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PubMed1981

[An angiographic study of congenital hand anomalies (author's transl)].

Accurate knowledge of the arterial variations of the anomalous hand is of considerable practical importance not only in the process of reconstructive surgery in hand anomalies but also in the consideration of the classification and the developmental stage of these defects. Between 1970 and 1980, we have performed an angiography on 102 anomalous hands of 97 patients at the Department of Orthopaedic Surgery, Nagoya University Branch Hospital. They consist of 28 cases of polydactyly, 25 of syndactyly, 14 of cleft hand, 13 of radial ray deficiency, 6 of ulnar ray deficiency, 6 of congenital constriction band syndrome, 5 of brachysyndactyly, 3 of macrodactyly and 1 each of monodactyly and aberrant muscle of the forearm. High origin of the radial artery was encountered in 11 out of 95 hands (11.6 per cent). In 5 out of 11 hands, an incomplete volar arch was found. The median artery entered into the formation of the superficial volar arch in about 20 per cent of cases. It occurred most frequently in radial ray deficiency (Table 1). An unusual division and course of the artery in the forearm occurred in 5 hands. The developmental disorders of the radial artery were encountered in 19 of the 102 hands (18.6 per cent). Especially, they were observed frequently in radial ray deficiency, and represented an occurrence in 84.6 per cent of these deficits (Table 2). The superficial volar arch was absent in about 25 per cent of cases. This arterial pattern was seen frequently in cleft hand and syndactyly (Table 3). In 30 of the 39 cases of syndactylism, the common digital artery bifurcated into the proper digital artery much further distally than normal. The digital arterial patterns of the duplicated thumb could be divided into 4 types (Fig. 3). The arterial patterns of cleft hand were quite different from those with radial ray deficiency, but were rather similar to those of syndactyly. The arterial patterns of ulnar ray deficiency tended to fall into two groups: those with the developmental disorders of the radial artery and those without them.

Adolescent↗

PubMed1999

The associations of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women.

OBJECTIVE: To determine whether Caucasian women ages 28-48 years with newly defined osteoarthritis (OA) would have greater bone mineral density (BMD) and less bone turnover over time than would women without OA. METHODS: Data were derived from the longitudinal Michigan Bone Health Study. Period prevalence and 3-year incidence of OA were based on radiographs of the dominant hand and both knees, scored with the Kellgren/Lawrence (K/L) scale. OA scores were related to BMD, which was measured by dual-energy x-ray absorptiometry, and to serum osteocalcin levels, which were measured by radioimmunoassay. RESULTS: The period prevalence of OA (K/L grade > or =2 in the knees or the dominant hand) was 15.3% (92 of 601), with 8.7% for the knees and 6.7% for the hand. The 3-year incidence of knee OA was 1.9% (9 of 482) and of hand OA was 3.3% (16 of 482). Women with incident knee OA had greater average BMD (z-scores 0.3-0.8 higher for the 3 BMD sites) than women without knee OA (P < 0.04 at the femoral neck). Women with incident knee OA had less change in their average BMD z-scores over the 3-year study period. Average BMD z-scores for women with prevalent knee OA were greater (0.4-0.7 higher) than for women without knee OA (P < 0.002 at all sites). There was no difference in average BMD z-scores or their change in women with and without hand OA. Average serum osteocalcin levels were lower in incident cases of hand OA (>60%; P = 0.02) or knee OA (20%; P not significant). The average change in absolute serum osteocalcin levels was not as great in women with incident hand OA or knee OA as in women without OA (P < 0.02 and P < 0.05, respectively). CONCLUSION: Women with radiographically defined knee OA have greater BMD than do women without knee OA and are less likely to lose that higher level of BMD. There was less bone turnover among women with hand OA and/or knee OA. These findings suggest that bone-forming cells might show a differential response in OA of the hand and knee, and may suggest a different pathogenesis of hand OA and knee OA.

Adult↗

PubMed1995

Longitudinal study of hand bone densitometry in rheumatoid arthritis.

