Athletes with Chronic Conditions
Flavia Meyer, Zbigniew Szygula, Boguslaw Wilk in Fluid Balance, Hydration, and Athletic Performance, 2016
Similar to individuals with type 1 diabetes, very few studies examining sweating responses in individuals with type 2 diabetes exist (Fealey et al. 1989; Petrofsky et al. 2005; Rand et al. 2008; Kenny et al. 2013), with only one of these studies examining sweat responses during moderate physical activity (Kenny et al. 2013). For the most part, studies of individuals with type 2 diabetes have found that sweating responses to local or whole-body heating (Fealey et al. 1989; Petrofsky et al. 2005), as well as electrical (Rand et al. 2008) stimuli are lower in individuals with type 2 diabetes compared to non-diabetic controls. These impairments in sudomotor function may be linked to changes in the sweat glands themselves, especially where participants have either long-standing or poorly controlled diabetes (Fealey et al. 1989; Luo et al. 2011). One study examining a 60-min bout of moderate cycling at 30°C did not find any differences in sweat rate between individuals with type 2 diabetes compared to matched controls, but did note that the measurement was highly variable, thereby making it difficult to find statistically significant differences between the two groups (Kenny et al. 2013). Unfortunately, there is a paucity of studies involving whole-body heat exposure with blood sampling or measures of core temperature to explain how these sweating impairments could potentially impact heat loss mechanisms in the body or overall fluid and electrolyte balance. More information on sweating and skin blood flow in diabetes is described in Chapter 3 (Section 3.3.2) of this book.
Diagnostic algorithms for painful peripheral neuropathy
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
There are a number of tests which rely on the effector function of unmyelinated fibers. An example is using laser Doppler to measure the size of the neurogenic flare in response to a chemical stimulus which activates C-fibers and this response is reduced in small-fiber neuropathy (for examples see Refs 12, 13[II]). A problem is that many other factors can alter this response. A number of tests can be used to measure sudomotor function (as a measure of dysfunction in postganglionic sympathetic neurons), including sweat testing, sympathetic skin response, and sudomotor axon reflex testing.14 In one recent study, 98 percent of patients with clinically defined small-fiber neuropathy were found to have abnormal sudomotor function as assessed by thermoregulatory sweat test and sudomotor axon reflex testing.15 Another group has also found a close correlation between abnormalities in sudomotor function and epidermal innervation density in painful sensory neuropathy.16
Peripheral nerve disorders
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Areas of altered sensation should be accurately mapped. Each spinal nerve root serves a specific dermatome (see Figure 11.3) and peripheral nerves have more or less discrete sensory territories which are illustrated in the relevant sections of this chapter. Despite the fact that there is considerable overlap in sensory boundaries, the area of altered sensibility is usually sufficiently characteristic to provide an anatomical diagnosis. Sudomotor changes may be found in the same topographic areas; the skin feels dry due to lack of sweating. If this is not obvious, the ‘plastic pen test’ may help. The smooth barrel of the pen is brushed across the palmar skin: normally there is a sense of slight stickiness, due to the thin layer of surface sweat, but in denervated skin the pen slips along smoothly with no sense of stickiness in the affected area.
Correlation of neurological level and sweating level of injury in persons with spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2021
Michelle Trbovich, Ashley Ford, Yubo Wu, Wouter Koek, Jill Wecht, Dean Kellogg
Measurement of sudomotor activity in past investigations has been captured via whole-body sweat rates, sweat capsules, and skin temperature as a surrogate SR index, i.e. sweating decreases skin temperature. The majority of previous studies measured evaporative cooling are primarily small pilot studies (N = 1–10) in persons with SCI with varying injury characteristics under protocols that employed a myriad of heat stressors (e.g. passive vs. exercise induced).12,13 While the general statements that sweating is impaired “below the lesion” or in “insensate areas” were commonly made,21,22 only one prior study had the specific objective of correlating NLOI with a sweating level using visual detection of water droplets over large skin surface areas under a plastic sheet.12 Using this technique, Normell found “dissociation between areas with loss of cutaneous thermoregulatory sudomotor responses and areas of loss of somatic sensibility.”33 He also reported that in most of individuals “the dissociation between sudomotor responses and somatic sensation was only a few centimeters or … the width of one or more somato-sensory dermatomes.”33 Thus, data suggests that the sensory and sweating level are not always equivalent, which parallels the anatomic arrangement of the sympathetic sudomotor versus sensorimotor tracts.
Sweat rate and sweat composition following active or passive heat re-acclimation: A pilot study
Published in Temperature, 2021
Lisa Klous, Cornelis de Ruiter, Puck Alkemade, Hein Daanen, Nicola Gerrett
Both WBSL and WBSR were measured and reported to provide insight in the whole-body sudomotor adaptations that occurred during five consecutive HRA days. WBSR was found to be similar between CH-CH and CH-HWI, but WBSL was higher in CH-CH compared to CH-HWI (Table 3). This can be explained by the twofold longer heat exposure time for the CH-CH group, which is also reflected by the thermal impulse. First and foremost, sweat glands must be active to adapt (i.e., be able to secrete more sweat) during HA [50]. These sudomotor adaptations may be elicited above a certain sweat rate, rather than total sweat volume. Support of this idea comes from work by Taylor et al. [51], suggesting that a WBSR of 0.4–0.8 L·h−1 is required to gain sudomotor adaptations. In the present study, WBSR exceeded this suggested threshold in both CH-CH and CH-HWI (Table 3), which potentially contributes to the explanation of similar sudomotor adaptations following active or passive HRA. With a comparable WBSR after active or passive HRA, similar amounts of heat can in theory be removed from the body. This has implications in sports or occupational settings where prolonged periods of heat exposure occur frequently.
Chameleons, red herrings, and false localizing signs in neurocritical care
Published in British Journal of Neurosurgery, 2022
Boyi Li, Tolga Sursal, Christian Bowers, Chad Cole, Chirag Gandhi, Meic Schmidt, Stephan Mayer, Fawaz Al-Mufti
Cervical disc herniation (CDH) typically results in ipsilateral neck and arm pain corresponding to the level of the lesion.73 However, false localizing CDH can present with contralaterally radiating neck pain and contralateral upper and lower extremity pain. Diagnosis can be confirmed on MRI. It is hypothesized that this FLS results from cord compression of the lateral spinothalamic tract.73 The symptoms can be completely resolved by surgical discectomy and fusion, further confirming the false localizing nature of the condition.73 CDH as a FLS can also present as hemifacial hyperhidrosis with no facial flushing, anisocoria or blepharoptosis, compensating for anhidrosis/hypohydrosis on the ipsilateral side below the lesion.74 Useful diagnostic tools include the Minor test, quantitative sudomotor function tests, and microneurography of sudomotor nerve activity.74 Tests showing no intramedullary signal abnormalities on MRI suggest that the pathophysiology may be impairment of premotor neuron from the hypothalamus to the intermediolateral nucleus by the disc herniation.74 The ipsilateral anhidrosis or hypohydrosis can directly be attributed to the disc herniation myelopathy.74 Of note, crossed hypohydrosis can occur ipisilateral but above the hyperhidrosis.74 Thus, when patients present with hemihydrosis, the Minor test should be done to determine the anhidrotic and hyperhidrotic areas, and thermography to determine the localization of the potential CDH to be investigated further.74
Related Knowledge Centers
- Apocrine Sweat Gland
- Autonomic Nervous System
- Eccrine Sweat Gland
- Grip Strength
- Hair Follicle
- Perspiration
- Skin Temperature
- Thermoregulation
- Wound Healing
- Sweat Gland