision of Subungual Glomus Tumor

IntroductionGlomus tumor is rare and subungual location of the distal phalanx is the most common site. Surgical excision is the mainstay of treatment to relieve the symptoms. The objective of this study was to analyze the clinical characteristics and result of transungual excision of the tumor.MethodsA retrospective cross sectional study of was conducted among 15 cases of subungual glomus tumors operated with transungual excision over 8 years period in the department of Orthopedics. The clinical and demographic characteristics were noted from the case record. The outcome variables were assessed from case records, OPD visits, and telephone interviews and the results analyzed were pain relief, postoperative recurrence, nail deformity, and patient satisfaction. Data was analyzed by using descriptive statistical tools in SPSS-20.ResultsThe mean age of the patients was 32.6 years with the mean duration of symptoms 1.8 years. The mean tumor size was 3.4 mm. Pain and pinpoint tenderness were present in all 15 cases and positive cold sensitivity test and positive Hildreth’s test in 13 (86.7%) and 10 (66.7%) cases respectively. All cases had complete relief of pain within 2 weeks of the operation. There was no case of recurrence and nail deformity till a minimum of 1 year of follow up.ConclusionsThe diagnostic clinical triad of pain, point tenderness, and cold sensitivity are the most common findings. The transungual excision of the tumor can give rise to excellent results with complete relief of pain in all cases with no recurrence or nail deformity.

The peripheral vascular responses in non-freezing cold injury and matched controls.

What is the central question of this study? Does non-freezing cold injury (NFCI) alter normal peripheral vascular function? What is the main finding and its importance? Individuals with NFCI were more cold sensitive (rewarmed more slowly and felt more discomfort) than controls. Vascular tests indicated that extremity endothelial function was preserved with NFCI and that sympathetic vasoconstrictor response might be reduced. The pathophysiology underpinning the cold sensitivity associated with NFCI thus remains to be identified. The impact of non-freezing cold injury (NFCI) on peripheral vascular function was investigated. Individuals with NFCI (NFCI group) and closely matched controls with either similar (COLD group) or limited (CON group) previous cold exposure were compared (n=16). Peripheral cutaneous vascular responses to deep inspiration (DI), occlusion (PORH), local cutaneous heating (LH) and iontophoresis of acetylcholine and sodium nitroprusside were investigated. The responses to a cold sensitivity test (CST) involving immersion of a foot in 15°C water for 2min followed by spontaneous rewarming, and a foot cooling protocol (footplate cooled from 34°C to 15°C), were also examined. The vasoconstrictor response to DI was lower in NFCI compared to CON (toe: 73 (28)% vs. 91 (17)%; P=0.003). The responses to PORH, LH and iontophoresis were not reduced compared to either COLD or CON. During the CST, toe skin temperature rewarmed more slowly in NFCI than COLD or CON (10min: 27.4 (2.3)°C vs. 30.7 (3.7)°C and 31.7 (3.9)°C, P<0.05, respectively); however, no differences were observed during the footplate cooling. NFCI were more cold-intolerant (P<0.0001) and reported colder and more uncomfortable feet during the CST and footplate cooling than COLD and CON (P<0.05). NFCI showed a decreased sensitivity to sympathetic vasoconstrictor activation than CON and greater cold sensitivity (CST) compared to COLD and CON. None of the other vascular function tests indicated endothelial dysfunction. However, NFCI perceived their extremities to be colder and more uncomfortable/painful than the controls.

Antinociceptive Investigations of Rubiadin in Chronic pain induced by Freund’s adjuvant in mice

Main aim of study is to investigate the Rubiadin effects in mice model of chronic inflammation and pain. Complete Freund’s adjuvant (CFA) inflammatory model was used for investigation of chronic hypersensitivity. Prior CFA inflammation, Von Frey filaments and acetone induced cold sensitivity test was used to evaluate hypersensitivity, respectively. The paw edema was measured using digital plethysmometer. Intraperitoneally administered Rubiadin (100 and 200mg/kg) prior testing reduced CFA induced mechanical hypersensitivity. Rubiadin reduces evoked acetone cold hypersensitivity. Compared with vehicle, Rubiadin reduces paw edema too. Rubiadin reduced mechanical hypersensitivity significantly when administered two times a day from first to fifth day and from ninth to tenth day. In conclusion study revealed Rubiadin anti-nociceptive activity in chronic pain and also might be potential for effective management of pain.

