REGIONAL HYPOTHERMIA IN RESPONSE TO MINOR INJURY

Minor injuries ave sometimes followed by a potentially disabling syndr ome of hyperalgesia hyperesthesia, allodynia, and sudomotor disturbanc e as well as, eventually, weakness, muscle atrophy, trophic skin chang es, and bone and joint abnormalities. Vasomotor changes frequently pre sent as hypothermia or hyperthermia. Most of the literature refers to this syndrome as reflex sympathetic dystrophy (RSD). To observe possib le early RSD changes, we studied 1000 military recruits before and dur ing basic training. Evaluations consisted of lower limb clinical exami nations and pain assessment. Infrared images were taken of anterior, p osterior, medial, lateral legs, and plantar surface of the feet. If th e clinical examination suggested a possible stress fracture, a bone sc an was performed. Recruits were studied before training and again each time musculoskeletal complaints arose. The controls were recruits tes ted before the onset of training who had no musculoskeletal complaints . Two-hundred seven soldiers were injured. Regional hypothermia was no ted in 8.6% of all thermograms, with 75% on the left and 25% on the ri ght. The most common injuries causing this phenomenon were ankle pain/ sprain and minor foot stress fractures, especially the left metatarsal s. Hypothermia occurred within 24 to 48 h, usually beginning in the pe riphery and ascending proximally, lasting a few days to 6 wk (end of s tudy). None of the recruits developed the full syndrome of RSD during the study period. Whether the continued training, even though modified , helped to prevent this complication or the observed post-traumatic h ypothermia has no relationship to RSD needs to be determined.