Diagnosis Of Hand-arm Vibration Syndrome Research Articles

Thermotopography of hands in diagnosis of occupational diseases: Hand-arm vibration syndrome and cold injury syndrome

The analysis of the current state of thermal imaging screening diagnostics and monitoring of the treatment of occupational pathology affecting the thermotopography of the upper extremities is carried out. The possibilities of thermal imaging in the diagnosis of hand-arm vibration syndrome (HAVS) and cold injury syndrome are considered in detail.

Neurosensory component of hand-arm vibration syndrome: a 22-year follow-up study.

BackgroundKnowledge about the long-term course of the neurologic component of hand–arm vibration syndrome (HAVS) is scarce.AimsTo study the course and prognostic factors of the neurosensory component of HAVS over a period of 22 years.MethodsForty male sheet metal workers, with a mean age of 60 (range 45–78) years at follow-up, were examined with a test battery in 1994 and 2017. At baseline, the sample comprised 27 workers with HAVS symptoms and 13 workers without HAVS symptoms. Among the 27 workers, 25 workers reported work-related hand–arm vibration during follow-up (mean 3639 h). In 2017, the mean time since vibration stopped was 8.4 years.ResultsAmong the 27 workers with HAVS in 1994, no overall statistically significant change was observed in hand numbness (Stockholm Workshop Scale), shoulder/arm pain (pain scale) or finger pain from 1994 to 2017. However, vibration exposure during follow-up was associated with increased finger pain. Cotinine, carbohydrate-deficient transferrin, glycosylated haemoglobin and folate were not associated with changes in neurosensory symptoms or manual dexterity (Grooved Pegboard) from 1994 to 2017. A diagnosis of HAVS in 1994 did not predict poor hand strength 22 years later. Isolated hand numbness (without white finger attacks) was more common at baseline than at follow-up.ConclusionsThis 22-year follow-up study indicates a tendency towards irreversibility of hand numbness and finger pain in workers with HAVS. Continued vibration exposure seems to predict increased finger pain. Our findings highlight the importance of HAVS prevention.

Do exposure limits for hand-transmitted vibration prevent carpal tunnel syndrome?

An apparently high frequency of carpal tunnel syndrome (CTS) among shipyard workers undergoing health surveillance because of exposure to hand-transmitted vibration (HTV) prompted concerns that current regulatory limits on exposure might not protect adequately against the disorder. To explore whether within regulatory limits, higher exposures to HTV predispose to CTS. As part of a retrospective audit, we compared duration and current intensity of exposure to HTV in cases with new-onset CTS and controls matched for age. Conditional logistic regression was used to quantify associations, which were summarized by odds ratios (ORs) and 95% confidence intervals (CIs). There were 23 cases and 55 controls. After adjustment for body mass index and previous diagnosis of diabetes, no clear associations were observed either with duration of exposure to HTV or with current intensity of exposure. Risk was non-significantly elevated in men with ≥30 years' exposure to HTV (OR 1.6), but in the highest category of current exposure [8-h energy-equivalent frequency-weighted acceleration (A8) ≥ 4.0 m/s(2)], risk was lower than that in the reference category (A8 < 2.5 m/s(2)). Moreover, there was a significantly reduced risk of CTS in men with a previous diagnosis of hand-arm vibration syndrome (HAVS) (OR 0.2, 95% CI 0.1-0.9). We found no evidence that below the current limit for A(8) of 5 m/s(2), higher exposures to HTV predispose to CTS. However, care should be taken not to overlook the possibility of treatable CTS when workers with diagnosed HAVS present with new or worsening sensory symptoms in the hand.

Work disability after diagnosis of hand-arm vibration syndrome.

Our aim was to study the course of vasospastic and sensorineural symptoms after the clinical diagnosis of hand-arm vibration syndrome (HAVS), and the association of current HAVS symptoms with occupational status, self-evaluation of health, quality of life, and work ability. We gathered all HAVS cases diagnosed at the Finnish Institute of Occupational Health in Helsinki and Tampere during 1990-2008. A questionnaire was sent to all these patients (n = 241). Altogether 149 of them (62 %) returned the questionnaire. Cumulative lifelong vibration exposure was evaluated on the basis of the data in the patient files. On average, 8.5 years after the diagnosis of HAVS, approximately one-third of the patients reported improvement in symptoms of vibration-induced white finger (VWF) and the sensorineural symptoms. Young age and shorter exposure time were associated with improvement in VWF symptoms (p = 0.033 and p < 0.001, respectively). Persistent or deteriorated symptoms of both VWF and sensorineural symptoms were associated with lowered work ability, quality of life (EQ-5D), and general health, also after adjusting for age, smoking, and diseases other than HAVS. The patients' own prediction of work ability in 2 years was more negative if the VWF symptoms or sensorineural symptoms had continued after diagnosis of HAVS (p = 0.065 and p = 0.001, respectively). Our results suggest that in about two-thirds of the patients, the HAVS symptoms may stabilize or deteriorate in the follow-up. Considering the effects on work ability, timely prevention measures should be taken more actively to help patients continue their working careers.

