SCIENTIFIC ARTICLE Rewarming Patterns in Hand Fracture Patients With and Without Cold Intolerance Ernst S. Smits, MSc, Tim H. J. Nijhuis, MSc, Frank J. P. M. Huygen, MD, PhD, Ruud W. Selles, PhD, Steven E. R. Hovius, MD, PhD, Sjoerd P. Niehof, PhD Purpose It is often assumed that cold intolerance is associated with abnormalities in the skin temperature due to changes in the blood flow of the hands. In this study, we determined whether patients with and without cold intolerance after a hand fracture or healthy controls have a diminished rewarming after a cold stimulus. Methods The severity of cold intolerance was evaluated using the Cold Intolerance Symptom Severity (CISS) questionnaire. To determine whether abnormal rewarming plays a major role in the underlying pathophysiology of cold intolerance, a cold-stress test was applied at a mean of 30 months (with a range of 11 mo) after the patients recovered from a hand fracture. A control group also underwent identical cold-stress testing for comparison. Temperature during the rewarming phase was measured using videothermography. Results Thirteen control subjects and 18 patients participated. Control subjects did not report any symptoms of cold intolerance (CISS score, 0) and no loss of sensibility was measured. The mean CISS score of all patients was 27.8; 9 patients scored above the cut-off value for normal cold intolerance. No significant differences were found in the rewarming patterns between (1) the affected and non-affected hand of the postfracture patients, (2) the dominant and non-dominant hand of the control subjects, and (3) the patients and controls. Conclusions The results of this study revealed no relation between the severity of cold intolerance and rewarming patterns after cold stress testing. This might suggest that tem- perature regulation of the hands in post-fracture patients might not be responsible for the symptoms of cold intolerance, based on cold-stress test response. (J Hand Surg 2011;xx:. Copyright © 2011 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Prognostic II. Key words Cold intolerance, hand fracture, rewarming patterns, thermoregulation, videothermography. C OLD INTOLERANCE IS a disabling symptom that is defined as abnormal pain following exposure to mild cold that often occurs after trauma. 1–8 In a study on patients with a hand fracture, the prevalence of cold intolerance was found to be 38%. In addition, cold intolerance is commonly reported by patients who have had Raynaud’s disease, 9 –12 upper extremity trauma, digital replantations, 13–22 hand and arm vibration syn- drome, and a radial forearm flap. 23,24 In many studies, the presence of cold intolerance is determined us- ing a single yes/no question. Alternatively, the severity of cold intolerance can be determined in From the Department of Plastic, Reconstructive, and Hand Surgery, Department of Rehabilitation Medicine,ExperimentalAnesthesiology&IntensiveCare,andthePainTreatmentCenter,ErasmusMC, University Medical Center, Rotterdam, The Netherlands. Received for publication April 13, 2010; accepted in revised form December 28, 2010. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Corresponding author: Ernst Smits, MSc, Erasmus MC, Department of Rehabilitation Medicine and Department of Plastic and Reconstructive Surgery, PO Box 2040, 3000 CA Rotterdam, The Netherlands; e-mail: e.smits@erasmusmc.nl. 0363-5023/11/xx0x-0001$36.00/0 doi:10.1016/j.jhsa.2010.12.034 ©  ASSH  Published by Elsevier, Inc. All rights reserved.  1