Diagnosis Of Vibration-induced White Finger Research Articles

Cold water immersion test (10°C, 10min) for diagnosing vibration-induced white finger among a group of polishers in a subtropical environment.

This study aimed to investigate whether the finger skin temperature (FST) after cold provocation (10°C, 10min) is as a useful indicator for assisting in the diagnosis of vibration-induced white finger (VWF) in a group of polishers in a subtropical environment. Ninety male vibration-exposed metal polishers (30 patients and 60 controls) from the Guangdong Province in Southern China were recruited. The FSTs at 30, 20, 10, and 0min before cold water immersion (FSTpre-30, FSTpre-20, FSTpre-10, and FSTbaseline) and 0, 5, 10, 15, 20, 25, and 30min after immersion (FST0, FST5, FST10, FST15, FST20, FST25, and FST30) were measured on the index, middle, and ring fingers of both hands. During the first 20-min adaptation period, there was a significant increase in FST in three fingers on both hands in the two groups. In contrast, there were no significant differences between FSTpre-10 and FSTbaseline. Furthermore, FSTpre-30, FSTpre-20, FSTpre-10, and FSTbaseline of the three fingers in both hands did not differ significantly. During recovery, the indicators FST5-0, FST10-0, R5, and R10 for the index finger of the left hand in patients were lower than for the controls. Among the various indicators, the absolute recovery rate, FST5-0, at 5min after immersion was identified as the best diagnosis indicator with a sensitivity of 76.7% and specificity of 70.0% when applied to the index finger of the left hand. The cold water immersion test as applied in a subtropical environment can have a fair discriminating ability for diagnosing VWF.

Effect of room temperature on tests for diagnosing vibration-induced white finger: finger rewarming times and finger systolic blood pressures

PurposeThis study investigates the effects of room temperature on two standard tests used to assist the diagnosis of vibration-induced white finger (VWF): finger rewarming times and finger systolic blood pressures.MethodsTwelve healthy males and twelve healthy females participated in four sessions to obtain either finger skin temperatures (FSTs) during cooling and rewarming of the hand or finger systolic blood pressures (FSBPs) after local cooling of the fingers to 15 and 10 °C. The measures were obtained with the room temperature at either 20 or 28 °C.ResultsThere were lower baseline finger skin temperatures, longer finger rewarming times, and lower finger systolic blood pressures with the room temperature at 20 than 28 °C. However, percentage reductions in FSBP at 15 and 10 °C relative to 30 °C (i.e. %FSBP) did not differ between the two room temperatures. Females had lower baseline FSTs, longer rewarming times, and lower FSBPs than males, but %FSBPs were similar in males and females.ConclusionsFinger rewarming times after cold provocation are heavily influenced by room temperature and gender. For evaluating peripheral circulatory function using finger rewarming times, the room temperature must be strictly controlled, and a different diagnostic criterion is required for females. The calculation of percentage changes in finger systolic blood pressure at 15 and 10 °C relative to 30 °C reduces effects of both room temperature and gender, and the test may be used in conditions where the ±1 °C tolerance on room temperature required by the current standard cannot be achieved.

A prospective cohort study of exposure-response relationship for vibration-induced white finger

Objectives:To investigate prospectively the relation between vibration-induced white finger (VWF) and measures of cumulative (lifetime) exposure to hand-transmitted vibration (HTV).Methods:Two hundred and forty-nine HTV workers and 138 control men of...

Salivary endothelin and vascular disorders in vibration-exposed workers

This study investigated the relation between salivary endothelin, vibration exposure, and vascular disorders in a group of forestry workers. Altogether 54 forestry workers and 52 controls underwent a medical examination and a cold test with measurement of the percentage of change in finger systolic blood pressure after finger cooling from 30 degrees C to 10 degrees C (FSBP% (10 degrees)). Salivary endothelin concentration (ET(1-21), in fmol/ml) was measured by a commercially available enzyme-linked immunosorbent assay before and after the cold challenge. The anamnestic diagnosis of vibration-induced white finger (VWF), assisted by color charts, was based on the Stockholm Workshop criteria. Six forestry workers (11%) and one control (2%) reported white fingers. Before the cold challenge, the salivary ET(1-21) concentration was significantly greater in the VWF workers than in the controls (P=0.036). The cold response of digital arteries was stronger in the VWF workers than in the controls (P<0.001) and the asymptomatic forestry workers (P=0.008). After the cold test, there was a small, not significant, increase in the salivary ET(1-21) concentration in both the controls and the forestry workers. For the latter, the salivary ET(1-21) concentration was significantly associated with both daily and total operating time with vibrating tools. A significant inverse relation between FSBP% (10 degrees )and the salivary ET(1-21) concentration was observed for the forestry workers with an abnormal cold response in their digital arteries. This study showed an association between salivary ET(1-21) concentration, daily and cumulative vibration exposure, and vascular disorders in the fingers of professional forestry workers. Since ET(1-21) can induce powerful and long-lasting constriction of human vessels, these findings suggest a possible role of this vasopeptide in the pathogenesis of VWF.