Estrogen receptor β/substance P signaling in spinal cord mediates antinociceptive effect in a mouse model of discogenic low back pain.

Discogenic low back pain (DLBP) is the most commonly described form of back pain. Our previous studies indicated that estrogen-dependent DLBP mechanism was mediated by estrogen receptors (ERs) in the intervertebral disc (IVD) tissue, and the IVD degeneration degree is accompanied by downregulation of ERs, particularly ERβ. However, the neuropathological mechanisms underlying ERs modulation of DLBP are still not well understood. In this study, we investigated the antinociceptive effects of selective ERβ agonists on DLBP-related behavior by regulating substance P in spinal cord and dorsal root ganglia. Two weeks after ovariectomies, 18-week-old female mice were randomly separated into four groups: control group; DLBP sham surgery plus vehicle group; DLBP plus vehicle group; DLBP plus ERβ-specific agonist diarylpropionitrile (DPN) group. Behavioral data was collected including behavioral measures of axial back pain (grip force and tail suspension tests) and radiating hypersensitivity (mechanical sensitivity and cold sensitivity test). Dual label scanning confocal immunofluorescence microscopy was used to observe spatial colocalization of ERβ and substance P in spinal cord. Substance P changes in spinal cord and dorsal root ganglia were measured by immunohistochemistry and real-time PCR. ERβ activation could improve both axial and radiating behavioral disorders of DLBP. DPN facilitated the decrease of the amount of time in immobility 1 week after agonist administration. At the time point of 3 weeks, DPN group spent significantly less time in immobility than the vehicle group. In the grip strength tests, starting from postoperative week 1-week 3, DPN injection DLBP mice showed more resistance to stretch than the vehicle injection DLBP mice. Significant differences of cold withdrawal latency time were observed between the DLBP plus DPN injection and DLBP vehicle injection groups at 2- and 3-week injection time point. DPN significantly reversed the paw withdrawal threshold of DLBP mice at the time point of 1, 2, and 3 weeks. Substance P colocalized with ERβ in spinal dorsal horn, mainly in laminae I and II, a connection site of pain transmission. Substance P levels in dorsal horn and dorsal root ganglia of DLBP group were distinctly increased compared with that of control and DLBP sham group. DPN therapy could decrease substance P content in the dorsal horn and the dorsal root ganglia of DLBP mice compared with that of vehicle-treated DLBP mice. Activation of ERβ is antinociceptive in the DLBP model by controlling substance P in spinal cord and dorsal root ganglia, which might provide a therapeutic target to manage DLBP in the clinic.

Glomus Tumor of the Nail Bed with Local Pain: A Case Report

Glomus tumors are rare mesenchymal perivascular tumors that often developed in adult age between 30 to 50 years, near fine peripheral neurovascular structures, most notably finger nail beds. A 34 years old woman presented to OPD with pain in the left little finger nail for last five years. On examination, we found Love’s pin test and Hildreth’s test was positive, cold sensitivity test was equivocal. She was diagnosed as glomus tumor. Surgical intervention used to remove completely the tumor and the outcome was excellent. Histopathology confirmed the diagnosis.

Head and neck radiotherapy effects on the dental pulp vitality and response to sensitivity tests: A systematic review with meta-analysis.