OBJECTIVE: To measure hand bone mineral content (BMC) by dual x-ray absorptiometry and to seek clinical correlates in patients with rheumatoid arthritis (RA), in a prospective, longitudinal study. METHODS: Eighty-one patients with non-steroid-treated RA were assessed at baseline and at month 12, for hand BMC and for disease activity and severity. Hand BMC in patients was compared with that in a control group of 95 normal volunteers, and rate of loss was compared with that in 37 controls. RESULTS: At the initial assessment, male and female patients with RA had lower hand BMC than controls, after correction for age, height, and weight (mean reduction 7.5% in men [P = 0.003] and 7.8% in women [P = 0.01]). After 1 year, there was a further loss of hand BMC in patients (median loss 3.25% in men [P = 0.001] and 1.46% in women [P = 0.05]), but normal controls did not have significant changes in their hand BMC. In patients with disease duration of < 2 years at study entry, the parameters of disease activity improved over 1 year, but they lost significant amounts of hand BMC. Hand BMC loss correlated with baseline C-reactive protein levels. In those with RA of > 2 years duration at entry, the Health Assessment Questionnaire scores and Larsen scores had worsened after 1 year, but there was no significant loss of hand BMC. CONCLUSION: Patients with RA had low hand BMC compared with normal controls, even within 2 years of disease onset. The rate of loss was highest in patients with early disease and correlated with measures of initial disease activity. This loss continued despite clinical improvement.

Absorptiometry, Photon↗

PubMed2005

Does hand osteoarthritis predict future hip or knee osteoarthritis?

OBJECTIVE: To evaluate the risk of future hip or knee osteoarthritis (OA) in subjects with hand OA at baseline and to evaluate whether the concurrent presence of hand OA, other risk factors for OA, or an OA biomarker (type II collagen C-telopeptide degradation product [CTX-II]) further increases the risk. METHODS: Radiographs of the hands (baseline) and the hips and knees (baseline and 6.6 years later) were obtained in a randomly selected subset of participants in the Rotterdam Study who were ages 55 years and older. Radiographs were scored for the presence of OA using the Kellgren/Lawrence (K/L) system. A total of 1,235 subjects without OA of the hip/knee (K/L score 0-1) at baseline were included in the study. CTX-II levels were measured at baseline. The independent risk of future hip/knee OA in subjects with hand OA at baseline was assessed by logistic regression, as stratified for age, sex, body mass index, family history of OA, and heavy workload. RESULTS: Overall 12.1% of the participants (19.7% of those with hand OA versus 10.0% of those without) developed hip or knee OA (odds ratio [OR] 2.1 [95% confidence interval (95% CI) 1.3-3.1]). Subjects with hand OA had an increased risk of future hip OA (OR 3.0 [95% CI 1.6-5.4]), which was further increased in those with a family history of OA. Subjects with hand OA had an OR of 1.6 [95% CI 1.0-2.8) for the future development of knee OA, which was further increased in those who were overweight. Concurrent hand OA and high levels of CTX-II further increased the risk of having hip or knee OA at followup (OR 4.2 [95% CI 2.3-7.8]). CONCLUSION: The presence of hand OA at baseline showed an increased risk of future hip/knee OA (higher for hip OA than for knee OA). The concurrent presence of hand OA and other OA risk factors or high CTX-II levels further increased the risk of future hip/knee OA.

Aged↗

PubMed1992

Oculo-manual coordination control: ocular and manual tracking of visual targets with delayed visual feedback of the hand motion.

The aim of this study was to examine coordination control in eye and hand tracking of visual targets. We studied eye tracking of a self-moved target, and simultaneous eye and hand tracking of an external visual target moving horizontally on a screen. Predictive features of eye-hand coordination control were studied by introducing a delay (0 to 450 ms) between the Subject's (S's) hand motion and the motion of the hand-driven target on the screen. In self-moved target tracking with artificial delay, the eyes started to move in response to arm movement while the visual target was still motionless, that is before any retinal slip had been produced. The signal likely to trigger smooth pursuit in that condition must be derived from non-visual information. Candidates are efference copy and afferent signals from arm motion. When tracking an external target with the eyes and the hand, in a condition where a delay was introduced in the visual feedback loop of the hand, the Ss anticipated with the arm the movement of the target in order to compensate the delay. After a short tracking period, Ss were able to track with a low lag, or eventually to create a lead between the hand and the target. This was observed if the delay was less than 250-300 ms. For larger delays, the hand lagged the target by 250-300 ms. Ss did not completely compensate the delay and did not, on the average, correct for sudden changes in movement of the target (at the direction reversal of the trajectory). Conversely, in the whole range of studied delays (0-450 ms), the eyes were always in phase with the visual target (except during the first part of the first cycle of the movement, as seen previously). These findings are discussed in relation to a scheme in which both predictive (dynamic nature of the motion) and coordination (eye and hand movement system interactive signals) controls are included.

