Clinical Assessment of Pain and Sensory Function in Peripheral Nerve Injury and Recovery: A Systematic Review of Literature

Peripheral nerve injuries (PNIs) often present with variable symptoms, making them difficult to diagnose, treat, and monitor. When neurologic compromise is inadequately assessed, suboptimal treatment decisions can result in lasting functional deficits. There are many available tools for evaluating pain and functional status of peripheral nerves. However, the literature lacks a detailed, comprehensive view of the data comparing the clinical utility of these modalities, and there is no consensus on the optimal algorithm for sensory and pain assessment in PNIs. We performed a systematic review of the literature focused on clinical data, evaluating pain and sensory assessment methods in peripheral nerves. We searched through multiple databases, including PubMed/Medline, Embase, and Google Scholar, to identify studies that assessed assessment tools and explored their advantages and disadvantages. A total of 66 studies were selected that assessed various tools used to assess patient's pain and sensory recovery after a PNI. This review may serve as a guide to select the most appropriate assessment tools for monitoring nerve pain and/or sensory function both pre- and postoperatively. As the surgeons work to improve treatments for PNI and dysfunction, identifying the most appropriate existing measures of success and future directions for improved algorithms could lead to improved patient outcomes.

Patient-reported outcome measures for patients with hand-specific impairments-A scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly used to provide evidence for treatment effects and to guide rehabilitation. To our knowledge, no disease-specific PROM exists for the assessment of patients with flexor tendon lesions of the hand. We believe that PROMs used to assess hand function, regardless of diagnosis, contain relevant items for patients with flexor tendon lesions of the hand.

PURPOSE

The aim of our study was to identify and collect items from pre-existing PROMs used by clinical experts to assess the health status and function in patients with reduced hand function.

STUDY DESIGN

A scoping review searching for PROMs with hand-specific content was conducted to ensure face validity. As these items are assumed to have been through an evaluation process by the clinical specialists, they have the advantage and likelihood of being useful.

METHODS

We searched five bibliographic databases. All PROMs with hand-specific content used to assess hand function were considered for inclusion. Questionnaires written in English, Danish, Swedish, and Norwegian were included. An analysis of content redundancy was conducted, and items were grouped according to The World Health Organization's International Classification of Functioning, Disability and Health.

RESULTS

Seventy-three PROMs were included with a total of 1,582 items. The majority of the items were redundant across measurement instruments, and redundant items were consolidated, resulting in 179 nonredundant items. All nonredundant items were classified according to the International Classification of Functioning, Disability and Health components.

CONCLUSIONS

This review presents a collection of 179 items ensuring face validity for patients with hand-related disease/injury.

Functional and symptomatic assessment of medico-legal claims after upper limb injuries

A consecutive group of 250 patients underwent medico-legal assessment at a mean of 24 (±13) months following upper limb injuries. Each had completed questionnaires to assess function (Quick-DASH) and cold intolerance (CIQ36) before clinical assessment following which their whole limb impairment percentage was calculated. The mean(±SD) whole limb impairment, QDASH and CIQ36 scores were 9(±14)%, 43(±24) and 17(±10), respectively. There was a significant correlation between whole limb impairment and QDASH, although some patients reported surprisingly high disability levels despite minimal or no objective functional impairment. Whilst useful qualitative information can be obtained from questionnaires, the correlation between subjective and objective scores is weak albeit statistically significant. Individual patients can show marked discrepancies between objective and subjective functional scores. The results of questionnaires in individual medico-legal patients should be treated with caution.

Translation and cross-cultural adaptation of the McCabe Cold Sensitivity Severity scale (CSS) and Potential Work Exposure scale (PWES) to Norwegian

Introduction

The McCabe Cold Sensitivity Severity scale (CSS) is one of the most used questionnaires for measuring cold sensitivity in patients with hand injuries. The Potential Work Exposure scale (PWES) measures cold exposure at work. Good reliability and validity have been reported for the Swedish translations. No version in the Norwegian language has been available.

Methods

The CSS and PWES were translated forward and backward, and then tested for content validity in patients with hand injuries ( n = 23 and 12, respectively). We categorised the CSS scores (0–400) into five severity levels, from none to extreme cold hypersensitivity, and asked each patient how the categories matched their perceived cold hypersensitivity levels.

Results

Good content validity was confirmed for the Norwegian version of the CSS to assess cold sensitivity in patients with hand injuries. Preliminary findings support the categorisation of scores into five severity levels.

Conclusions

The Norwegian CSS is an appropriate instrument to assess cold sensitivity after hand injury.