Simultaneous Observation of Zero‐Value of FSBP% and Raynaud's Phenomenon during Cold Provocation in Vibration Syndrome

Journal of Occupational HealthVolume 50, Issue 1 p. 75-78 Case StudyFree Access Simultaneous Observation of Zero-Value of FSBP% and Raynaud's Phenomenon during Cold Provocation in Vibration Syndrome Yutaka Fujiwara, Corresponding Author Yutaka Fujiwara [email protected] Department of Internal Medicine, JapanCorrespondence to: Y. Fujiwara, Atsubetsukita 3-Jo 5-Chome 17–5, Atsubetsu-ku, Sapporo 004–0073, Japan (e-mail: [email protected])Search for more papers by this authorSatoshi Yoshino, Satoshi Yoshino Department of Clinical Laboratory, Bibai Rosai Hospital, JapanSearch for more papers by this authorYoshiro Nasu, Yoshiro Nasu Clinical Research Center for Hand-Arm Vibration Syndrome, Japan Labor, Health and Welfare Organization, San-in Rosai Hospital, JapanSearch for more papers by this author Yutaka Fujiwara, Corresponding Author Yutaka Fujiwara [email protected] Department of Internal Medicine, JapanCorrespondence to: Y. Fujiwara, Atsubetsukita 3-Jo 5-Chome 17–5, Atsubetsu-ku, Sapporo 004–0073, Japan (e-mail: [email protected])Search for more papers by this authorSatoshi Yoshino, Satoshi Yoshino Department of Clinical Laboratory, Bibai Rosai Hospital, JapanSearch for more papers by this authorYoshiro Nasu, Yoshiro Nasu Clinical Research Center for Hand-Arm Vibration Syndrome, Japan Labor, Health and Welfare Organization, San-in Rosai Hospital, JapanSearch for more papers by this author First published: 16 February 2008 https://doi.org/10.1539/joh.50.75Citations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Mechanical vibration and shock- cold provocation tests for the assessment of peripheral vascular function. Part 1: Measurement and evaluation of finger skin temperature. International Standard ISO 14835–1, 2005. 2 Mechanical vibration and shock- cold provocation tests for the assessment of peripheral vascular function. Part 2: Measurement and evaluation of finger systolic blood pressure. International Standard ISO 14835–2, 2005. 3Nielsen SL: Raynaud's phenomenon and finger systolic blood pressure during cooling. Scand J Clin Lab Invest 38, 765– 770 (1997) 4Nasu Y and Kurozawa Y: Comparison of the diagnostic values of three provocation tests for vibration white finger. Arete OCH HÄLSA 5, 109– 116 (1995) 5Bovenzi M: Finger systolic blood pressure during local cooling in normal subjects aged 20 to 60 years. Int Arch Occup Environ Health 61, 179– 181 (1988) 6Bovenzi M: Digital arterial responsiveness to cold in healthy men, vibration white finger and primary Raynaud's phenomenon. Scand J Work Environ Health 19, 271– 276 (1993) 7Bovenzi M: Finger systolic blood pressure indices for the diagnosis of vibration-induced white finger. Int Arch Occup Environ Health 75, 20– 28 (2002) 8Kurozawa Y, Nasu Y and Nose T: Diagnostic value of finger systolic blood pressure in the assessment of vasospastic reactions in the finger skin of vibrationexposed subjects after finger and body cooling. Scand J Work Environ Health 17, 184– 189 (1991) 9Kurozawa Y, Nasu Y and Osino H: Finger systolic blood pressure measurements after finger cooling using the laser-Doppler method for assessing vibration induced white finger. J Occup Med 34, 683– 686 (1992) Citing Literature Volume50, Issue1January 2008Pages 75-78 ReferencesRelatedInformation

Multicenter study on finger systolic blood pressure test for diagnosis of vibration-induced white finger

