Work ability in vibration-exposed workers

Neurosensory and vascular symptoms and clinical findings in the hands of Arctic open-pit miners in Sweden and Norway - a descriptive study

This cross-sectional study aimed to describe exposure to cold climate and hand-arm vibration (HAV) as well as neurosensory and vascular symptoms and clinical findings among open-pit Arctic miners. It was based on data from questionnaires and physical examinations, including 177 men and 75 women from two open-pit mines in Sweden and Norway (response rate 54%). Working outdoors or in an unheated building or machine for at least two hours per day was reported by 44% and HAV exposure of the same duration by 10%. Neurosensory symptoms (e.g. reduced perception of touch) in the hands were reported by 47% and Raynaud's phenomenon by 14%. In brief conclusion, the study showed that Arctic miners were commonly exposed to both cold temperatures and HAV. They also reported a broad range of neurosensory and vascular symptoms in their hands and had abnormal clinical findings related to the symptoms. The results emphasise the need for additional preventive measures in this occupational setting.

Vibration Isolation Properties of Novel Spacer Fabric with Silicone Inlay

Spacer fabrics are good for impact force absorption and have the potential for vibration isolation. Inlay knitting of additional material to the spacer fabrics can give reinforcement to the structure. This study aims to investigate the vibration isolation properties of three-layer sandwich fabrics with silicone inlay. The effect of the presence of the inlay, inlay patterns and materials on the fabric geometry, vibration transmissibility and compression behaviour were evaluated. The results showed that the silicone inlay increases the unevenness of the fabric surface. The fabric using polyamide monofilament as the spacer yarn in the middle layer creates more internal resonance than that using polyester monofilament. Silicone hollow tubes inlay increases the magnitude of damping vibration isolation, whereas inlaid silicone foam tubes have the opposite effect. Spacer fabric with silicone hollow tubes inlaid by tuck stitches has not only high compression stiffness but also becomes dynamic, showing several resonance frequencies within the tested frequency range. The findings show the possibility of the silicone inlaid spacer fabric and provide a reference for developing vibration isolation materials with knitted structure and textiles materials.

Evaluation of the design and materials of anti-vibration gloves: Impact on hand dexterity and forearm muscle activity

Many anti-vibration gloves are available in the market but there are lacks of understanding of their effectiveness in facilitating various hand movements. This study addresses the knowledge gap through a wear trial with five types of anti-vibration gloves made of chloroprene rubber and spacer fabric. Surface electromyography of three forearm muscles of 16 male subjects was conducted during gripping, key pinching, woodblock transporting, screw inserting and screw driving tasks. The correlation between the compression properties of the gloves and hand performance was also evaluated. The results show that hand dexterity is inhibited and more muscle activity is needed to carry the woodblocks with the spacer fabric glove without special design features. A thicker glove can reduce the demand of the flexor digitorum superficialis muscle when using an impact driver. A thinner dorsal side and tailored padding can enhance hand dexterity. The findings can be used as a reference for designing anti-vibration gloves.

Median nerve travel and deformation in the transverse carpal tunnel increases with chuck grip force and deviated wrist position

Background

We assessed median nerve travel and deformation concurrently to better understand the influence of occupational risk factors on carpal tunnel dynamics, including forceful chuck gripping and deviated wrist positions.

Methods

Fourteen healthy right-hand dominant participants performed a chuck grip in 6 experimental conditions: two relative force levels (10% and 40% of maximum voluntary effort); three wrist positions (15° radial deviation, 0° neutral, 30° ulnar deviation). Chuck grip forces were measured with a load cell while the transverse cross-section of the carpal tunnel was imaged via ultrasound at the distal wrist crease. Images of the median nerve were analyzed in ImageJ to assess cross-sectional area, circularity, width, and height as well as travel in the anterior-posterior and medial-lateral axes.

Results

We found a main effect of deviated wrist position on both anterior-posterior and medial-lateral travel, with the greatest nerve travel occurring in 30° ulnar deviation. There was also a significant interaction between chuck grip force and deviated wrist position on cross-sectional area. Specifically, the area decreased with 40% vs. 10% chuck grip force when the wrist was in 30° ulnar deviation; however, there were no changes in 0° neutral and 15° radial deviation.

