Health & Environmental Research Online (HERO)


Print Feedback Export to File
2616160 
Journal Article 
Hypoesthesia in the Distal Residual Limb of Amputees 
Harden, RN; Gagnon, CM; Khan, A; Wallach, G; Zereshki, A 
2010 
1 
P M & R (New York)
ISSN: 1934-1482 
2 
7 
607-611 
20659715 
WOS:000208361500003 
Objective: To test the emerging hypothesis that there is polymodal fiber degeneration/loss in distal residual limbs (DRL) of amputees.



Design: Prospective qualitative and quantitative psychophysical testing.



Setting: A pain research center at an urban academic rehabilitation hospital.



Participants: Forty-four amputees (32 with pain, 12 without pain) with a single (upper or lower) limb amputation. Subjects are a clinical "convenience" sample derived from our amputee or prosthetic clinics.



Methods: Interventions were prospectively acquired psychophysical tests. The primary quantitative test was thermal Quantitative Sensory Testing (tQST) using a Peltier type thermal testing device, assessing sites on the DRL compared with anatomically similar regions on the contralateral "unaffected" extremity.



Results: Perceptual responses for several qualitative psychophysical stimuli and perceptual thresholds for tQST cold sensation were significantly reduced in the DRL (t(43) = -2.613, P = .012). There were no significant tQST differences in thresholds for warm perception, cold pain, or hot pain (P > .05).



Conclusion: These results show a point prevalence of differential hypoesthesia in distal residual limbs. There was a selective loss of cold, but not warm perception or threshold for hot or cold pain by tQST. There are several possible explanations for this polymodal and selective hypoesthesia; specifically, these data may be indicative of a differential "dying back" peripheral neuropathy of the DRL, which may be operational in such clinical features as postamputation pain. PM R 2010;2:607-611