Cold water immersion test in patients with vibration disease

Diagnosis of vascular injuries caused by hand-transmitted vibration

OBJECTIVE

For a reliable objective diagnosis of vascular injuries in hand-arm vibration syndrome (HAVS), the standardized cold provocation tests--finger skin temperature measurement during hand(s) immersion in cold water (FST test) and finger systolic blood pressure measurement during local cold exposure (FSBP test)--are widely used. In recent years there is a growing controversy regarding the diagnostic value of these tests. The aim of this study was to describe particularly the diagnostic performance of FST and FSBP tests, and also to focus on the problems and uncertainties regarding the test conditions and results, in the laboratory diagnosis of vascular injuries caused by hand-transmitted vibration.

METHOD

A review of pertinent published English- and Japanese-language articles and conference proceedings (between 1976 and 2006) was conducted.

RESULTS

From the reports with regard to diagnostic significance of the FSBP test, it seems to be an important laboratory test for diagnosing vibration-induced white finger (VWF). On the other hand, despite a large number of research studies with the FST test, there is a lack of data for the standardized FST test, which can confirm the value of it in diagnosing VWF. Moreover, there is no agreement on effective parameter/s to quantify and compare the responses in FST induced by immersion in cold water. While assessing and staging vascular injuries in HAVS, inquiry regarding finger coldness appears to be useful.

CONCLUSIONS

As there is no single test with satisfactory diagnostic ability for VWF, at present it is reasonable to use the cold provocation tests as a part of the comprehensive approach to evaluate HAVS patients. In addition to the objective methods, the index of finger coldness may be useful while diagnosing the vascular component of HAVS.

Hearing of forest workers with vibration-induced white finger: a five-year follow-up

To examine the association between vibration-induced white finger (VWF) and hearing loss, 108 male forest workers who regularly used vibrating tools were followed up for five years. Case-control pairs matched for initial age and hearing level and exposure time to noise during the study period were selected from men with and without VWF. The hearing levels significantly worsened during the follow-up period at 2, 4 and 8 kHz in the affected cases but only at 8 kHz in the controls. Since threshold shift at 4 kHz, which is a typical effect of noise exposure, was significant only in the affected cases, it is suggested that the hearing of people with VWF was more vulnerable to noise. A pathological change causing VWF might also increase the susceptibility of hearing to noise damage.