Last reviewed: 27 Sep 2021
Last updated: 14 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • cold or numbness of affected extremity
  • pain during rewarming
  • purplish skin discoloration
  • white or yellow skin plaque
  • superficial skin vesiculation
  • deep purple blisters
  • tissue necrosis and mummification (dry gangrene)

Other diagnostic factors

  • erythema
  • joint dislocation
  • fractures

Risk factors

  • cold exposure
  • previous frostbite
  • vascular insufficiency
  • high altitude
  • hypoxia
  • alcohol
  • tobacco
  • dehydration
  • extremity trauma
  • constrictive clothing or equipment

Diagnostic investigations

Investigations to consider

  • technetium-99m pertechnetate scintigraphy
  • magnetic resonance angiogram of affected extremity
  • plain radiography

Emerging tests

  • thermography and duplex imaging

Treatment algorithm

Contributors

Authors

Elizabeth A. Kaufman, MD, CAQ-SM

Attending Physician

Scripps Green Hospital

Urgent Care Center

Scripps Clinic

La Jolla

CA

Disclosures

EAK declares that she has no competing interests.

Christopher Imray, PhD, FRCS, FRCP, FRGS

Director of Research, Development and Innovation

University Hospital Coventry and Warwickshire NHS Trust

Warwick Medical School

Coventry

UK

Disclosures

CI has been paid for medico-legal work as a medical expert and receives royalties of approximately £150 per annum for the Oxford Handbook of Wilderness and Environmental Medicine. CI has spoken pro bono at lectures and other educational events.

Acknowledgements

Professor Christopher Imray and Dr Elizabeth A. Kaufman would like to gratefully acknowledge Professor Paul S. Auerbach and Dr Claire Turchi, previous contributors to this topic. PSA and CT declare that they have no competing interests.

Peer reviewers

Luanne Freer, MD, FACEP, FAWM

Medical Director

Yellowstone National Park

WY

Founder/Director

Everest Base Camp Medical Clinic

Nepal

Disclosures

LF declares that she has no competing interests.

Grant S. Lipman, MD

Clinical Assistant Professor of Surgery and Emergency Medicine

Associate Director Wilderness Medicine Fellowship

Assistant Research Director

Stanford University School of Medicine

Palo Alto

CA

Disclosures

GSL declares that he has no competing interests.

Peter Hackett, MD

Director

Institute for Altitude Medicine

Telluride

CO

Disclosures

PH declares that he has no competing interests.

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