Discussion

Overall, we demonstrated that forceful chuck gripping in deviated wrist positions influenced carpal tunnel dynamics, resulting in both migratory and morphological changes to the median nerve. These changes may, in turn, increase local strain and stress with adjacent structures in the carpal tunnel. Future studies mapping contact stress between structures may further elucidate injury development of work-related carpal tunnel syndrome.

Style: J of occupational medicine and toxicology vibration induced injuries in hands in long-term vibration exposed workers

Introduction

Long-term vibration exposure may cause neurophysiological disturbances such as numbness and tingling, reduced grip strength and difficulties in handling small objects. The dominant hand will usually have a higher vibration exposure than the non-dominant hand, which may cause more severe neurological symptoms and signs in the dominant hand.

Methods

The study is based on 47 (36 males and 11 females) vibration exposed workers, all former patients from the department of Occupational and Environmental medicine, Gothenburg university. The comparison group consisted of 18 randomly selected subjects from the general population of Gothenburg. All participants completed several questionnaires and had a standardized medical examination. Thereafter, neurophysiological tests such as the determination of vibration and thermal perception thresholds were performed, as well as muscle strength tests in hands and fingers.

Results

The temperature perception thresholds (TPTs) and the vibration perception thresholds (VPTs) did not differ significantly between the dominant and non-dominant hand in vibration exposed workers. The referents showed a significantly better performance (p ≤ 0.02 and p ≤ 0.034, respectively) than the workers for both TPTs and VPTs, indicating a negative effect on the Aß, as well as on the Aδ and C-fibers among the exposed workers.The Purdue Pegboard test showed a significantly better performance in the dominant vs non-dominant hand in both workers (p = 0.001) and referents (p = 0.033). The referents showed a better performance than the workers in both hands (p < 0.001). The Baseline handgrip, the Pinch grip and 3-Chuck grip tests did not differ significantly between the dominant and non-dominant hand in neither workers nor referents.

Conclusions

In this study, minor differences between the dominant and non-dominant hand were noted for the Purdue Pegboard test in both workers and referents. Despite a probably higher vibration exposure in the dominant hand (mostly the right hand), however, quite similar test results were noted for VPTs, TPTs, Baseline handgrip, Pinch grip and 3-Chuck grip when comparing the dominant and non-dominant hand in the vibration exposed workers. In case of lack of time and financial obstacles, neurological tests in solely the dominant hand, will probably satisfactory reflect the conditions in the non-dominant hand.

Working hand syndrome: A new definition of non-classified polyneuropathy condition

The aim of this paper was to define an unexplained non-classified polyneuropathy condition as a new neurological disease. This new diagnosis of occupation related polyneuropathy has been named as "WORKING HAND SYNDROME (WHS)."This study collected and compared clinic and electrophysiological analyze data from healthy controls, WHS patients, carpal tunnel syndrome (CTS) patients and polyneuropathy patients. The WHS patients presented to the clinic with pain, numbness, tingling, and burning sensations in their hands that increased significantly during rest and nighttime. However, there was no weakness in the muscles, and the deep tendon reflexes were normal in this disease. The patients had all been working in physically demanding jobs requiring the use of their hands/arms for at least 1 year, but no vibrating tools were used by the patients. All of the cases were men. I supposed that overload caused by an action repeated chronically by the hand/arm may impair the sensory nerves in mentioned hand/arm. In patients with these complaints, for a definitive diagnosis, similar diseases must be excluded. Nonetheless, the specific electrophysiological finding that the sural nerves are normal on the lower sides, as well as the occurrence of sensory axonal polyneuropathy in the sensory nerves without a significant effect on velocity and latency in the work-ups of the upper extremity are enough to make a diagnosis.In conclusion, WHS has been defined as a polyneuropathy and occupational disease. Patients with WHS present with pain, numbness, tingling, and burning sensations in their hands that increases significantly during rest and nighttime. They also use their arms/hands for jobs that require heavy labor. The neurological examinations of patients with WHS are normal. Only the sensory nerves in the upper extremities are affected. This article is suggested to serve as a resource for patients, health care professionals, and members of the neurology community at large.

