Small-to-moderate decreases in cold hypersensitivity up to 3 years after severe hand injuries: A prospective cohort study

Background: The natural course and predictors for decreased cold hypersensitivity were studied in 85 patients with severe hand injuries involving nerve lesions. Methods: Questionnaires including the McCabe Cold Sensitivity Severity scale (CSS 0-400) were collected after injury, and at 6-month, 12-month, 2-year, and 3-year follow-ups. Results: Between the 12-month and 3-year follow-up, there was a small decrease in cold hypersensitivity as measured by the CSS (median = 24; Q1-Q3 = -11-75; n = 85). Five of the patients recovered from cold hypersensitivity, and similar to 40% of the patients were less affected by cold hypersensitivity in daily life. Little or no pain early after injury and higher CSS-scores 12 months after primary surgery were weakly associated with the reduced CSS-scores (R-2 = 0.20) at the 3-year follow-up. Six patients had changed work or did not work due to cold hypersensitivity, but the majority of the patients had kept their cold-exposed work. Conclusion: Cold-hypersensitive patients may have a reasonable chance for decreased cold sensitivity and cold-associated activity limitations over time, although the majority of the patients will experience persistent problems. Tools to predict improvement remain insufficient.