Hand-arm Vibration Syndrome Cases Research Articles

Infrared thermography in the hands and feet of hand-arm vibration syndrome (HAVS) cases and controls

This study evaluated IR thermography during 15 min of re-warming after cold water immersion in accordance with ISO guidelines (12 °C for 5 min) in cases with the vascular component of HAVS and controls. The purposes of the study were: (1) To evaluate the performance of IR thermography as a diagnostic test for the vascular effects of HAVS in the fingers, (2) To determine if there were any temperature differences in the toes between cases and controls and, if so, to evaluate the IR thermography as a diagnostic test for toe vascular effects in HAVS. A total of 39 HAVS cases and 46 controls were included in the study. In the fingers, an ROC analysis indicated that the highest areas under the curve (AUC) were obtained at 7 min of re-warming for the fingertips, middle phalanges and proximal phalanges. However, at these locations and time period of re-warming the sensitivities and specificities were not sufficiently high. For example a sensitivity of 66.7% was associated with specificities of 60.9%–67.4%. In the toe analysis 33 (84.6%) cases but only 3 controls (6.5%) reported increased cold intolerance in the feet and this difference was statistically significant (p < 0.001). These 33 cases were then compared to the 46 controls. In the ROC analysis for the toes, the AUC's were lower than those for the fingers and the estimated sensitivities and specificities were worse for the toes than for the fingers. However some statistically significant colder temperatures were found in cases in comparison to controls towards the end of the re-warming period. IR thermography after the ISO recommended cold water stimulation conditions did not perform well as a diagnostic test in the hands or feet. The statistically significant colder temperatures in the toes towards the end of re-warming are relevant to our understanding of foot vascular effects associated with vibration. In industry there is recent interest in determining the effects of foot transmitted vibration (FTV). Many workers have mixed HAV and FTV and it is important to account for feet effects secondary to HAVS in the hands when evaluating the effects of FTV.

The relationship between clinical and standardized tests for hand-arm vibration syndrome.

Standardized laboratory tests are undertaken to assist the diagnosis and staging of hand-arm vibration syndrome (HAVS), but the strength of the relationship between the tests and clinical stages of HAVS is unknown. To assess the relationship between the results of thermal aesthesiometry (TA), vibrotactile (VT) thresholds and cold provocation (CP) tests with the modified Stockholm scales for HAVS and to determine whether the relationship is affected by finger skin temperature. Consecutive records of workers referred to a Tier 5 HAVS assessment centre from 2006 to 2015 were identified. The diagnosis and staging of cases was undertaken from the clinical information contained in the records. Cases with alternative or mixed diagnoses were excluded and staging performed according to the modified Stockholm scale without knowledge of the results of the standardized laboratory tests. A total of 279 cases of HAVS were analysed. Although there was a significant trend for sensorineural (SN) and vascular scores to increase with clinical stage (P < 0.01), there was no significant difference in scores between 2SN early and 2SN late or between 2SN late and 3SN. There was moderate correlation between the TA and VT scores and the clinical SN stages (r = 0.6). This correlation did not change when subjects were divided into those with a finger skin temperature <30 and >30°C. CP scores distributed bimodally and correlated poorly with clinical staging (r = 0.2). Standardized SN tests distinguish between the lower Stockholm stages, but not above 2SN early. This has implications for health surveillance and UK policy.

Vascular hand–arm vibration syndrome—magnetic resonance angiography

The diagnosis of vascular hand-arm vibration syndrome (HAVS) requires consistent symptoms, photographic evidence of digital blanching and sufficient exposure to hand-transmitted vibration (HTV; A(8) > 2.5 m/s2). There is no reliable quantitative investigation for distinguishing HAVS from other causes of Raynaud's phenomenon and from normal individuals. Hypothenar and thenar hammer syndromes produce similar symptoms to HAVS but are difficult to diagnose clinically and may be confused with HAVS. Magnetic resonance angiography (MRA) is a safe and minimally invasive method of visualizing blood vessels. Three cases of vascular HAVS are described in which MRA revealed occlusions of the ulnar, radial and superficial palmar arteries. It is proposed that HTV was the cause of these occlusions, rather than blows to the hand unrelated to vibration, the assumed mechanism for the hammer syndromes. All three cases were advised not to expose their hands to HTV despite one of them being at Stockholm vascular stage 2 (early). MRA should be the investigation of choice for stage 2 vascular HAVS or vascular HAVS with unusual features or for a suspected hammer syndrome. The technique is however technically challenging and best done in specialist centres in collaboration with an occupational physician familiar with the examination of HAVS cases. Staging for HAVS should be developed to include anatomical arterial abnormalities as well as symptoms and signs of blanching. Workers with only one artery supplying a hand, or with only one palmar arch, may be at increased risk of progression and therefore should not be exposed to HTV irrespective of their Stockholm stage.