Infrared thermometry in the diagnosis of hand-arm vibration syndrome

Clinicians need an accurate diagnostic test for hand-arm vibration syndrome (HAVS). To validate a simple thermometric method to diagnose HAVS-related Raynaud's phenomenon. Fifteen workers with photographically confirmed HAVS-related Raynaud's phenomenon were compared to controls without Raynaud's phenomenon and an occupational history of hand-arm vibration exposure. Digit temperatures were measured using an infrared thermometer before and after immersion in 5 degrees C water for 1 min. The HAVS patients differed significantly from the controls in terms of baseline temperature, rewarming time and rate. The fingertip-base temperature gradient was more commonly positive among the controls. The test method evaluated in this study is simple, cheap and accurate. If the pre-test probability is at least 35%, the best test variable to confirm the diagnosis of HAVS-related Raynaud's phenomenon is the time to rewarm to baseline of the first three fingertips providing the interval is > or =8-9 min.

Cold haemagglutinin disease misdiagnosed as hand-arm vibration syndrome

A patient with a diagnosis of hand-arm vibration syndrome was referred for a second opinion. He worked as a multi-skilled operative in the housing department of a local authority, a job not normally associated with high levels of exposure to hand-transmitted vibration ( > 2.5 m/s(2) A(8)). He described blanching of his fingers and a blue discolouration of his extremities in cold weather. On examination, his fingertips, toes and pinnae were acrocyanotic, the fingers were patchily pale and sensation was subjectively impaired in all of the digits. Investigations revealed a haemolytic anaemia and haemagglutination. He was diagnosed with idiopathic cold haemagglutinin disease. Exposure to vibration may confound with exposure to cold in which case the differential diagnoses of cold haemagglutinin disease or cryoglobulinaemia should be excluded before diagnosing hand-arm vibration syndrome.

Thenar hammer syndrome: a case report

Raynaud's phenomenon occurs among automobile mechanics secondary to long-term use of vibrating hand-held tools. It can also occur from traumatic injury to the upper extremity. This report describes a case of single digit Raynaud's phenomenon in an automobile mechanic due to focal arterial impact trauma. A 38-year-old right-handed transmission mechanic complained of paraesthesia and blanching of the right index finger on exposure to cold and eventually developed a transient necrotic ulcer at the tip of the digit. He had a long history of occupational exposure to vibrating hand-held power tools. Evaluation for common causes of Raymond's phenomenon was negative. The diagnosis of hand-arm vibration syndrome (HAVS) was rejected because of the rapidity of progression and severity of the symptoms restricted only to the index finger without corresponding symptoms of the other digits of the right hand as would be expected. Angiography revealed an obstructive lesion of the distal right radial artery at the wrist and he was diagnosed with thenar hammer syndrome. This uncommon condition was due to focal injury of the distal radial artery caused by repeated slamming of transmission parts on a work table. Not all cases of Raynaud's phenomenon in workers using vibrating hand-held tools are due to HAVS. Alternative aetiologies should be considered especially if symptoms are asymmetrical and unilateral.

