Cold Sensation in Post-Surgery Hand Rehabilitation

After surgery for a hand fracture (after the insertion of metal pins), the hand may feel cold?

Hello Dr.
Chen,
My mother, who is currently 65 years old, underwent surgery eight years ago for a fracture in her left hand (commonly referred to as pinning with metal screws) at a major hospital.
She has since recovered and had the screws removed.
However, we have noticed that occasionally her hand feels cold (there are no issues with sensation, it just feels cold), and it is not both hands at the same time; rather, the hand that underwent surgery is colder than the other hand.

I would like to ask the following questions:
1.
Is it normal for there to be a temperature difference between both hands (including the palms and fingers)? How much of a difference is typical? At what point does it become abnormal?
2.
Could the colder temperature in the surgical hand be due to insufficient rehabilitation?
3.
Given that it has been 6 to 8 years, are there any ways to improve this condition?
4.
Are there any recommended specialties for diagnosis and treatment?
Thank you.

Yang Xiao-jie, 30~39 year old female. Ask Date: 2010/02/23

Dr. Chen Wayda reply Rehabilitation

1.
There should be no temperature difference between both hands under normal conditions.

2.
The hand that underwent surgery is colder; rehabilitation should continue along with complementary traditional Chinese medicine treatment.

Reply Date: 2010/02/23

More Info

Understanding cold sensations in the hand after surgery can be complex, especially in the context of previous injuries and surgeries. Your mother’s experience of having one hand feeling colder than the other after a surgical procedure is not uncommon, and several factors could contribute to this phenomenon.

1. Normal Temperature Variations: It is normal for there to be slight temperature variations between the two hands. Typically, the difference in temperature should not exceed 1-2 degrees Celsius (approximately 1.8-3.6 degrees Fahrenheit). If the temperature difference is greater than this, it may indicate an underlying issue, such as poor circulation or nerve damage. Coldness in one hand could be a sign of vascular insufficiency or nerve compression, particularly if it is accompanied by other symptoms like tingling or numbness.

2. Rehabilitation and Cold Sensation: The fact that the surgical hand feels colder could be related to several factors, including the effectiveness of rehabilitation. If the hand has not regained full circulation or if there is residual swelling or scar tissue from the surgery, this could contribute to a sensation of coldness. Rehabilitation exercises are crucial for restoring blood flow and nerve function. If your mother has not been consistently engaging in rehabilitation exercises, it may be beneficial to revisit her rehabilitation program with a physical therapist who specializes in post-surgical recovery.

3. Long-Term Solutions: Given that it has been 6-8 years since the surgery, there are still options to improve her condition. Physical therapy can help enhance circulation and nerve function. Techniques such as manual therapy, ultrasound, and electrical stimulation may be beneficial. Additionally, occupational therapy can provide strategies for managing daily activities and improving hand function. If there is significant concern about vascular or nerve issues, consulting with a vascular surgeon or a neurologist could provide further insights and treatment options.

4. Recommended Specialties: For a comprehensive evaluation, I would recommend consulting with a few different specialties. A physiatrist (rehabilitation physician) can assess her overall function and develop a tailored rehabilitation plan. A neurologist can evaluate any potential nerve damage or compression that may be contributing to the cold sensation. If vascular issues are suspected, a vascular surgeon or a hand surgeon could provide insights into blood flow and circulation in the affected hand.

In summary, while some temperature variation between hands is normal, significant differences, especially in the context of past surgery, warrant further investigation. Engaging in a structured rehabilitation program and consulting with the appropriate specialists can help address the cold sensation and improve your mother’s overall hand function. It’s essential to monitor her symptoms closely and seek medical advice if there are any changes or worsening of her condition.

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