Experimental studies are controversial regarding the effects of radiotherapy for head and neck cancer (HNC) on the dental pulp. Therefore, a systematic review of clinical studies is necessary to investigate whether alterations in pulp status occur. To evaluate the evidence on radiotherapy for HNC and pulp status. A systematic search of articles published until November 2021 was performed in the MEDLINE/PubMed, Cochrane Library, Web of Science (All Databases), Scopus, EMBASE, and Open Grey databases. The eligibility criteria were based on the PICOS strategy, as follows: (P) vital teeth of adult patients with intraoral and/or oropharyngeal cancer; (I) radiotherapy; (C) control group or values of the same tooth before radiotherapy (basal values); (O) pulpal status after radiotherapy; and (S) clinical studies. The Cochrane Risk of Bias in Nonrandomized Studies of Interventions tool was used to assess the quality of the included studies. Meta-analyses were performed using fixed and random effects. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Six studies were included for qualitative analysis. Five were classified as serious risk of bias and one as moderate risk of bias. Four studies reported altered pulp responses to cold thermal tests after radiotherapy initiation. Meta-analyses were performed using three included studies. From these, all were included in the meta-analysis for pulp response values to cold sensitivity test immediately after radiotherapy initiation (risk ratio: 0.00 [CI: 0.00, 0.02], p<.00001; I2 =0%); and two in the meta-analysis for pulp response values to cold sensitivity test after 4-5months of radiotherapy (risk ratio: 0.01 [CI: 0.00. 0.06], p<.00001; I2 =0%). Two reported progressively higher readings to pulp response in the electrical test after radiotherapy initiation (mean difference: -11.46 [-13.09, -9.84], p<.00001; I2 =68%). Two studies demonstrated a pulp oxygen saturation (SpO2 ) decrease at the end of radiotherapy; and an increase after 4-6months of radiotherapy beginning. And other demonstrated normal dental pulp SpO2 4-6years after treatment. GRADE analysis presented a moderate certainty of evidence. This review verified that radiotherapy for HNC causes significant alterations on the dental pulp responses, but does not seem to induce pulp necrosis. Significant limitations regarding controlling for confounding factors, classification of interventions, and measurement of outcomes were verified, evidencing the need for well-designed studies. This systematic review demonstrated that radiotherapy for HNC induced significant changes in the pulp response with moderate quality of evidence. Such altered responses cannot determine pulp status accurately.

Evaluation of Secondary Thermal Hyperalgesia Resulting from Pulpal Inflammation in Patients with Symptomatic Irreversible Pulpitis

IntroductionInflammation can lead to hyperalgesia and allodynia by activation or sensitization of peripheral and central nervous system neurons. This study aimed to assess the occurrence of secondary thermal hyperalgesia in patients with symptomatic irreversible pulpitis (SIP). MethodsThe cold sensitivity test (visual analog scale) was performed for the tooth with SIP, its adjacent sound tooth, the same sound tooth in the opposite jaw, and the contralateral sound tooth in the opposite quadrant of the same jaw. Next, the tooth with SIP underwent root canal treatment, and 3 weeks later, after complete elimination of pain, the teeth underwent cold sensitivity testing again. ResultsA total of 64 patients, including 41 women and 23 men 18–65 years old, were evaluated in this study. The response to the cold sensitivity test significantly decreased in the tooth with SIP (P < .001), its adjacent sound tooth (P < .001), and the same sound tooth in the opposite jaw (P = .004) but not in the contralateral sound tooth in the opposite quadrant of the same jaw (P = .45) after endodontic treatment. No significant difference was noted between men and women in the groups (P > .05). ConclusionsHypersensitivity to cold test due to pulpal inflammation can also result in exaggerated response of the adjacent sound tooth and the same tooth in the opposite jaw to cold sensitivity test; these observations can be explained by the central and peripheral sensitization mechanisms.

Accuracy of Root ZXII, E-PEX and FIND apex locators in teeth with vital pulp: an in vivo study.

This research evaluated, in vivo, the accuracy of three electronic apex locators - EALs (Root ZXII, E-PEX and FIND) in teeth with vital pulp submitted to biopulpectomy, preserving the periodontal stump. For this study, 90 single-rooted teeth with extraction indication were selected. After positive pulpal cold sensitivity test, pulp chamber access was performed. The cervical and middle thirds of root canals were instrumented with Reciproc R25, and the K#15 file was used as a standard instrument to determine working length, forming 2 groups: Constriction (insertion of the instrument until the apical constriction limit) and Foramen (insertion of the instrument until the foramen and then repositioning at constriction, without removing the file from the canal). The hand file was stabilized with a light-cured flow resin. After extraction, the samples were analyzed through microCT SkyScan 1272, with CTAN software, which evaluated the proximity between the tip of the file to the apical constriction, providing data for comparative analysis using Kruskal-Wallis and Dunn tests (p<0.05). There was a statistically significant difference in the abilities of the EALs to detect the apical constriction after reaching the foramen with Root ZX II showing higher accuracy (89%). However, there was no difference in the accuracy of the three EALs in detecting the apical constriction without reaching the foramen. Based on the present results, we conclude that EALs may show accurate measures in detecting apical constriction and foramen, even without damaging the periodontal stump in biopulpectomy.

