umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Neurosensory sequelae assessed by thermal and vibrotactile perception thresholds after local cold injury
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Sundsvall Hosp, Dept Occupat & Environm Med, SE-85186 Sundsvall, Sweden. (Arcum)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. (Arcum)
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Sundsvall Hosp, Dept Occupat & Environm Med, SE-85186 Sundsvall, Sweden. (Arcum)
Show others and affiliations
2014 (English)In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 73, 23540Article in journal (Refereed) Published
Abstract [en]

Background. Local freezing cold injuries are common in the north and sequelae to cold injury can persist many years. Quantitative sensory testing (QST) can be used to assess neurosensory symptoms but has previously not been used on cold injury patients.

Objective. To evaluate neurosensory sequelae after local freezing cold injury by thermal and vibrotactile perception thresholds and by symptom descriptions.

Design. Fifteen patients with a local freezing cold injury in the hands or feet, acquired during military training, were studied with QST by assessment of vibrotactile (VPT), warmth (WPT) and cold (CPT) perception thresholds 4 months post-injury. In addition, a follow-up questionnaire, focusing on neurovascular symptoms, was completed 4 months and 4 years post-injury.

Results. QST demonstrated abnormal findings in one or both affected hands for VPT in 6 patients, for WPT in 4 patients and for CPT in 1 patient. In the feet, QST was abnormal for VPT in one or both affected feet in 8 patients, for WPT in 6 patients and for CPT in 4 patients. Freezing cold injury related symptoms, e. g. pain/discomfort when exposed to cold, cold sensation and white fingers were common at 4 months and persisted 4 years after the initial injury.

Conclusions. Neurosensory sequelae after local freezing cold injury, in terms of abnormal thermal and/or vibration perception thresholds, may last at least 4 months after the initial injury. Symptoms such as pain/discomfort at cold exposure, cold sensations and white fingers may persist at least 4 years after the initial injury.

Place, publisher, year, edition, pages
2014. Vol. 73, 23540
Keyword [en]
case series, neurovascular, quantitative sensory testing, military, frostbite, Sweden
National Category
Environmental Health and Occupational Health
Identifiers
URN: urn:nbn:se:umu:diva-87184DOI: 10.3402/ijch.v73.23540ISI: 000331885300001PubMedID: 24624368OAI: oai:DiVA.org:umu-87184DiVA: diva2:707770
Available from: 2014-03-25 Created: 2014-03-24 Last updated: 2017-10-25Bibliographically approved
In thesis
1. Effects of cold and hand-arm vibration on the peripheral neurosensory and vascular system: an occupational perspective
Open this publication in new window or tab >>Effects of cold and hand-arm vibration on the peripheral neurosensory and vascular system: an occupational perspective
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background In Swedish working life, exposure to cold and exposure to hand-arm vibration (HAV) are two common health hazards. Health effects of HAV in the neurosensory, vascular and musculoskeletal systems are collectively denoted hand-arm vibration syndrome (HAVS), and have been thoroughly studied. Effects of cold exposure in terms of effects on the peripheral neurosensory and vascular system are on the contrary limited, especially in an occupational setting. Effects of cold exposure or cold injury have not previously been assessed with quantitative sensory testing (QST). Commonly reported symptoms after exposure to HAV and after cold injuries, includes cold sensitivity and sensation of cold. Cold sensitivity can also occur without previous exposure to vibration or cold and may have a major impact on quality of life. Other possible risk factors for cold sensitivity need to be assessed. Sensation of cold hands could theoretically imply an early manifestation of damage to the neurosensory or vascular system, and therefore be of importance to enable early detection of vascular and neurosensory HAVS. The purpose of this thesis was to increase the knowledge about health effects from cold and HAV on the peripheral neurosensory and vascular system, with an occupational perspective. The aims were: first, to identify and evaluate health effects and sequelae in the peripheral neurosensory and vascular system due to cold injury and cold exposure; second, to investigate if sensation of cold hands is a predictor for future onset of Raynaud's phenomenon or paresthesia; and third, to identify possible risk factors associated with cold sensitivity.

