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.
|Status||Published - 2022 juli|
Bibliografisk informationFunding Information:
This work was supported by grants from the Swedish Research Council (2021-01942, LD, www.vr.se), Lund University, Region Skåne (2018-Projekt0104, LD), Swedish Diabetes Foundation (DIA2020-492, LD, www.diabetes.se) Skåne University Hospital (2019-659, LD), Magnus Bergvall´s Foundation (2020-03612, MZ, www. magnbergvallsstiftelse.nu), Greta och Johan Kocks Foundation (MZ, kockskastiftelsen.se) and Stig och Ragna Gorthons foundation(MZ, gorthonstiftelsen. se). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to thank the staff at HAKIR and all participating individuals. A special thanks to the National Diabetes Registry and the late Ann-Marie Svensson for her work on data collection.
- Klinisk medicin