A distal curved incision approach of lunula for treatment of subungual glomus tumor in nail root

To investigate the feasibility and effectiveness of the distal curved incision approach of lunula in treating subungual glomus tumor in nail root. Between March 2017 and October 2019, 16 patients (16 fingers) with subungual glomus tumor in nail root were treated. There were 2 males and 14 females with an average age of 35.3 years (range, 21-67 years). The disease duration ranged from 5 months to 17 years, with a median duration of 15 months. There were 6 cases of thumb, 3 cases of index finger, 2 cases of middle finger, 4 cases of ring finger, and 1 case of little finger. All of them showed typical "triad syndromes", and the cold sensitivity test and Love test were positive before operation. Each patient removed the nail, the tumor was exposed under the nail bed via the distal curved incision approach of lunula. After the tumor was removed completely, the nail bed was reducted in situ without suturing. The self-made nail template was pressurized and fixed on the surface of the nail bed with suture. The conditions of nail bed healing, pain, and growth of nail were observed after operation. All wounds of the nail bed with laceration healed by first intention. Postoperative pathological results confirmed the diagnosis of subungual glomus tumor in all the patients. All cases were followed up 3-26 months with an average of 15 months. The pain symptom disappeared and no obvious pain occurred during dressing change in all cases; and the cold sensitivity test and Love test were negative. The nails recovered smoothly with satisfactory appearance, and no obvious complications such as longitudinal ridge deformities or recurrences was observed. The treatment of subungual glomus tumor in nail root via the distal curved incision approach is an effective method, which can easily operated, resect the tumor completely, protect the nail bed effectively, and also has a significant effect on preventing postoperative nail deformity.

Subungual onychomycosis due to Aspergillus niger mimicking a glomus tumor: A case report.

Onychomycosis is a common nail infection caused by dermatophytes, while non-dermatophytes including Aspergillus spp. are causes of nail onychomycosis. Aspergillus niger is not common as a cause of nail onychomycosis. In the current study we present a 60-year-old woman with subungual onychomycosis due to Aspergillus niger mimicking a glomus tumor. Physical examination revealed right thumb had a black color of nail bed. Localized tenderness and severe pain were observed. However, the cold sensitivity test, Loves pin test and Hildreths test were negative. On radiograph, bone erosion was found in a part of distal phalanx at the right thumb. Magnetic resonance imaging identified a mass at the subungual space, which exhibited low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The differential diagnosis included glomus tumor and infection. The histological findings demonstrated dichotomous septate hyphae. The culture was positive for Aspergillus niger. The results suggested that when physical examination is not typical for a glomus tumor, other diseases may be considered. Additionally, frozen section diagnosis may be useful.

Subungual Glomus Tumours: Is Magnetic Resonance Imaging or Ultrasound Necessary for Diagnosis?

IntroductionDiagnosis of subungual glomus tumour is mostly based on detailed history and clinical examination. Recently, Magnetic Resonance Imaging (MRI) and Ultrasound have been proposed as the imaging modality to confirm the clinical diagnosis and in planning the surgical management of these tumours. However, these imaging modalities are not routinely available in rural setting and also are expensive. Due to these limitations, we set out to establish that diagnosis and management of these rare tumours can be based solely on a battery of clinical tests and history taking.Materials and MethodsRetrospectively, we reviewed nine cases of glomus tumour. A clinical evaluation proforma was developed on the basis of clinical history and specific clinical test for diagnosis of these tumours. All the cases were evaluated and treated surgically by a single surgeon with a specific technique. Post-operatively, diagnosis was confirmed by histopathological examination.ResultsFemales (77.78%) were predominantly affected in this series and the tumours commonly occurred in the right hand (66.66%). Spontaneous pain, cold sensitivity test and Love’s Pin test was positive in all cases (100%). Hildreth’s test was positive in 88.89%. In none of the cases the tumours recurred during minimum follow-up of one year. In all cases, histopathological examination confirmed the preoperative diagnosis of glomus tumours.ConclusionDiagnosis of glomus tumours can be made clinically based on history taking and clinical examination. Magnetic Resonance Imaging and Ultrasound are not necessary for diagnosis and management of typical subungual tumours.