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Objectif

Permettre aux médecins de famille de comprendre l’épidémiologie, la pathogenèse, les symptômes, le diagnostic et la prise en charge de la maladie des vibrations, une maladie professionnelle importante et courante au Canada.

Sources d’information

Une recherche a été effectuée sur MEDLINE afin de relever les recherches et comptes rendus portant sur la maladie des vibrations. Une recherche a été effectuée sur Google dans le but d’obtenir la littérature grise qui convient au contexte canadien. D’autres références ont été tirées des articles relevés.

Message principal

La maladie des vibrations est une maladie professionnelle répandue touchant les travailleurs de diverses industries qui utilisent des outils vibrants. La maladie est cependant sous-diagnostiquée au Canada. Elle compte 3 éléments : vasculaire, sous la forme d’un phénomène de Raynaud secondaire; neurosensoriel; et musculosquelettique. Aux stades les plus avancés, la maladie des vibrations entraîne une invalidité importante et une piètre qualité de vie. Son diagnostic exige une anamnèse minutieuse, en particulier des antécédents professionnels, un examen physique, des analyses de laboratoire afin d’éliminer les autres diagnostics, et la recommandation en médecine du travail aux fins d’investigations plus poussées. La prise en charge consiste à réduire l’exposition aux vibrations, éviter les températures froides, abandonner le tabac et administrer des médicaments.

Conclusion

Pour assurer un diagnostic rapide de la maladie des vibrations et améliorer le pronostic et la qualité de vie, les médecins de famille devraient connaître cette maladie professionnelle courante, et pouvoir obtenir les détails pertinents durant l’anamnèse, recommander les patients aux cliniques de médecine du travail et débuter les demandes d’indemnisation de manière appropriée.

Hand-arm vibration syndrome: What family physicians should know

OBJECTIVE

To provide family physicians with an understanding of the epidemiology, pathogenesis, symptoms, diagnosis, and management of hand-arm vibration syndrome (HAVS), an important and common occupational disease in Canada.

SOURCES OF INFORMATION

A MEDLINE search was conducted for research and review articles on HAVS. A Google search was conducted to obtain gray literature relevant to the Canadian context. Additional references were obtained from the articles identified.

MAIN MESSAGE

Hand-arm vibration syndrome is a prevalent occupational disease affecting workers in multiple industries in which vibrating tools are used. However, it is underdiagnosed in Canada. It has 3 components-vascular, in the form of secondary Raynaud phenomenon; sensorineural; and musculoskeletal. Hand-arm vibration syndrome in its more advanced stages contributes to substantial disability and poor quality of life. Its diagnosis requires careful history taking, in particular occupational history, physical examination, laboratory tests to rule out alternative diagnoses, and referral to an occupational medicine specialist for additional investigations. Management involves reduction of vibration exposure, avoidance of cold conditions, smoking cessation, and medication.

CONCLUSION

To ensure timely diagnosis of HAVS and improve prognosis and quality of life, family physicians should be aware of this common occupational disease and be able to elicit the relevant occupational history, refer patients to occupational medicine clinics, and appropriately initiate compensation claims.

Tremor and hand-arm vibration syndrome (HAVS) in road maintenance workers

Objectives

The aim of this study was to evaluate postural and rest tremor among workers using vibrating hand tools, taking into account the possible effects of toxicants such as alcohol and tobacco. A further aim was to study workers diagnosed with hand-arm vibration syndrome (HAVS) at the time of examination.

Methods

This study comprises 103 road maintenance workers, 55 exposed to vibrating hand tools (age 41.0 years; range 21–62) and 48 referents (age 38.5 years; range 19–64). They were examined with the CATSYS Tremor Pen^®. Exposure to vibrating tools and serum biomarkers of alcohol and tobacco consumption were measured.

Results

Cumulative exposure to vibrating tools was associated with increased postural (p < 0.01) and rest tremor (p < 0.05) and with a higher Center Frequency of postural tremor (p < 0.01) among smokers and users of smokeless tobacco. Rest tremor Center Frequency was higher than postural tremor frequency (p < 0.001).