Diagnostic Criteria and Staging of Hand-Arm Vibration Syndrome in the United Kingdom

In the United Kingdom the diagnosis of Hand-arm Vibration Syndrome varies depending on the purpose of that diagnosis. The criteria differ in three situations. More than 100,000 miners and ex-miners with claims for HAVS have been examined using a Medical Assessment Process which included the use of standardised tests. This contract is unique but it has had significant effects on the two other processes. The Industrial Injuries Disablement Benefit Scheme provides a benefit that can be paid to an employed earner because of an accident or Prescribed Disease. New recommendations have been published to remove the anomalies in the present format for assessing HAVS. If implemented the new scheme will recognise the Stockholm Workshop Scales and workers with neurological problems will also be compensated. The Health and Safety Executive will issue new guidance in the near future on the hazards of hand-arm vibration. Health surveillance in the workplace will be fundamental and the HSE propose a tiered approach with levels 1 to 5. Specialist occupational nurses and doctors with training in the diagnosis and assessment of HAVS will be needed for levels 3 and 4. Only at this level may a diagnosis of HAVS be made. The Medical Assessment Process has demonstrated that it is possible to examine a large number of claimants in a standardised manner. The IIAC and HSE recommendations contain very important improvements on the existing positions in the UK and it must be hoped that they will be implemented in the near future.

Thoracic outlet syndrome--aspects of diagnosis in the differential diagnosis of hand-arm vibration syndrome.

Thoracic outlet syndrome (TOS) is a cause of vascular and neurological compromise to the arm and hand, and may manifest as Raynaud's phenomenon. It may be under-diagnosed. This review was undertaken in order to clarify the diagnostic and investigative features of TOS that may differentiate it from hand-arm vibration syndrome. A tiered review of the world literature was undertaken using Medline and Embase as the primary search engines. Thoracic outlet syndrome most commonly presents with neurological symptoms in the arm. Vascular symptoms, including Raynaud's phenomenon, may occur in approximately 10% of cases. Careful clinical assessment by history and examination may reveal the elements of forearm and upper arm symptoms with postural exacerbation, which distinguish this condition from hand-arm vibration syndrome. The usefulness of investigation is unclear, but Doppler and neuroelectric studies may be valuable. Magnetic resonance imaging scan is the investigation of choice.

The relationship between hand-arm vibration and lower extremity clinical manifestations: a review of the literature.

To assess the current literature supporting a relationship between hand-arm vibration (HAV) and lower extremity clinical effects. An initial review of the literature identified lower extremity vascular and neurological effects reported in association with HAV. A second literature review was performed with explicit search and evaluation strategies. It focused on analytical studies and looked for epidemiological evidence supporting the relationship between HAV and lower extremity effects. Eight analytical studies which met all of the initial inclusion/exclusion criteria were identified. All of these had serious validity deficiencies with respect to selection bias, response rates and lack of examination of confounders. There was consistency with respect to an association between those exposed who were diagnosed with hand-arm vibration syndrome (HAVS) and vascular symptoms in the lower extremities. There was no evidence that hand-held vibration exposure independent of the diagnosis of HAVS was associated with lower extremity vascular symptoms. There was no evidence to suggest that HAV was associated with clinically significant lower extremity neurological symptoms.

Evaluation of Finger Skin Temperature by Cold Provocation Test for Diagnosis of Hand-Arm Vibration Syndrome

Evaluation of Finger Skin Temperature by Cold Provocation Test for Diagnosis of Hand-Arm Vibration Syndrome

A minireview of studies conducted in japan using finger-skin temperature during cold-stress tests for the diagnosis of hand-arm vibration syndrome.

For the diagnosis of the hand-arm vibration syndrome, cold-stress tests using different water temperatures and periods of hand immersion have been investigated in Europe, North America, and Japan. In recent years, peripheral circulation and sensory tests, including finger-skin temperature measurement involving immersion of one hand in cold water at 10 degrees C for 10 min, have been widely accepted in Japan. On the other hand, standardization of the vascular assessment method is under discussion at the International Organization of Standardization. We reviewed research findings from Japan concerning finger-skin temperature measurement during the cold-stress test, especially factors influencing the test results and the diagnostic significance. For establishment of the cold-stress test for epidemiology studies of the hand-arm vibration syndrome, standardization of the environmental factors influencing the test results and reporting of its sensitivity and specificity are needed.

An epidemiologic study of carpal tunnel syndrome and hand-arm vibration syndrome in relation to vibration exposure

No Minnesota workers' compensation claims have been filed for permanent partial disability benefits with a diagnosis of hand-arm vibration syndrome (HAVS). A cross-sectional study was undertaken to evaluate 519 compensation claimants following carpal tunnel surgery. Workers with significant vibration exposure and symptoms compatible with HAVS were identified within the group. The results show that some workers are not diagnosed as having HAVS even though they meet the diagnostic criteria. This suggests that HAVS should be considered in the differential diagnosis when a worker presents with neural and/or vascular symptoms of the hands and fingers.