Abstract P5-15-10: A combination natural product therapy attenuates common side effects associated with chemotherapy

Abstract Background: The taxanes and platinum agents provide substantial improvement in the treatment of breast and other cancers. Neuropathy is often the dose limiting toxicity of these agents and can devastatingly affect the patient due to diminished fine motor skills and pain in the hands and feet that diminishes the ability to exercise and interact in normal life. Clinically significant neuropathy occurs in 40% of patients and &amp;gt;10% will persist past a year causing permanent effects on quality of life. Perhaps more devastating, patients often have to discontinue effective treatment due to the development of these symptoms. Additionally, anemia contributes to dose reductions and delays that compromise therapy and cause significant fatigue that diminishes quality of life. Interventions that could reduce these symptoms would provide a substantial improvement in the ability to care for these patients. Toward this end we have developed a non-toxic dietary approach that incorporates supplementation with several natural products. Together, this therapeutic approach, called CS.001 is able to alleviate many of the negative side effects of breast cancer chemotherapy. Methods: C57BL/6 mice were treated with Paclitaxel weekly or Oxaliplatin three times weekly. Animals were tested for neuropathic pain using a cold sensitivity test [acetone test] and sensitivity to mechanical stimulus [Von Frey Test]. A CBC and CMP were performed to assess systemic toxicity. Animals were provided with a nutritional complete diet that limited their carbohydrates to 10% of total caloric input and were additionally supplemented with the following natural products: [1] Medium chain triglycerides [30g/kg], [2] Curcumin [1200mg/kg], [3]EGCG [1200mg/kg] and [4]broccoli sprout powder [20g/kg]. Animals were placed on the CS.001 diet 1 week before beginning chemotherapy. Results: Paclitaxel &amp; Oxaliplatin treatment resulted in a statistically significantly increase in sensitivity to cold stimulus [Acetone test, p&amp;lt;0.001] that was reduced to control levels in the CS.001 treated animals. Mechanosensitivity was increased with Oxaliplatin &amp; reduced with Paclitaxel treatment, and addition of CS.001 resulted in a statistically significant attenuation of the chemotherapy treatment [Paclitaxel vs Paclitaxel+CS.001, p&amp;lt;0.005 &amp; Oxaliplatin vs Oxaliplatin+CS.001, p&amp;lt;0.05]. Additionally, reductions in RBC, Hemoglobin and Hematocrit with Oxaliplatin treatment [p&amp;lt;0.001] were significantly attenuated [p&amp;lt;0.05] with CS.001 treatment. Conclusion: Dietary intervention combined with a supplementation of 4 natural products was able to attenuate chemotherapy induced anemia and neuropathy following chemotherapy treatment in mice. This combination is a promising quality of life intervention to evaluate in cancer patients receiving taxanes or platinums. Citation Format: Coy D Heldermon, Ben G Griffith, Matt Bloom, Jennifer Owen, Regina J Martuscello, Yosef Schwartz, Brent A Reynolds, Loic P Deleyrolle. A combination natural product therapy attenuates common side effects associated with chemotherapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-10.

The effect of ethnicity on the vascular responses to cold exposure of the extremities.

Cold injuries are more prevalent in individuals of African descent (AFD). Therefore, we investigated the effect of extremity cooling on skin blood flow (SkBF) and temperature (T sk) between ethnic groups. Thirty males [10 Caucasian (CAU), 10 Asian (ASN), 10 AFD] undertook three tests in 30 °C air whilst digit T sk and SkBF were measured: (i) vasomotor threshold (VT) test--arm immersed in 35 °C water progressively cooled to 10 °C and rewarmed to 35 °C to identify vasoconstriction and vasodilatation; (ii) cold-induced vasodilatation (CIVD) test--hand immersed in 8 °C water for 30 min followed by spontaneous warming; (iii) cold sensitivity (CS) test--foot immersed in 15 °C water for 2 min followed by spontaneous warming. Cold sensory thresholds of the forearm and finger were also assessed. In the VT test, vasoconstriction and vasodilatation occurred at a warmer finger T sk in AFD during cooling [21.2 (4.4) vs. 17.0 (3.1) °C, P = 0.034] and warming [22.0 (7.9) vs. 12.1 (4.1) °C, P = 0.002] compared with CAU. In the CIVD test, average SkBF during immersion was greater in CAU [42 (24) %] than ASN [25 (8) %, P = 0.036] and AFD [24 (13) %, P = 0.023]. Following immersion, SkBF was higher and rewarming faster in CAU [3.2 (0.4) °C min(-1)] compared with AFD [2.5 (0.7) °C min(-1), P = 0.037], but neither group differed from ASN [3.0 (0.6) °C min(-1)]. Responses to the CS test and cold sensory thresholds were similar between groups. AFD experienced a more intense protracted finger vasoconstriction than CAU during hand immersion, whilst ASN experienced an intermediate response. This greater sensitivity to cold may explain why AFD are more susceptible to cold injuries.