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.

Assessment of coarse and fine hand motor performance in asymptomatic subjects exposed to hand-arm vibration

A frequently encountered exposure profile for hand-arm vibration in contemporary occupational setting comprises workers with a long history of intermittent exposure but without detectable signs of hand-arm vibration syndrome (HAVS). Yet, most of the published studies deal with developed HAVS cases, rarely discussing the biological processes that may be involved in degradation of manual dexterity and grip strength when it can be most beneficial - during the asymptomatic stage. In the present paper, a group of 31 male asymptomatic vibration-exposed workers (according to the Stockholm Workshop Scale) were compared against 30 male controls. They were tested using dynamometry and dexterimetry (modelling coarse and fine manual performance respectively) and cold provocation was done to detect possible differences in manual performance drop on these tests. The results showed reduced manual dexterity but no significant degradation in hand grip strength in the exposed subjects. This suggests that intermittent exposure profile and small cumulative vibration dose could only lead to a measurable deficit in manual dexterity but not hand grip strength even at non-negligible A(8) levels and long term exposures.

Work-related musculoskeletal conditions: evidence from the THOR reporting system 2002-2005

Musculoskeletal disorders (MSDs) are commonly encountered in current occupational health practice and comprise up to 45% of the workload for occupational physicians (OPs). To compare the reported incidence of work-related (WR) MSDs by specialist OPs and specialist rheumatologists and to relate it to self-reported and general practitioners-reported WR MSDs. Analysis of data reported to surveillance schemes within The Health and Occupation Reporting network and comparison to denominator data derived from the Labour Force Survey and occupational/work activity classifications. There are significant differences between the patterns of WR MSDs seen by the different specialist groups. Thus OPs report three times as many back and lower limb conditions. However, both specialist groups report similar numbers of cases of hand-arm vibration syndrome (12/9%) and 'vague and ill-defined' upper limb conditions (16/14%). The absolute risk of physician reported that WR MSDs increases 5-fold between ages 15-24 and 45-64. The specialist reporting schemes give an indication of current practice and are useful both to update and to strategically inform planning. The data are amenable, with appropriate statistical analysis, for comparison with self-reporting and to the characterization of risk in broad categories of occupation and work activity.

The validity of Raynaud's phenomenon symptoms in HAVS cases

Raynaud's phenomenon, a common manifestation of the hand-arm vibration syndrome (HAVS), is typically diagnosed by a subjective history provided by employees. This study evaluates the validity of the subjective history of Raynaud's phenomenon provided by individuals applying for compensation for HAVS. Thirty-six workers with a history of occupational hand-arm vibration exposure who were labelled as having Raynaud's phenomenon were asked to photographically document their finger symptoms before undergoing a detailed clinical assessment. Each individual was provided with a disposable camera and instructions. Returned photographs were reviewed for signs of Raynaud's phenomenon. The reliability of photograph interpretation was tested with three physicians and a non-physician. Inter and intra-rater reliability was very good, Kappa coefficient >0.80. Six individuals (17%) did not return cameras. Thirty individuals provided photographs and underwent a clinical evaluation. The photographs of 13 individuals (43%) did not show Raynaud's phenomenon and for four of these the diagnosis was not supported by careful symptom history. Seventeen individuals (57%) had photographic evidence of Raynaud's phenomenon. A presenting history of Raynaud's phenomenon in workers seeking compensation for HAVS may not be accurate since approximately half the cases are unable to provide objective photographic evidence of Raynaud's phenomenon.

Hand-arm vibration syndrome in South African gold miners

Hand-arm vibration syndrome (HAVS) is associated with the use of hand-held vibrating tools. Affected workers may experience symptoms of tingling, numbness, loss of grip strength and pain. Loss of dexterity may impair everyday activities, and potentially increase the risk of occupational accidents. Although high vibration levels (up to 31 m/s(2)) have been measured in association with rock drills, HAVS has not been scientifically evaluated in the South African mining industry. The aim of this study was to determine the prevalence and severity of HAVS in South African gold miners, and to identify the tools responsible. A cross-sectional study was conducted in a single South African gold-mine. Participants were randomly selected from mineworkers returning from annual leave, comprising 156 subjects with occupational exposure to vibration, and 140 workers with no exposure. Miners who consented to participate underwent a clinical HAVS assessment following the UK Health and Safety Laboratory protocol. The prevalence of HAVS in vibration-exposed gold miners was 15%, with a mean latent period of 5.6 years. Among the non-exposed comparison group, 5% had signs and symptoms indistinguishable from HAVS. This difference was statistically significant (P < 0.05). All the cases of HAVS gave a history of exposure to rock drills. The study has diagnosed the first cases of HAVS in the South African mining industry. The prevalence of HAVS was lower than expected, and possible explanations for this may include a survivor population, and lack of vascular symptom reporting due to warm-ambient temperatures.

