M. Dibenedetto et al., REGIONAL HYPOTHERMIA IN RESPONSE TO MINOR INJURY, American journal of physical medicine & rehabilitation, 75(4), 1996, pp. 270-277
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.