Evaluation of Cold Sensitivity in Patients with Upper Extremity Nerve Compression Syndromes: A Scoping Review
Moaath Saggaf, MD, University of Toronto, Toronto, ON, Canada, Evangelista Vianca Jeunice, HBSc, Toronto Western Hospital, Toronto, ON, Canada, Christine B Novak, PT, PhD, Toronto Western Hospital Hand Program, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada and Dimitri J Anastakis, MD, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
Introduction:
Cold sensitivity has been reported in 52% of patients with upper extremity nerve compression syndromes. The aim of this study was to review the literature to map the prevalence of cold sensitivity in upper extremity nerve compression syndromes, and the impact of treating upper extremity nerve compression syndromes on cold sensitivity.
Methods:
The study was designed based on stages from the Joanna Briggs Institute for scoping reviews. Following a standardized scoping review protocol, this study included interventional and observational study designs assessing patients with both cold sensitivity and upper extremity nerve compression syndromes. Review articles, case reports, and small case series (n<5) were excluded. An experienced librarian assisted in the search strategy and study design. The abstracts and eligible full texts were screened by two independent reviewers. Data were extracted into a pretested tabular form and reported according to PRISMA-ScR reporting guidelines.
Results:
The three databases were searched (MEDLINE, EMBASE, and CINAHL) and after removing duplicates; 274 references were reviewed. Fifteen studies from the database search and 8 studies from the reference search were eligible for final analysis in this review (n=23). Two interventional and 21 observational studies were identified. The most common method for assessing cold sensitivity was cold pain threshold testing (n=12) followed by subjective patient reporting (n=4). The Cold Intolerance Symptom Severity questionnaire was the most common validated patient-reported outcome questionnaire used in the studies. Cold sensitivity was most commonly reported in carpal tunnel syndrome (96% of the studies). The prevalence of cold sensitivity in nerve compression syndromes ranged from 20% to 69%. Nerve decompression improved the severity of cold sensitivity in some patients and was reported in both carpal tunnel syndrome and cubital tunnel syndrome.
Conclusion:
There is a heterogenicity in the studies assessing cold sensitivity in upper extremity nerve compression syndromes. Despite moderate prevalence in patients with carpal tunnel syndrome, cold sensitivity is underreported. Within the limitations of eligible studies reviewed, surgical decompression improved the severity of cold sensitivity in some studies. Future studies assessing the precise impact of an open carpal tunnel release on cold sensitivity are warranted. Combining multiple tools in cold sensitivity assessment would allow a greater understanding of its complex domains.
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