Hand–arm vibration syndrome with concomitant arterial thrombosis in the hands

Hand-arm vibration syndrome (HAVS) refers to the vascular, neurological and musculoskeletal effects that may occur in workers with prolonged exposure to vibrating tools. Hypothenar hammer syndrome (HHS) is a lesion of the ulnar artery at the level of the hamate bone secondary to single or repeated episodes of trauma to the hypothenar eminence. The literature suggests that digital arterial thrombosis and HHS may be associated with the use of vibrating tools. This study will familiarize investigators with the range of vascular abnormalities seen in workers using vibrating tools, and highlight the importance of screening for arterial thrombosis in the hand when assessing hand-arm vibration-exposed patients. In the patients referred to our clinic for HAVS assessment, three were identified during the period 2001 to 2004 who had vascular occlusions in the hands in addition to HAVS. In addition to standardized HAVS vascular investigations, all three patients had arteriograms based on a significantly positive Allen's test. All three cases had documented HAVS based on vascular testing. Arteriograms revealed a spectrum of severity of arterial thromboses from severe HHS, to occlusion limited to the digital arteries. Our study reports three cases of HAVS with concomitant HHS and/or digital artery thrombosis. These findings support previous reports of an association between HAVS and vascular thrombosis in the hands. Screening for arterial occlusive problems in the hands should be included in the HAVS work up.

Upper limb disability in HAVS cases—how does it relate to the neurosensory or vascular elements of HAVS?

Hand-arm vibration syndrome (HAVS) consists of vascular, neurosensory and musculoskeletal components, characterized by symptoms that include Raynaud's phenomenon, tingling and numbness in the hands. However, there has been little published data on the effects of HAVS on the capability to carry out normal daily tasks. We have investigated the application of the widely-used disability, arm, shoulder and hand (DASH) disability questionnaire that reflects functionality problems in the upper extremities, as well as symptoms, in a HAVS cohort. The cohort consisted of 118 males who, as a part of their health surveillance, had been referred for further assessment and Stockholm workshop staging. This process involved medical interview, physical examination and quantitative tests covering neurosensory function, manual dexterity and handgrip strength. The relationship between DASH outcome metric and a combination of quantitative tests reflecting a range of abnormalities found in HAVS, supports the validity of this questionnaire in HAVS studies. The data suggest that HAVS cases have a greater level of upper extremity disability compared with a general population. The study confirms that disability in HAVS is very largely related to sensorineural Stockholm workshop staging, rather than vascular staging. Any influence of vibration-induced Raynaud's phenomenon on upper extremity disability is related to the frequency of blanching attacks rather than their extent across the digits. This study strengthens the importance of identifying and preventing the exacerbation of the neurosenory component of HAVS, that unlike the blanching attacks of the vascular component does not have such an obvious pathognomic signal.

Occupational hand–arm vibration syndrome in Korea

It is suspected that there is a large number of patients suffering from hand-arm vibration syndrome (HAVS) in Korea. However, no cases have been reported since 1992. This study was conducted to identify HAVS cases and determine the characteristics of the syndrome. In April 2001, the Busan, Ulsan, and Gyeong-Nam Province Occupational Disease Surveillance System (BUGODSS) was established to identify work-related HAVS and other occupational diseases. In the 2 years of this project, occupational physicians from five hospitals in these provinces collected information by way of interviews and questionnaires during mandatory occupational medical examinations. Among the initial 189 suspected HAVS cases, 58 volunteers were given cold-water provocation tests in order to diagnose the vascular component of the disorder. One hundred fifty-four approximately occupational HAVS cases were identified from ca. 21,000 workers. One hundred fifty about of these cases were male. The cases were most often found in workers from the shipbuilding industry, and the grinder was the most common source of vibration exposure. Cases of sensorineural disorder (SD) were more common than cases of vascular disorder (VD). The mean values of the finger skin temperature and its recovery rate at 5 min and 10 min after cold-water provocation were significantly lower in the group with the VD than in the group with the SD. We identified 154 occupational HAVS cases, although no cases have been reported during the occupational medical examinations mandated by the state. The majority of the cases were in workers that used grinders in the shipbuilding industry. We determined that peripheral VD and peripheral SD can progress independently of each other. We conclude that exposure to hand-transmitted vibration (HTV) and HAVS cases are common in shipbuilding industry in Korea. The recovery rate of finger skin temperature after cold-water provocation is one of the useful methods for diagnosing the vascular component of HAVS.

