Manifestations of cold sensitivity – a case series

• Published in: International Journal of Circumpolar Health
• Main Authors: Albin Stjernbrandt, Bodil Björ, Hans Pettersson, Ronnie Lundström, Ingrid Liljelind, Tohr Nilsson, Jens Wahlström
• Format: Article in Journal/Newspaper
• Language: English
• Published: Taylor & Francis Group 2020
• Subjects: (mesh): hand; cold exposure; occupational exposure; hand-arm vibration; frostbite; nerve injury; sweden; Arctic medicine. Tropical medicine; RC955-962; Arctic; Circumpolar Health; International Journal of Circumpolar Health
• Online Access: https://doi.org/10.1080/22423982.2020.1749001; https://doaj.org/article/26de04a544074e4ea1919e404ff18d5b

Objectives: To characterise cold sensitivity using a semi-structured interview, physical examination, thermal quantitative sensory testing (QST), and laser speckle contrast analysis (LASCA). Methods: Eight women and four men, ages 22–74, with cold sensitivity were interviewed and examined by an occupational physician. Thermal perception thresholds were established using QST, on the pulp of the index and little finger of the most affected hand. Skin perfusion in the dorsum of the hand was measured using LASCA, at baseline, after two-minute 12°C water immersion, and during rewarming. Results: The physical examination yielded few findings indicative of vascular or neurosensory pathology. One subject (8%) had impaired thermal perception thresholds. LASCA at baseline showed absent proximal-distal perfusion gradients in six subjects (50%), and a dyshomogeneous perfusion pattern in five (42%). Perfusion on a group level was virtually unchanged by cold stress testing (median 52.5 PU; IQR 9.0 before versus 51.3 PU; IQR 27.2 afterwards). Conclusions: Physical examination and thermal QST offered little aid in diagnosing cold sensitivity, which challenges the neurosensory pathophysiological hypothesis. LASCA indicated disturbances in microvascular regulation and could prove a useful tool in future studies on cold sensitivity.