Adult↗

PubMed1988

Alteration of period and amplitude of circadian rhythms in shift workers. With special reference to temperature, right and left hand grip strength.

48 male shift workers in various industries volunteered to document circadian rhythms in sleeping and working, oral temperature, grip strength of both hands, peak expiratory flow and heart rate. All physiological variables were self-measured 4 to 5 times a day for 2 to 4 weeks. Individual time series were analyzed according to several statistical methods (power spectrum, cosinor, chi squares, ANOVA, correlation, etc.) in order to estimate rhythm parameters such as circadian period (tau) and amplitude (A), and to evaluate subgroup differences with regard to tolerance to shift work, age, duration of shift work, speed of rotation and type of industry. The present study confirms for oral temperature and extends to other variables (grip strength of both hands, heart rate) that intolerance to shift work is frequently associated with both internal desynchronization and small circadian amplitude. The internal desynchronization among several circadian rhythms supports the hypothesis that these latter are driven by several oscillators. Many differences were observed between circadian rhythms in right and left hand grip strength: circadian tau in oral temperature was correlated with that in the grip strength of the dominant hand but not with that of the other hand; changes in tau s of the non-dominant hand were age-related but did not correlate with temperature tau; only the circadian A of the non-dominant hand was associated with a desynchronization. Thus, circadian rhythms in oral temperature and dominant hand grip strength may be driven by the same oscillator while that of the non-dominant hand may be governed by a different one. Internal desynchronization between both hand grip rhythms as well as desynchronization of performance rhythms reported by others provide indirect evidence that circadian oscillator(s) may be located in the human cerebral cortex.

Adult↗

PubMed2004

Human handedness: is there a difference in the independence of the digits on the preferred and non-preferred hands?

In non-human primates, comparative studies show that greater dexterity is associated with greater independent control over the digits. Studies of humans, however, show no difference in the degree of independent control of single digits on the more dexterous preferred hand and its less dexterous partner. We wondered whether there might be a difference in the degree of independent control on the two hands during performance of functionally relevant tasks. Many object manipulation tasks require the ability to produce and control forces with more than one finger at the same time. We hypothesized that asymmetrical independence, with greater independence on the preferred than the non-preferred hand, would be evident with a task that requires the simultaneous production of force in two digits. We examined digit individuation when subjects produced flexion forces with a single digit in isolation, and simultaneous flexion forces in all ten combinations of two digits. Consistent with previous studies, we found no difference between the individuation of the digits on the preferred and non-preferred hands during force production with single digits in isolation. Similarly, no asymmetry was present when forces were produced by two digits. However, separation of two-digit forces into thumb-to-digit opposition forces and non-opposition forces showed that although there was no difference in individuation between the two hands for non-opposition forces, the digits on the preferred hand were more independent than those on the non-preferred hand for opposition forces. We suggest that this independence asymmetry is not itself the underlying cause of the dexterity differences between the hands, but rather arises from a difference in the capacity for use-dependent reorganization of the motor cortical circuits controlling each hand, and that this difference might underlie the dexterity differences between the hands.

Adult↗

PubMed2004

Predictive strategies in interception tasks: differences between eye and hand movements.

To investigate how the sensorimotor systems of eye and hand use position, velocity, and timing information of moving targets, we conducted a series of three experiments. Subjects performed combined eye-hand catch-up movements toward visual targets that moved with step-ramp-like velocity profiles. Visual feedback of the hand was prevented by blanking the target at the onset of the hand movement. A multiple regression was used to determine the effects of position, velocity, and timing accessed before each movement on the movement amplitudes of eye and hand. The following results were obtained: 1. The predictive strategy of eye movements could be modeled by a linear regression on the basis of the position error and the target velocity. This was not the case for hand movements, for which there was a significant partial correlation between the movement amplitude and the product of target velocity and movement duration. This correlation was not observed for eye movements suggesting that the predictive strategy of hand movements takes movement duration into account, in contrast to the strategy used in eye movements. 2. To determine whether the movement amplitudes of eye and hand depend on a categorical classification between a discrete number of movement types, we compared an experiment in which target position and velocity were distributed continuously with an experiment using only four different combinations of target position and velocity. No systematic differences between these experiments were observed. This shows that the system output is a function of continuous, interval-scaled variables rather than a function of discrete categorical variables. 3. We also analyzed the component of the movement amplitudes not explained by the regression, i.e., the residual error. The residual errors between subsequent trials were correlated more strongly for eye than for hand movements, suggesting that short-term temporal fluctuations of the predictive strategy were stronger for the eye than for the hand.

Adult↗

PubMed2005

Partition of voluntary command to antagonist muscles during cyclic flexion-extension of the hand.

Activity distribution between wrist movers during rhythmic flexion-extension of the wrist has been analysed in three different mechanical conditions. Wrist angular position and surface EMG from Extensor Carpi Radialis (ECR) and Flexor Carpi Radialis (FCR) were recorded. In the first condition (hand prone, flexion-extension in a vertical parasagittal plane) the hand passive equilibrium position was approximately 50 degrees in flexion. During hand oscillations FCR and ECR were alternatively recruited to move the hand symmetrically away from the equilibrium and de-recruited to allow conservative forces to restore the equilibrium. Switching between antagonists occurred at the centre of the oscillation (equilibrium crossing). In the second condition (hand semi-prone, flexion-extension in a horizontal transversal plane) the hand equilibrium was attained over an angle of about 26 degrees . When the hand was oscillated symmetrically around this equilibrium range, each muscle was recruited when the hand entered the equilibrium range and switching between antagonists therefore occurred in advance of the oscillation centre. Both vertical and horizontal oscillations were also performed all externally to the equilibrium position or range: in these cases only one muscle was recruited over the entire cycle, the EMG burst starting at the onset of the related movement. In the third condition (hand semi-prone, flexion-extension in a horizontal transversal plane) a frictional load added to the platform pivot expanded the equilibrium range to encompass the entire hand oscillation. Now concentric muscle contraction was needed throughout each phase of the movement and switching between antagonists occurred at the movement reversal, i.e. ~90 degrees in advance of the oscillation centre. The above descriptions held for oscillation frequencies from 0.2 Hz to 3.0 Hz, once the frequency-dependent effects of viscosity and inertia were accounted for. In all the three conditions, contractile forces started developing when an intrinsic or external resistance had to be overcome in order to continue the movement. To account for this control, a neural network is proposed that compares the afferent information about joint position with a position central command, thus detecting the position error caused by the forces that resist to movement. From the sign and amplitude of the error signal the network determines the direction (agonist vs antagonist) and the amount of motor activation.

Adult↗

PubMed2006

Control of the dominant and nondominant hand: exploitation and taming of nonmuscular forces.

Movements of the dominant and nondominant hand have been claimed to differ with respect to how they take intersegmental dynamics into account. Consistent with this claim, movements of the dominant hand are hypothesized to better exploit the intrinsic limb dynamics, whereas movements of the nondominant hand are controlled to make the intrinsic dynamics ineffective as far as this is possible. For rapid finger oscillations this hypothesis implies a higher level of co-contractions in the nondominant than in the dominant hand. Replicating previous findings on finger tapping, finger oscillations of the dominant hand were faster and less variable than those of the nondominant hand. More importantly, the variance of the relative difference between myoelectric signals of antagonistic muscles and thus the power of reciprocal myoelectric activity was smaller in the nondominant hand, indicating a relatively higher level of co-contractions than in the dominant hand. In addition, a spectral decomposition of the total power of the relative-difference signal revealed stronger relative power in the frequency band of the finger oscillations in the dominant than in the nondominant hand. These findings are consistent with the hypothesis that for the dominant hand more accurate feedforward control is possible based on a more accurate internal model of limb dynamics.

Action Potentials↗

PubMed1990

A role delineation study of hand surgery.

In 1986, The American Association for Hand Surgery and the American Society for Surgery of the Hand jointly sponsored a Role Delineation Study of Hand Surgery. The purpose of this study was to define the knowledge and skills necessary for competent hand surgery practice and to determine the responsibilities and activities of hand surgeons. Eight hundred thirty-eight hand surgeons returned a self-report questionnaire. This questionnaire was designed to collect information relative to the demographic characteristics of the respondents, the importance of 38 surgical procedures, and 60 categories of knowledge related to hand surgery, and to elicit respondents opinions regarding certification in hand surgery. This study is a first attempt to define the domain of hand surgery. The data collected in this study provide the basis for designing residency fellowship and continuing education programs and may also be used to study manpower needs, regional variations in practice patterns, and to identify the educational needs of the profession of hand surgery.

Education, Medical↗

PubMed2006

Causes and consequences of hand injuries.

BACKGROUND: Hand injuries are considered to be the most frequent body injuries, the treatment of which is of long duration and great community expense. The aim of this study was to define the most frequent causes of hand injury in the investigated materials; the severity of hand injuries and outcome of treatment performed in the typical trauma surgery ward; and overall costs of hand-injury treatment. METHODS: Between 1987 and 2000, 1199 patients (average age 37.0 years (+/- 15) were treated for complex hand injuries in II Surgery Clinic in Cracow. Causes, places, and mechanisms of hand injuries were evaluated as were types and duration of treatment. We also estimated also total (direct and indirect) treatment costs. RESULTS: Of all hand injuries, 45.3% occurred at home and 19.7% at work. Hand injuries caused by mechanical equipment predominated (34.9%) and were the most severe. Up to 26.7% of injuries occurred after alcohol consumption. Average total treatment time was 76.9 days (+/- 67). Hand impairment of variable severity was found in 58.5% of patients. Indirect costs constituted a dominant part of overall costs (96%). CONCLUSIONS: The complex treatment of the injured hand at specialist centers allows for shorter treatment duration, improved treatment results, and decreased indirect expenses.

Accidents, Occupational↗

PubMed2004

Identifying factors of comfort in using hand tools.

To design comfortable hand tools, knowledge about comfort/discomfort in using hand tools is required. We investigated which factors determine comfort/discomfort in using hand tools according to users. Therefore, descriptors of comfort/discomfort in using hand tools were collected from literature and interviews. After that, the relatedness of a selection of the descriptors to comfort in using hand tools was investigated. Six comfort factors could be distinguished (functionality, posture and muscles, irritation and pain of hand and fingers, irritation of hand surface, handle characteristics, aesthetics). These six factors can be classified into three meaningful groups: functionality, physical interaction and appearance. The main conclusions were that (1) the same descriptors were related to comfort and discomfort in using hand tools, (2) descriptors of functionality are most related to comfort in using hand tools followed by descriptors of physical interaction and (3) descriptors of appearance become secondary in comfort in using hand tools.

Consumer Behavior↗

PubMed2006

Hand involvement in Behçet's disease.

AIMS: To study the clinical hand findings in Behçet's disease (BD) and to observe scintigraphic changes of these areas. METHODS: Fifty-seven randomly selected BD patients and the patients in the control group (N=40) were evaluated by two blind rheumatologists. The hands were examined for the presence of pain, tenderness, swelling, effusion, erythema, warmth, range of motion and limitation of motion, deformities and muscle atrophy. Then scintigraphic examination of the hands was performed. Control hand scintigrams were obtained from 40 age- and sex-matched patients and were examined by the same two observers. RESULTS: Thirty-two of the 57 patients (56.1%) showed Behçet's clinical hand findings. Terminal phalangeal pulp atrophy was observed in 17 (29.81%), rheumatoid-like hand findings were observed in 16 (28.1%), dorsal interosseos atrophy was observed in 12 (20.05%) and erythema over the digits was observed in 12 (20.05%). Twenty-four patients (42.1%) had scintigraphic involvement. The disease duration was observed to be an important factor for hand findings (P=0.040) and scintigraphic involvement (P=0.011). CONCLUSION: High prevalence of hand involvement in BD and its relationship with disease duration is demonstrated. Hand involvement tends to be overlooked and careful examination is required in the evaluation of BD. The scintigraphic involvement detected in hands requires special consideration, too.

Adolescent↗

PubMedDate not supplied

Hand span and digital motion on the keyboard: concerns of overuse syndrome in musicians.

PURPOSE: To investigate the hand motion of pianists when they performed an octave and a chord, which accounted for 74% of the piano techniques that the subjects practiced at the onset of overuse hand problems. The octave position was to strike 2 keys that were 16.7 cm apart simultaneously with the thumb and small finger, and the chord position was to strike 3 keys with 4.8 cm between the borders. METHODS: The abduction angle of both the thumbs and the small fingers of 10 pianists while playing a chord and an octave were measured repeatedly with a video-based passive marker detection system. The angles were compared between pianists with large hand spans and those with small hand spans. RESULTS: When playing the octave both the maximal and minimal abduction angles of the thumb were significantly larger for the smaller-hand pianists as compared with the pianists with larger hand spans. When playing the chord the maximal abduction angle of the thumb of small-hand-span pianists was significantly larger than that of large-hand-span pianists. The abduction of the small finger, however, did not differ during performance of either the octave or the chord. CONCLUSIONS: These results suggest that the small-hand-span pianists must abduct the thumb more than large-hand-span pianists while minimizing movement of the small finger. This may cause de Quervain's tenosynovitis in pianists.

Adult↗

PubMed2003

Effect of sensory discrimination training on structure and function in patients with focal hand dystonia: a case series.

OBJECTIVE: To measure the effects of sensorimotor training based on the principles of neuroplasticity for patients with focal hand dystonia. DESIGN: Case series of 3 subjects with focal hand dystonia of the left hand, compared with age-matched normative controls. SETTING: Outpatient clinic. PARTICIPANTS: Three consecutive clinic patients-musicians with focal hand dystonia-who described a history of repetitive practice and performance (2 women; ages, 23 y and 35 y; 1 man; age, 24 y). INTERVENTION: Subjects were asked to stop performing the tasks that caused the abnormal movements, to participate in a wellness program (aerobics, postural exercises, stress free hand use), and to carry out supervised, attended, individualized, repetitive sensorimotor training activities at least once week for 12 weeks and reinforced daily at home. MAIN OUTCOME MEASURES: Standard tests documenting somatosensory hand representation, target-specific hand control, and clinical function. RESULTS: On the affected side, the 3 subjects improved an average of 86.8% on somatosensory hand representation, 117% on target-specific performance, 23.9% on fine motor skills, 22.7% on sensory discrimination, 31.9% on musculoskeletal skills, and 32.3% on independence. All 3 subjects improved 10% or more on 90% of the subtests with 20% improvement on 50% of the subtests. CONCLUSION: Individuals with focal hand dystonia who have a history of repetitive hand use can improve cortical somatosensory responses and clinical motor function after individualized sensorimotor training consistent with the principles of neural adaptation.

Adult↗

PubMed2000

Predicting hand preference with performance on motor tasks.

Handedness may be defined as preference or hand-differences in task performance. The strength and significance of the relationship between hand preference and hand performance asymmetries have been contested. To evaluate this relationship, we administered the Edinburgh Handedness Inventory and measured asymmetries in finger tapping, Purdue Pegboard, and grip strength in 30 subjects who prefer their right hand and 30 subjects who prefer their left hand. Hand asymmetries in finger tapping, Purdue Pegboard, and grip strength each predicted hand preference scores. However, a multiple regression equation best predicted hand preference by using performance of each task. Hand asymmetries in finger tapping correlated strongly with asymmetries in Purdue Pegboard performance, but neither of these asymmetries correlated strongly with asymmetries in grip strength. These findings indicate that hand preference and asymmetries in motor proficiency are strongly related, but suggest that preference and proficiency for different aspects of motor performance may be independently lateralized.

Adult↗

PubMed1994

Hand skin temperature changes in patients with chronic liver disease.

Previous studies have shown that changes in the peripheral circulation occur in patients with liver disease. We have investigated the temperature of the hands of 26 patients and 13 controls using a liquid crystal contact thermography system. Significant differences in resting hand temperature and appearance were observed when the patients were categorised according to Child's score. The appearance depended upon the severity of liver disease; Child's A patients have warm hands of normal thermographic appearance; Child's B patients have cold hands with an abnormal thermographic appearance; whilst Child's C patients have warm hands with an abnormal thermographic appearance. After right-hand ice-cold water immersion, right-hand recovery was abnormally slow in Child's B & C groups compared with Child's A patients and controls. In addition, there was left-hand reflex vasoconstriction during the right-hand warm-up period in those with severe liver disease. With regard to autonomic function, no significant difference in right-hand temperature, thermographic appearance or warm-up rate was detected between those with and those without autonomic neuropathy. These results indicate that autonomic nervous system dysfunction is not the predominant cause of these changes.

Autonomic Nervous System↗