A multicenter study (six Rosai hospitals around Japan) was performed to investigate the diagnostic value of changes in finger systolic blood pressure (FSBP) after segmental local cooling for vibration-induced white finger (VWF). Subjects were 154 men without exposure to vibration and 135 men with occupational vibration exposure. They were classified into four groups: Group A, 154 unexposed control cases; Group B, 21 exposed cases without VWF; Group C, 31 cases with a history of VWF but without any signs of VWF within the last year; and Group D, 83 cases with active VWF within the last year. FSBP% measurements were taken at room temperatures of 23 +/- 1 and 21 +/- 1 degrees C, using a strain-gauge Digimatic 2000 plethysmograph (Medimatic). At a room temperature of 23 +/- 1 degrees C, there was a significant difference between Groups A and D, and B and D. At a room temperature of 21 +/- 1 degrees C, there was a significant difference between Groups A and C, A and D, and B and D. The values in Group D were the lowest at both room temperatures. Assuming a cut-off value of 75% at 23 +/- 1 degrees C, the sensitivity and specificity were 65.2 and 87.5%, respectively. Assuming the same cut-off value at 21 +/- 1 degrees C, the sensitivity and specificity were 73.9 and 82.5%, respectively. These values were not too high. Most of the subjects with WVF in this study were retired and had not used vibratory tools for many years. The situation of the subjects may affect the results of the FSBP test. Our data did not confirm a difference in diagnostic accuracy between room temperatures of 23 +/- 1 and 21 +/- 1 degrees C. Our study showed that the sensitivity and specificity of the FSBP test with a cut-off value of 75% at 23 +/- 1 degrees C, were 65.2 and 87.5%, respectively, and at 21 +/- 1 degrees C, they were 73.9 and 82.5%, respectively.

Factors influencing finger systolic blood pressure test for diagnosis of vibration-induced white finger

Finger systolic blood pressure (FSBP) measurement during finger cooling is a feasible method for the diagnosis of vibration-induced white finger (VWF). The standardization of the FSBP test is required. The final draft of an international standard for the measurement and evaluation of FSBP (ISO/DIS 14835-2) has been proposed in 2004. The aim of this review is to overview factors influencing the FSBP test and discuss some issues in the final draft. The FSBP test is a method of diagnosing VWF with reasonable sensitivity and specificity, although the sensitivity was relatively low in studies of mild VWF. The test results depend on cold provocation procedures including finger cooling, body cooling, room temperature and other factors such clothing and smoking. There are some versions of procedures for cold provocation and the tested fingers in the final draft. These may cause a low sensitivity of the FSBP test. To determine how the methodological difference influence the results of the FSBP test, further studies are needed. Although there are issues in the draft, the international standard of the FSBP test is extremely useful for the diagnosis, treatment and compensation of VWF.

Test battery for assessing vascular disturbances of fingers.

The diagnosis of vibration-induced white finger (VWF) is difficult, often relying on medical interview and history. The condition is characterized by an exaggerated vasoconstriction of digital arteries in response to cold. The complete closure of digital arteries is episodic and results in a characteristic blanching that is rarely observed by a clinician. Objective measurements of the response of the digital circulation to cold can assist in evaluating a patient for VWF. Finger systolic blood pressure (FSBP) following local cooling is a measure of cold-induced vasoconstriction in digital arteries and is an assessment of vasomotor tone. Low FSBPs following cooling are indicative of dysfunction. Finger skin temperature (FST) following hand cooling is a measure of cutaneous blood flow. The mechanism underlying the recovery of cutaneous blood flow following cooling is as yet not fully understood, but a delayed recovery is believed to arise from persistent vascular disturbances of the fingers or from a resulting in conflicting opinions concerning the utility of the measurements, a scarcity of comparable data from epidemiological investigations, and limited normative data to aid clinicians in decision-making. This review of evidence on which the tests are based is aimed at providing clinicians and researchers with an understanding of the factors that must be considered when conducting the tests, interpreting the results, and comparing results between different studies.

Diagnostic significance of cold provocation test at 12°C

In Germany, vibration-induced white finger (VWF) disease is accepted as an occupational disease (BK No. 2104 BKV), for which compensation may be paid provided that the sociolegal requirements are met in accordance with the list of occupational diseases that is valid at the time. A cold provocation test (thermometry, infrared thermography) is helpful in the diagnosis of VWF and we believe that it could contribute to the standardization of vascular assessment methods. In Germany, the approved degree of the decrease in earning power is downgraded as disease symptoms improve with time; therefore, insured individuals suffering from VWF are regularly reassessed every 1-3 years. In the context of such follow-up examinations and the assessment of reversibility of this disease, a standardized cold provocation test is of central importance. Currently, there is a lack of data that confirm the diagnostic value of this test. Further investigations on VWF patients to validate the use of the cold provocation test in obtaining sufficient data for determining the satisfactory diagnostic value of this test are required.