Conclusions

The main findings indicate an association between cumulative exposure to hand-held vibrating tools, tremor parameters and consumption of tobacco products. The hand position is important when testing for tremor. Rest tremor had a higher Center Frequency. Postural tremor was more strongly associated with exposure than rest tremor. The finding of increased tremor among the HAVS subjects indicated that tremor might be a part of the clinical picture of a HAVS diagnosis. As with all cross-sectional studies, inferences should be made with caution when drawing conclusions about associations between exposure and possible effects. Future research using longitudinal design is required to validate the findings of the present study.

Factors affecting finger and hand pain in workers with HAVS

BACKGROUND

Pain and its management are important aspects of hand-arm vibration syndrome (HAVS).

AIMS

To determine the factors associated with finger and hand pain in workers with HAVS and, specifically, to assess the impact of several neurological variables as well as the vascular component of HAVS, grip strength and age.

METHODS

We assessed men with HAVS at a hospital occupational medicine clinic over 2 years. Subjects scored finger and hand pain separately using the Borg Scale (0-10). The possible predictors we evaluated included the Stockholm Neurological Scale (SNS) and Stockholm Vascular Scale (SVS) stages, current perception threshold (CPT), carpal tunnel syndrome (CTS), ulnar neuropathy, grip strength and age. We carried out nerve conduction testing to confirm the presence of CTS and ulnar neuropathy and measured CPT in the fingers at 2000 Hz, 250 Hz and 5 Hz corresponding to A-beta (large myelinated), A-delta (small myelinated) and C (unmyelinated) fibres, respectively. We calculated Spearman rank correlations to examine the relation between finger and hand pain and possible predictor variables.

RESULTS

Among the 134 subjects, the median (25th-75th percentile) pain scores were 6 (4-8) for the fingers and 5 (1-7) for the hands. We found statistically significant correlations with finger pain for the SVS stage (r = 0.239; P < 0.01) and CTS (r = 0.184; P < 0.05). The only statistically significant correlation identified for hand pain was a negative correlation with grip strength (r = -0.185; P < 0.05).

CONCLUSIONS

Management of finger and hand pain in HAVS should focus on the correlates we have identified.

Test-retest reliability of neurophysiological tests of hand-arm vibration syndrome in vibration exposed workers and unexposed referents

Background

Exposure to hand-held vibrating tools may cause the hand-arm vibration syndrome (HAVS). The aim was to study the test-retest reliability of hand and muscle strength tests, and tests for the determination of thermal and vibration perception thresholds, which are used when investigating signs of neuropathy in vibration exposed workers.

Methods

In this study, 47 vibration exposed workers who had been investigated at the department of Occupational and Environmental Medicine in Gothenburg were compared with a randomized sample of 18 unexposed subjects from the general population of the city of Gothenburg. All participants passed a structured interview, answered several questionnaires and had a physical examination including hand and finger muscle strength tests, determination of vibrotactile (VPT) and thermal perception thresholds (TPT). Two weeks later, 23 workers and referents, selected in a randomized manner, were called back for the same test-procedures for the evaluation of test-retest reliability.

Results

The test-retest reliability after a two week interval expressed as limits of agreement (LOA; Bland-Altman), intra-class correlation coefficients (ICC) and Pearson correlation coefficients was excellent for tests with the Baseline hand grip, Pinch-grip and 3-Chuck grip among the exposed workers and referents (N = 23: percentage of differences within LOA 91 – 100%; ICC-values ≥0.93; Pearson r ≥0.93). The test-retest reliability was also excellent (percentage of differences within LOA 96–100 %) for the determination of vibration perception thresholds in digits 2 and 5 bilaterally as well as for temperature perception thresholds in digits 2 and 5, bilaterally (percentage of differences within LOA 91 – 96%). For ICC and Pearson r the results for vibration perception thresholds were good for digit 2, left hand and for digit 5, bilaterally (ICC ≥ 0.84; r ≥0.85), and lower (ICC = 0.59; r = 0.59) for digit 2, right hand. For the latter two indices the test-retest reliability for the determination of temperature thresholds was lower and showed more varying results.

Conclusion

The strong test-retest reliability for hand and muscle strength tests as well as for the determination of VPTs makes these procedures useful for diagnostic purposes and follow-up studies in vibration exposed workers.