The contribution of blood flow to the skin temperature responses during a cold sensitivity test

The presumption in a cold sensitivity test (CST) used for cold injuries is that the skin temperature (T sk) observed reflects the return of blood flow to the extremity following a local cold challenge. We questioned this assumption. Six non-cold injured participants undertook two CSTs in 30 °C air. The control (CON) CST involved 12 min gentle exercise prior to immersing the foot into 15 °C water for 2 min followed by 15 min of spontaneous rewarming. The occlusion (OCC) CST was the same except that blood flow to the foot was occluded during the rewarming period. These results were compared to CSTs from six individuals with non-freezing cold injury and moderate-severe cold sensitivity (CS) and a non-perfused human digit model (NPDM). Before immersion, great toe skin blood flow (SkBF) was similar in CON and OCC conditions [255 (107) laser Doppler units (LDU)] and was higher than CS [59 (52) LDU]. During rewarming, SkBF in CON returned to 104 % of the pre-immersion value and was higher than both OCC and CS. Great toe T sk before immersion was lower in CS [28.5 (2.1) °C] compared to CON [34.7 (0.4) °C], OCC [34.6 (0.9) °C] and NPDM [35.0 (0.4) °C]. During rewarming skin/surface temperature in OCC, CS and NPDM were similar and all lower than CON. SkBF does contribute to the skin rewarming profile during a CST as a faster rate of rewarming was observed in CON compared to either OCC or NPDM. The lower T sk in CS may be due to a reduced basal SkBF.

Cold sensitivity test for individuals with non-freezing cold injury: the effect of prior exercise

BackgroundOne of the chronic symptoms of non-freezing cold injury (NFCI) is cold sensitivity. This study examined the effects of prior exercise on the response to a cold sensitivity test (CST) in NFCI patients with the aim of improving diagnostic accuracy.MethodsTwenty three participants, previously diagnosed with NFCI by a Cold Injuries Clinic, undertook two CSTs. Participants either rested (air temperature 31°C) for approximately 80 min (prior rest condition (REST)) or rested for 30 min before exercising gently for 12 min (prior exercise condition (EX)). Following REST and EX, the participants placed their injured foot, covered in a plastic bag, into 15°C water for 2 min; this was followed by spontaneous rewarming in 31°C air for 10 min.ResultsThe great toe skin temperature (Tsk) before immersion averaged 32.5 (3.4)°C in both conditions. Following immersion, the rate of rewarming of the great toe Tsk was faster in EX compared to REST and was higher 5 min (31.7 (3.4)°C vs. 29.8 (3.4)°C) and 10 min (33.8 (4.0)°C vs. 32.0 (4.0)°C) post-immersion. Over the first 5 min of rewarming, changes in the great toe Tsk correlated with the changes in skin blood flow (SkBF) in EX but not the REST condition. No relationship was observed between Tsk in either CST and the severity of NFCI as independently clinically assessed.ConclusionsExercise prior to the CST increased the rate of the toe Tsk rewarming, and this correlated with the changes in SkBF. However, the CST cannot be used in isolation in the diagnosis of NFCI, although the EX CST may prove useful in assessing the severity of post-injury cold sensitivity for prognostic and medico-legal purposes.

GLOMUS TUMOUR OF THE HAND

We report a series of 18 patients with pain in the thumb or finger tips who were diagnosed as having glomus tumour. Fourteen patients were found to have histopathologically proven glomus tumours, one had a neuroma and three had haemangioma. The duration of symptoms before treatment averaged 1.9 years. Cold-sensitivity and Hildreth's tests have sensitivities of 100% and 77.4% respectively and specificity of 100%. Love's pin test had a sensitivity of 100%. Love's and Hildreth's tests showed 78% accuracy, whereas the cold-sensitivity test was 100% accurate. We used a double-tourniquet technique during dissection and excision of the tumour. None of our patients experienced recurrence of symptoms during the post-operative follow up.