Methods A case series on 15 military conscripts with local cold injuries in the hands or feet, involving QST and symptom descriptions, was conducted to investigate the hypothesis that cold injuries can result in similar neurosensory and vascular impairments as in HAVS. To assess health effects of cold exposure, a cohort study on 54 military conscripts in cold winter military training, with cold exposure assessments, was conducted. Possible health effects were assessed after 14 months of military training, containing considerable cold exposure, by means of QST, Finger systolic blood pressure after local cooling (FSBP) and a questionnaire. To investigate if sensation of cold hands is a predictor for vascular or neurosensory HAVS we investigated a cohort of 178 employees at a manufacturing company where HAV was a common exposure. The cohort was followed during 21 years and both vibration exposure and health outcomes were assessed regularly. Questionnaire items were used to assess sensations of cold hands as well as signs of Raynaud’s phenomenon and paresthesia. To identify risk factors for cold sensitivity a case-control study was conducted involving 997iiiparticipants from the general population in northern Sweden. The study was cross-sectional and explored possible risk factors for cold sensitivity.

Results Cold injuries and cold exposure were associated with reduced sensibility in QST and increase severity and prevalence of neurosensory and vascular symptoms. Our results did not show any impairment in peripheral blood flow due to cold exposure, detectable by FSBP. The risk of developing Raynaud's phenomenon was increased for workers previously reporting sensation of cold hands (OR 6.3, 95% CI 2.3-17.0). No increased risk for paresthesia in relation to a sensation of cold hands was observed. The identified risk factors for cold sensitivity were frostbite in the hands, rheumatic disease, nerve injury in upper extremities or neck, migraine and vascular disease. When analysing women and men separately, women’s risk factors were frostbite in the hands, rheumatic disease, migraine and cold exposure. Men’s risk factors were frostbite in the hands, vibration exposure and nerve injury in upper extremities or neck. BMI > 25 was a protective factor for both men and women.

Conclusion Cold injury and cold exposure are associated with impairments in the neurosensory system, detectable by QST. Symptoms such as sensation of cold hands and white fingers indicate vascular involvement, even though no vascular impairments due to cold exposure could be detected by objective measurements. A sensation of cold hands is a risk factor for development of Raynaud´s phenomenon, but not for paresthesia. At the individual level, reporting cold hands does not appear to be useful information when considering the possibility of a future development of Raynaud’s phenomenon. Frostbite in the hands is a risk factor for cold sensitivity among both women and men. For women rheumatic disease, migraine and cold exposure are also independent risk factors, and for men, exposure to HAV. Being overweight is a protective factor for both women and men.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. 41 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1927
Keyword
Hand-arm vibration, Raynaud’s phenomenon, paresthesia, sensation of cold, hand-arm vibration syndrome, quantitative sensory testing, cold sensitivity, cold, cold exposure, frostbite, Sweden, cold injury, military
National Category
Environmental Health and Occupational Health
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-141020 (URN)978-91-7601-790-6 (ISBN)
Public defence
2017-11-17, Aulan, Länssjukhuset i Sundsvall, Lasarettsvägen 21, Sundsvall, 13:00 (English)
Opponent
Supervisors
Available from: 2017-10-27 Created: 2017-10-20 Last updated: 2017-10-30Bibliographically approved

Open Access in DiVA

fulltext(462 kB)152 downloads
File information
File name FULLTEXT01.pdfFile size 462 kBChecksum SHA-512
60e3ce3fda55a5d1a72ff272f34656d060450e032f09d80f39b28cff447bf20e138d8d5d9b493a3b187539e51b54c8acb4ec6e2826313ec66d03e7ad53269cb8
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Carlsson, DanielBurström, LageHeldestad Lilliesköld, VictoriaNilsson, TohrNordh, ErikWahlström, Jens
By organisation
Occupational and Environmental MedicineDepartment of Pharmacology and Clinical Neuroscience
In the same journal
International Journal of Circumpolar Health
Environmental Health and Occupational Health

Search outside of DiVA

GoogleGoogle Scholar
Total: 152 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 168 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf