Which of the following symptoms of cold intolerance do you experience in your injured limb on exposure to cold? |
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Pain, numbness, stiffness, weakness, aching, skin colour change (white/bluish white/blue) |
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How often do you experience these symptoms? (Please tick) |
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Continuously/all the time |
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Several times a day |
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Once a day |
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Once a week |
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Once a month or less |
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Never |
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When you develop cold induced symptoms, on your return to a warm environment are the symptoms relieved? (Please tick) |
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Not applicably |
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Within a few minutes |
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Within 30 min |
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After more than 30 min |
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What do you do to ease or prevent your symptoms occurring? (Please tick) |
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Take no special action |
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Keep hand in pocket |
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Wear gloves in cold weather |
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Wear gloves all the time |
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Avoid cold weather/stay indoors |
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Other (please specify) |
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How much does cold bother your injured hand in the following situations? (Please score 0-10) |
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Holding a glass of ice water |
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Holding a frozen package from the freezer |
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Washing in cold water |
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When you get out of a hot bath/shower with air room temperature |
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During cold wintry weather |
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Please state how each of the following activities have been affected as a consequence of cold induced symptoms in your injured hand and score each (please score 0-4) |
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Domestic chores |
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Hobbies and interests |
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Dressing and undressing |
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Tying your |
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