Disability in the Upper Extremity and Quality of Life in hand-arm vibration syndrome

Purpose. To investigate whether hand-arm vibration syndrome (HAVS) leads to disability in the upper extremity or deficit in quality of life (QoL) using validated questionnaire tools, and to establish whether these effects are related to the Stockholm Workshop Staging (SWS).Method. This was a postal cross-sectional questionnaire study with a 50% response rate. Four hundred and forty-four males, who had been diagnosed and staged according to the SWS were sent the Disability in the Arm, Shoulder and Hand (DASH) and the SF-36v2 QoL questionnaires.Results. HAVS cases had significantly greater DASH disability scores and reduced QoL physical and mental component scores compared to published normal values. Those HAVS cases with a presumptive diagnosis of Carpal Tunnel Syndrome (CTS) had even higher disability scores. There was a clear, linear relationship between both the DASH disability score and the physical component of the QoL and sensorineural SWS, but not with the vascular SWS.Conclusions. HAVS has a significant effect on an individual's perceived ability to perform everyday tasks involving the upper extremity, and their quality of life. Physical capability may be further compromised in those individuals who have a presumptive diagnosis of CTS. These findings may have important implications regarding management of the affected worker.

The diagnostic value of finger systolic blood pressure and cold-provocation testing for the vascular component of hand-arm vibration syndrome in health surveillance

Hand-arm vibration syndrome (HAVS) is a complex condition with vascular, sensorineural and musculoskeletal components. A number of quantitative tests have been used for assisting in the diagnosis of HAVS and grading disease severity. To investigate and compare the diagnostic value of finger systolic blood pressure (FSBP) and rewarming of finger skin temperature (FST) following cold-provocation testing, in the assessment of vascular HAVS. Twenty-four individuals with vascular HAVS (Stockholm Workshop stage 2 or 3V) and 22 control subjects underwent FSBP measurements at 30, 15 and 10 degrees C and monitoring of FST following immersion of the hands in water at 15 degrees C for 5 min. There was a significant reduction in median FSBP% in the vascular HAVS group in the change in FSBP from 30 to 15 degrees C adjusted for brachial blood pressure (FSBPC%). There was no difference in the median time for FST to rewarm by 4 degrees C between HAVS cases and controls. The sensitivity and specificity of FSBP to discriminate between the groups varied between 44 and 61% and 91 and 95%, respectively. The sensitivity and specificity for the time for FST to rewarm by 4 degrees C were 71 and 77%. There is little evidence that the described form of finger rewarming after cold-provocation testing is a useful diagnostic test for vascular HAVS, although it may have some moderate influence in ruling out vascular problems. Based on our data, the FSBP may also have limited use in confirming a positive diagnosis of vibration-induced vascular problems. The higher specificity of the FSBP test suggests it may have some value in ruling out the vascular component of HAVS. The data from this study do not confirm the diagnostic power of FSBP for the vascular component of HAVS reported by a few other investigators.

Hand-arm vibration syndrome: a guide for nurses.

It is estimated that 1.2 million workers are now exposed to hazardous levels of vibration in their work. In the year 1995-1996, over 3,000 new cases of hand-arm vibration syndrome were assessed by the Department of Social Security (DSS) under the Industrial Injuries Disablement Benefit Scheme. Formerly called vibration white finger, it is the most common of all diseases assessed by the DSS, with the majority of workers affected having up to 14 per cent disability. This article explains the syndrome and its management.

Vibration exposure and prevention in the United States.

There are over one million workers exposed to hand-arm vibration in the United States. Cases of hand-arm vibration syndrome have been reported in the U.S. since 1918. Typical hand-arm vibration exposure conditions are given in this presentation. Vibration control methods are discussed; these include vibration damping and isolation, use of antivibration (A/V) tool and gloves, and the application work practices and hand-arm vibration standards in the workplace.

A clinical assessment of seventy-eight cases of hand-arm vibration syndrome.

After the obtainment of an occupational history the following objective tests were carried out: esthesiometry, light touch, pain, temperature appreciation, Tinel's and Phalen's test, grip strength, Allen's test, and cold provocation (10-12 degrees C for 1 min). The 78 subjects were categorized (Taylor-Pelmear classification) according to the number, severity, and extent of the blanching attacks; sensory loss; musculoskeletal complaints; and interference with work and domestic and social activities. Four of the subjects had unequal hand assessments. It was not possible to correlate stage assessment with the objective tests on an individual basis. On a group basis, staging correlated with esthesiometry using the improved designs of Carlson et al. Cold provocation produced white finger attacks in only 50% of the cases. In some work processes (road ripping) of the subjects, damage to digital arteries and nerves was confined to the thumb and index and middle fingers. Four subjects had advanced tissue necrosis of the fingertips resulting from the use of hand-held pneumatic percussive tools. There was no evidence to support the view that the hand-arm vibration syndrome affects the central autonomic nervous system.