Thermoregulation and rheological properties of blood in primary Raynaud?s phenomenon and the vibration-induced white-finger syndrome

Frequent use of vibrating tools may lead to typical attacks of Raynaud's phenomenon (RP). The present study assesses the feasibility of the use of thermographic measurements of blood rheometry in the diagnosis of vibration-induced white-finger (VWF) syndrome. We studied 38 patients that were suffering from RP (primary RP, n=29; VWF, n=9) and 13 controls (six men and 45 women; mean age 49.1+/-11.6 years). Superficial finger skin blood flow was assessed with an infrared thermocamera before and after exposure to heat and cold. Fibrinogen, whole-blood viscosity and erythrocyte aggregation at different shear rates and plasma viscosity were measured. In patients with RP finger temperatures after re-warming were lower than those in controls [right hand digit (DIG) I P<0.02; DIG II-V P<0.01; left hand DIG I P<0.01; DIG II-V p<0.02], male patients with primary RP had higher Fg-values (P<0.02) and a trend to higher plasma viscosity. Patients with VWF had a trend to lower plasma viscosity than controls. Whole-blood viscosity at each shear rate was highest in patients with VWF. Provocation manoeuvres are essential in the diagnosis of RP. We speculate that the decreased plasma viscosity in VWF is a compensatory physiological mechanism, probably counteracting the chronic effects of vasospasm. The rise in whole-blood viscosity could be due to endothelial injury or to a reduction in the venous blood pH level. The abnormal cold reactivity of patients with RP may be partly related to rheological factors.

Correlation between Vibration Induced White Finger and Hearing Loss in Miners

Correlation between Vibration Induced White Finger and Hearing Loss in Miners: Szanto Cs., et al. Institute of Public Health Cluj‐Napoca, Romania—In the present investigation age and duration of exposure to vibration and noise were matched with the intention to confirm the earlier reported difference in hearing threshold loss in miners with vibration‐induced white finger (VWF) and those without VWF. The case‐referent study comprised 264 miners without VWF and 84 miners with VWF. Out of the two groups were selected 65 pairs, having the same duration of exposure to vibration and noise (in years) and a maximal difference in age of 2 yr. The diagnosis of VWF was made after cold provocation at 10°C for 10 min, when the clinical sign appeared: whitening of the fingers. The values for acceleration of vibration and noise intensity exceeded the permissible level, when taking measurements for P‐90 type pneumatic hammers used in miners. The mean hearing threshold level (HTL) was typical for hearing loss induced by noise, reaching the highest value at 6 kHz both in the case‐ and in the reference group. The HTL were lower in those suffering from VWF than without VWF, for all the frequencies, but significant differences exist only for 4, 6 and 8 kHz. The mean recovery rate (RR) for the skin temperature tested at the fingertips after 5, 10 and 15 min indicated significantly high values in the reference versus cases. The subjects were divided into three groups by RR of skin temperature 5 min after cold provocation. The miners having a smaller RR (&lt;0.25) had the lowest HTL; but the subjects with a prompt RR (&gt;0.90) had hearing thresholds significantly better at 4, 6 and 8 kHz. For the group with VWF a medium range correlation between HTL loss and duration of exposure to vibration at all frequencies was found. The same calculations for the reference group did not indicate a significant correlation. The effects of vibration in miners can appear in the hearing organ, far from the part of the body through which this risk factor enters (the hand/arm). The correlation between VWF and hearing loss is directly related to the duration of exposure.

Dose-response relation for vascular disorders induced by vibration in the fingers of forestry workers.

To study the relation between the prevalence of vascular disorders (white finger) and vibration exposure in a group of 222 forestry workers, of whom 164 (73.9%) had work experience limited to antivibration (AV) chain saws only and 58 (26.1%) had operated both non-AV and AV chain saws. The chain saw operators and 195 control workers never exposed to hand transmitted vibration were interviewed with health and workplace assessment questionnaires. The diagnosis of vibration induced white finger (VWF) was made on the basis of subjective symptoms of finger blanching and the results of a cold test with plethysmographic measurement of systolic blood pressure of the finger. Vibration was measured on a representative sample of AV and non-AV chain saws. Daily vibration exposure was assessed as eight hour energy equivalent frequency weighted acceleration (A(8)). A lifetime vibration dose was estimated for each of the forestry workers. The overall prevalence of VWF among the forestry workers was 23.4%. The diagnosis of VWF was made in 13.4% of the forestry workers who handled only AV chain saws and in 51.7% of those who had also operated non-AV chain saws in the past. Raynaud's phenomenon was found in 2.6% of the controls. In the forestry workers, the risk for VWF showed positive increments with each increment of vibration dose, suggesting a monotonic dose-response relation. The responsiveness to cold in the digital arteries of the forestry workers was also found to increase with increasing vibration dose and severity of VWF. The estimated relation between VWF and vibration exposure showed that the expected prevalence of VWF increased almost linearly to either A(8) (with exposure duration unchanged) or the number of years of exposure (with equivalent acceleration unchanged). In this study of VWF among forestry workers, the estimated dose-response relation showed that if the magnitude of vibration acceleration is doubled, the total duration of exposure should be halved to produce an equivalent effect. On the basis of the assessment of vibration exposure, the estimated risk for VWF in the study population was found to be lower than that predicted by the international standard ISO 5349. These findings suggest a revision of the risk estimates for VWF currently provided by ISO 5349.