title: Rewarming patterns in hand fracture patients with and without cold intolerance.
abstract: OBJECTIVE
  It is often assumed that cold intolerance is associated with abnormalities in the skin temperature due to changes in the blood flow of the hands. In this study, we determined whether patients with and without cold intolerance after a hand fracture or healthy controls have a diminished rewarming after a cold stimulus.
  
  
  METHODS
  The severity of cold intolerance was evaluated using the Cold Intolerance Symptom Severity (CISS) questionnaire. To determine whether abnormal rewarming plays a major role in the underlying pathophysiology of cold intolerance, a cold-stress test was applied at a mean of 30 months (with a range of 11 mo) after the patients recovered from a hand fracture. A control group also underwent identical cold-stress testing for comparison. Temperature during the rewarming phase was measured using videothermography.
  
  
  RESULTS
  Thirteen control subjects and 18 patients participated. Control subjects did not report any symptoms of cold intolerance (CISS score, 0) and no loss of sensibility was measured. The mean CISS score of all patients was 27.8; 9 patients scored above the cut-off value for normal cold intolerance. No significant differences were found in the rewarming patterns between (1) the affected and non-affected hand of the postfracture patients, (2) the dominant and non-dominant hand of the control subjects, and (3) the patients and controls.
  
  
  CONCLUSIONS
  The results of this study revealed no relation between the severity of cold intolerance and rewarming patterns after cold stress testing. This might suggest that temperature regulation of the hands in post-fracture patients might not be responsible for the symptoms of cold intolerance, based on cold-stress test response.
authors.affiliation: Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. e.smits@erasmusmc.nl
authors.forename: Ernst S
authors.initials: ES
authors.lastname: Smits
authors.forename: Tim H J
authors.initials: TH
authors.lastname: Nijhuis
authors.forename: Frank J P M
authors.initials: FJ
authors.lastname: Huygen
authors.forename: Ruud W
authors.initials: RW
authors.lastname: Selles
authors.forename: Steven E R
authors.initials: SE
authors.lastname: Hovius
authors.forename: Sjoerd P
authors.initials: SP
authors.lastname: Niehof
mesh_terms: D000328:Adult; D000368:Aged; D001833:Body Temperature Regulation / Q000502:physiology; D016022:Case-Control Studies; D003080:Cold Temperature; D058639:Cold-Shock Response; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006230:Hand Injuries / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D017694:Rewarming / Q000379:methods*; D012881:Skin Temperature / Q000502:physiology; D011795:Surveys and Questionnaires; D013817:Thermography / Q000379:methods*; D013697:Thermosensing / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult