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Stjernbrandt A, Pettersson H, Vihlborg P, Höper AC, Aminoff A, Wahlström J, Nilsson T. Raynaud's phenomenon in the feet of Arctic open-pit miners. Int J Circumpolar Health 2024; 83:2295576. [PMID: 38109321 PMCID: PMC10732197 DOI: 10.1080/22423982.2023.2295576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
The literature on Raynaud's phenomenon (RP) in the feet is scarce, especially in the occupational setting. The primary aim of our study was to investigate the occurrence of RP in the feet of miners. As part of the MineHealth project, written surveys and clinical examinations were completed by 260 Arctic open-pit miners working in northern Sweden and Norway (participation rate 53.6%). Data on RP were collected using standardised colour charts and questionnaire items. Clinical examination included assessing the perception of vibration and pain in both feet. There were eight women and three men who reported RP in the feet. Four also had RP in their hands but none acknowledged any first-degree relatives with the condition. Nine reported exposure to foot-transmitted vibration and one to hand-arm vibration. Seven showed signs of neurosensory injury in the feet. To conclude, the occurrence of RP in the feet of miners was 4.4%. Most cases with RP in the feet did not report the condition in the hands and were exposed to vibration transmitted directly to the feet. There were no reports of a hereditary component. Most cases with RP in the feet also had clinical findings suggestive of peripheral neuropathy in the feet.
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Affiliation(s)
- Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hans Pettersson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Vihlborg
- Department of Geriatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anje Christina Höper
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anna Aminoff
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tohr Nilsson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Stjernbrandt A, Johnsen M, Liljelind I, Aminoff A, Wahlström J, Höper AC, Pettersson H, Nilsson T. Neurosensory and vascular symptoms and clinical findings in the hands of Arctic open-pit miners in Sweden and Norway - a descriptive study. Int J Circumpolar Health 2023; 82:2254916. [PMID: 37669310 PMCID: PMC10481761 DOI: 10.1080/22423982.2023.2254916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/07/2023] Open
Abstract
This cross-sectional study aimed to describe exposure to cold climate and hand-arm vibration (HAV) as well as neurosensory and vascular symptoms and clinical findings among open-pit Arctic miners. It was based on data from questionnaires and physical examinations, including 177 men and 75 women from two open-pit mines in Sweden and Norway (response rate 54%). Working outdoors or in an unheated building or machine for at least two hours per day was reported by 44% and HAV exposure of the same duration by 10%. Neurosensory symptoms (e.g. reduced perception of touch) in the hands were reported by 47% and Raynaud's phenomenon by 14%. In brief conclusion, the study showed that Arctic miners were commonly exposed to both cold temperatures and HAV. They also reported a broad range of neurosensory and vascular symptoms in their hands and had abnormal clinical findings related to the symptoms. The results emphasise the need for additional preventive measures in this occupational setting.
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Affiliation(s)
- Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Magnar Johnsen
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Ingrid Liljelind
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anna Aminoff
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anje Christina Höper
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Hans Pettersson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tohr Nilsson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Khabbazi A, Farzaneh R, Mahmoudi M, Shahi M, Jabbaripour Sarmadian A, Babapour E, Alizadeh L, Khabbazi R, Nouri-Vaskeh M. Cold intolerance and associated factors: a population study. Sci Rep 2022; 12:18029. [PMID: 36302950 PMCID: PMC9613912 DOI: 10.1038/s41598-022-21842-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
Cold intolerance has been defined as a set of symptoms including pain, tingling, numbness, chills, stiffness, weakness, swelling or skin color changes on exposure to cold. Cold intolerance may have a profound effect on health-related quality of life. In this cross-sectional study, we investigated primarily the prevalence of cold intolerance and secondly associated factors in the general population of Tabriz. Simple random sampling of individuals aged ≥ 18 was performed from the population covered by Emamieh health center under the supervision of Tabriz University of Medical Sciences. A telephone interview was conducted with the participants by the general physician of that center. In participants with a positive response to each of two questions "I am oversensitive to cold" and "I experience pain or discomfort when exposed to cold" a Cold Intolerance Symptom Severity (CISS) questionnaire was filled. We used a cut off value 50 for defining cold intolerance. Of the 353 person who received telephone calls, 322 answered questions. Cold related symptoms and cold intolerance were reported in 144 (44.7%) and 38 (11.1%) persons, respectively. Cold intolerance was significantly more common in females and people with comorbidities. Cold intolerance led to a decrease in quality of job in 27 (8.4%) and a change in job in 6 (1.9%) persons. In conclusion, cold intolerance is a common problem in the general population of Tabriz.
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Affiliation(s)
- Alireza Khabbazi
- grid.412888.f0000 0001 2174 8913Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Imamreza Hospital, Flat 1, P.O Box 5166614756, Tabriz, Iran
| | - Rojin Farzaneh
- grid.412888.f0000 0001 2174 8913Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Imamreza Hospital, Flat 1, P.O Box 5166614756, Tabriz, Iran
| | - Maryam Mahmoudi
- grid.412888.f0000 0001 2174 8913Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Imamreza Hospital, Flat 1, P.O Box 5166614756, Tabriz, Iran
| | - Mohammad Shahi
- grid.412888.f0000 0001 2174 8913Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Imamreza Hospital, Flat 1, P.O Box 5166614756, Tabriz, Iran
| | - Amirreza Jabbaripour Sarmadian
- grid.412888.f0000 0001 2174 8913Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Imamreza Hospital, Flat 1, P.O Box 5166614756, Tabriz, Iran
| | - Elaheh Babapour
- grid.412888.f0000 0001 2174 8913Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Imamreza Hospital, Flat 1, P.O Box 5166614756, Tabriz, Iran
| | - Leila Alizadeh
- grid.412888.f0000 0001 2174 8913Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Raha Khabbazi
- grid.412888.f0000 0001 2174 8913Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Imamreza Hospital, Flat 1, P.O Box 5166614756, Tabriz, Iran
| | - Masoud Nouri-Vaskeh
- grid.412888.f0000 0001 2174 8913Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Imamreza Hospital, Flat 1, P.O Box 5166614756, Tabriz, Iran
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Stjernbrandt A, Pettersson H, Lundström R, Liljelind I, Nilsson T, Wahlström J. Incidence, remission, and persistence of Raynaud's phenomenon in the general population of northern Sweden: a prospective study. BMC Rheumatol 2022; 6:41. [PMID: 35858907 PMCID: PMC9301854 DOI: 10.1186/s41927-022-00272-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Raynaud's phenomenon is common condition, but little is known about the natural course. The primary aim of this study was to determine the incidence, remission, and persistence proportions of Raynaud's phenomenon in the general population of northern Sweden. Secondary aims were to determine how individual and exposure factors affect the course of Raynaud's phenomenon, and to assess gender differences. METHODS A prospective, survey-based, closed-cohort study was conducted on a sample of men and women between 18-70 years of age, living in northern Sweden. Data on Raynaud's phenomenon characteristics and general health status were collected during the winters of 2015 (baseline) and 2021 (follow-up). Rates of incidence, remission, and persistence were calculated. Binary logistic regression was used to determine the association between baseline variables and the course of Raynaud's phenomenon. RESULTS The study population consisted of 2703 women (53.9%) and 2314 men. There were 390 women (14.5%) and 290 men (12.7%) reporting Raynaud's phenomenon in the follow-up survey. The annual incidence proportion was 0.7% among women and 0.9% among men (gender difference p = 0.04). The annual remission proportion was 4.4% and 5.5%, respectively (p = 0.05). Having sustained a cold injury affecting the hands since baseline was significantly associated with incident Raynaud's phenomenon (OR 3.92; 95% CI 2.60-5.90), after adjusting for age and gender. CONCLUSIONS In the general population of northern Sweden, Raynaud's phenomenon is a common but variable condition, where symptoms may remit over time. Men had a higher incidence proportion than women. The results support a possible causal pathway where cold injury can precede the onset of Raynaud's phenomenon.
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Affiliation(s)
- Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Hans Pettersson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Ronnie Lundström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Ingrid Liljelind
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Tohr Nilsson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Jens Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
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Cold sensitivity and its association to functional disability following a major nerve trunk injury in the upper extremity—A national registry-based study. PLoS One 2022; 17:e0270059. [PMID: 35819958 PMCID: PMC9275699 DOI: 10.1371/journal.pone.0270059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
Aims
To investigate self-reported cold sensitivity and functional disability after a repaired major nerve trunk injury in the upper extremity.
Methods
We identified 735 individuals with a major nerve trunk injury in the upper extremity, surgically treated with direct nerve repair or reconstructed with nerve autografts, in the Swedish national quality registry for hand surgery (HAKIR). Patient-reported symptoms, including cold sensitivity, and perceived disability were collected using two questionnaires (HQ-8 and QuickDASH) preoperatively, and at three and 12 months postoperatively.
Results
We included 281 individuals, who had responded the questionnaires, where 197 (70%) were men (median age 34 [interquartile range 25–52] years) and 84 (30%) were women (median age 41 [25–55]). Cold sensitivity (scored 0–100) was the most prominent symptom 12 months postoperatively after an injured and repaired/reconstructed median (p<0.001) or ulnar (p<0.001) nerve, while individuals with a radial nerve injury showed milder symptoms. Concomitant injuries did not affect cold sensitivity scores. Individuals with ulnar nerve injuries scored higher in stiffness (p = 0.019), weakness (p<0.001) and ability to perform daily activities (p = 0.003) at 12 months postoperatively than median nerve injuries. Individuals with a median, ulnar or radial nerve injury with severe (>70) cold sensitivity had 25, 37 and 30 points higher QuickDASH scores, respectively (p<0.001), at 12 months postoperatively than individuals with mild (<30) cold sensitivity. There were no differences in QuickDASH score or cold sensitivity score at 12 months postoperatively between direct nerve repair or nerve reconstruction with nerve autografts. Neither age, nor sex, affected QuickDASH score at 12 months postoperatively.
Conclusion
Cold sensitivity after surgery for a major nerve trunk injury in the upper extremity can be substantial with impaired ability to perform daily activities, where an ulnar nerve injury may have a worse outcome.
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Frostadottir D, Ekman L, Zimmerman M, Andersson S, Arner M, Brogren E, Dahlin LB. Cold sensitivity, functional disability and predicting factors after a repaired digital nerve injury. Sci Rep 2022; 12:4847. [PMID: 35318398 PMCID: PMC8941129 DOI: 10.1038/s41598-022-08926-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
To investigate self-reported cold sensitivity and functional disability after a repaired digital nerve injury. We identified 3204 individuals operated with digital nerve repair in the Swedish national quality registry for hand surgery (HAKIR). Patient-reported symptoms, including cold sensitivity and perceived disability, were examined using two questionnaires (HQ-8 and QuickDASH), three and 12 months postoperatively. Patients with diabetes (n = 48; 3%) were identified in the Swedish National Diabetes Register (NDR). Cold sensitivity (scored 0–100) was the most prominent symptom among 1553 included individuals (998 men, 555 women; median age 41 [IQR 27–54] years). In the regression analysis, flexor tendon injury, hand fracture and injury to multiple structures predicted worsened cold sensitivity (6.9, 15.5 and 25.0 points; p = 0.005, 0.046 and < 0.001) at 12 months. Individuals with moderate (30–70) and severe (> 70) cold sensitivity had higher QuickDASH scores at three and 12 months postoperatively than individuals with mild cold sensitivity (6.0 and 5.5; 19.8 and 21.0 points; p = 0.001). Flexor tendon injury, injuries to multiple structures and diabetes had significant effect on QuickDASH scores at three, but not at 12, months postoperatively. Cold sensitivity is common after a digital nerve repair and impacts self-reported disability. A concomitant injury, particularly multiple injuries, predicts postoperative cold sensitivity.
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Affiliation(s)
- Drifa Frostadottir
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden. .,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
| | - Linnéa Ekman
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden
| | - Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden
| | - Stina Andersson
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden
| | - Marianne Arner
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Brogren
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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Stjernbrandt A, Liljelind I, Nilsson T, Wahlström J. Defining abnormal cold sensitivity using the Cold Intolerance Symptom Severity questionnaire: a population study. J Hand Surg Eur Vol 2021; 46:731-737. [PMID: 33709819 PMCID: PMC8377284 DOI: 10.1177/1753193421996221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cold sensitivity, a common and disabling sequela of hand injury, can be assessed using the Cold Intolerance Symptom Severity (CISS) questionnaire, rating symptoms on a scale from 4 to 100. The primary objective of this study was to define a clinical cut-off for abnormal cold sensitivity based on the CISS score in a healthy working-age population. The secondary objective was to investigate how age, gender and previous injuries and diseases influence CISS scoring. In this study, 1239 out of 1582 selected healthy subjects of working age living in northern Sweden completed the questionnaire, yielding a response rate of 78%. The 95th percentile for the CISS score was 49.5 for men and 53.0 for women. The effects of age, gender and previous injuries and diseases were minor and not considered clinically relevant. The results support that a CISS score above 50 should be considered as abnormal cold sensitivity.Level of evidence: III.
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Affiliation(s)
- Albin Stjernbrandt
- Albin Stjernbrandt, Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden.
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Stjernbrandt A, Abu Mdaighem M, Pettersson H. Occupational noise exposure and Raynaud's phenomenon: a nested case-control study. Int J Circumpolar Health 2021; 80:1969745. [PMID: 34415235 PMCID: PMC8381957 DOI: 10.1080/22423982.2021.1969745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The primary aim of this study was to determine if self-reported occupational noise exposure was associated with Raynaud’s phenomenon. In northern Sweden, a nested case–control study was performed on subjects reporting Raynaud’s phenomenon (N=461), and controls (N=763) matched by age, sex and geographical location. The response rate to the exposure questionnaire was 79.2%. The study showed no statistically significant association between occupational noise exposure and reporting Raynaud’s phenomenon (OR 1.10; 95% CI 0.83–1.46) in simple analyses. However, there was a trend towards increasing OR for Raynaud’s phenomenon with increasing noise exposure, although not statistically significant. Also, there was a significant association between noise exposure and hearing loss (OR 2.76; 95% CI 2.00–3.81), and hearing loss was associated with reporting Raynaud’s phenomenon (OR 1.52; 95% CI 1.03–2.23) in a multiple regression model. In conclusion, self-reported occupational noise exposure was not statistically significantly associated with Raynaud’s phenomenon, but there was a dose–effect trend. In addition, the multiple model showed a robust association between hearing loss and Raynaud’s phenomenon. These findings offer some support for a common pathophysiological background for Raynaud’s phenomenon and hearing loss among noise-exposed workers, possibly through noise-induced vasoconstriction.
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Affiliation(s)
- Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mahmoud Abu Mdaighem
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hans Pettersson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Tekavec E, Löfqvist L, Larsson A, Fisk K, Riddar J, Nilsson T, Nordander C. Adverse health manifestations in the hands of vibration exposed carpenters - a cross sectional study. J Occup Med Toxicol 2021; 16:16. [PMID: 33926509 PMCID: PMC8082821 DOI: 10.1186/s12995-021-00305-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Despite EU regulatory standards, many workers suffer injury as a result of working with hand-held vibrating tools. Our aim of this study was to confirm whether carpenters, a highly exposed group, suffer more injuries to their hands than painters, a group assumed to be less exposed to vibration. Methods 193 carpenters (participation rate 100%) and 72 painters (participation rate 67%), all men, answered a questionnaire and underwent a clinical examination to identify manifestations of neural and vascular origin in the hands. Neurosensory affection was defined as having at least one symptom in the fingers/hands (impaired perception of touch, warmth, or cold, impaired dexterity, increased sensation of cold, numbness or tingling, or pain in the fingers/hands when cold) and at least one clinical finding (impaired perception of touch, warmth, cold, vibration, or two-point discrimination). Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results Neurosensory affection was fulfilled for 31% of the carpenters and 17% of the painters, age-adjusted OR 3.3 (CI 1.6–7.0). Among carpenters with neurosensory affection 18% reported interference with daily life activities, the most common symptoms being increased sensation of cold, numbness and pain in the fingers/hands when cold, the most common clinical findings were impaired perception of touch and vibration. Neurosensory affection was found in 12% of young carpenters (≤ 30 years old). No difference was found in the prevalence of white fingers between carpenters and painters. Conclusions Carpenters showed more symptoms and clinical findings of neurosensory affection than painters, probably due to vibration exposure. Also young carpenters showed signs of neurosensory affection, which indicates that under current conditions workers at these companies are not protected against injury. This underlines the importance of reducing exposure to vibration and conducting regular medical check-ups to detect early signs of neural and vascular manifestations indicating hand-arm vibration injuries. Special attention should be given to symptoms of increased sensation of cold, pain in the fingers when cold, and numbness, as these were the most common initiating ones, and should be addressed as early as possible in the preventive sentinel process. It is also important to test clinically for small- and large-fibre neuropathy, as the individual may be unaware of any pathology.
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Affiliation(s)
- Eva Tekavec
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
| | - Lotta Löfqvist
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Anna Larsson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Karin Fisk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Jakob Riddar
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Tohr Nilsson
- Division of Sustainable Health and Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Catarina Nordander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Zimmerman M, Nyman E, Dahlin LB. Occurrence of cold sensitivity in carpal tunnel syndrome and its effects on surgical outcome following open carpal tunnel release. Sci Rep 2020; 10:13472. [PMID: 32778796 PMCID: PMC7417569 DOI: 10.1038/s41598-020-70543-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/31/2020] [Indexed: 11/25/2022] Open
Abstract
Cold sensitivity is common following nerve injuries in the upper extremity, but is less well studied in carpal tunnel syndrome (CTS). We investigated cold sensitivity in CTS and its effects on surgical outcome. A search of the Swedish National Registry for Hand Surgery (HAKIR) for open carpal tunnel releases (OCTR) from 2010-2016 identified 10,746 cases. Symptom severity questionnaires (HQ-8; HAKIR questionnaire 8, eight Likert-scale items scored 0-100, one item on cold sensitivity) and QuickDASH scores before and after surgery were collected. Patient mean age was 56 ± SD 16 years, and 7,150/10,746 (67%) were women. Patients with severe cold sensitivity (defined as cold intolerance symptom severity score > 70; n = 951), scored significantly higher on QuickDASH at all time points compared to those with mild cold sensitivity (cold intolerance symptom severity scores ≤ 30, n = 1,532); preoperatively 64 [50-75] vs. 40 [25-55], at three months 32 [14-52] vs. 18 [9-32] and at 12 months 25 [7-50] vs. 9 [2-23]; all p < 0.0001. Severe cold sensitivity predicted higher postoperative QuickDASH scores at three [12.9 points (95% CI 10.2-15.6; p < 0.0001)] and at 12 months [14.8 points (11.3-18.4; p < 0.0001)] compared to mild cold sensitivity, and adjustment for a concomitant condition in the hand/arm, including ulnar nerve compression, did not influence the results. Cold sensitivity improves after OCTR. A higher preoperative degree of cold sensitivity is associated with more preoperative and postoperative disability and symptoms than a lower degree of cold sensitivity, but with the same improvement in QuickDASH score.
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Affiliation(s)
- Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, 205 02, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, 205 02, Malmö, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.
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