Evaluation of neurological testing for hand-arm vibration syndrome

BACKGROUND

The neurological component of hand-arm vibration syndrome (HAVS) uses the Stockholm Workshop Scale sensorineural (SWS SN) stages for classification. Proximal compressive neuropathies are common in HAVS and the symptoms are similar to SN HAVS. The SWS may not be a valid staging tool if a patient has comorbid proximal compression neuropathy.

AIMS

To evaluate the prevalence of proximal compression neuropathy in patients presenting for HAVS assessment and examine the association between compressive neuropathies and SWS SN.

METHODS

A standardized assessment protocol was used to assess 431 patients for HAVS at St. Michael's Hospital, Toronto, Ontario. The prevalence of median and ulnar compressive neuropathies was determined. The association between proximal compression neuropathies and SWS SN stage (0/1 versus 2/3) was evaluated using Chi-square and Fisher's exact tests as well as multivariable logistic regression.

RESULTS

Most patients (79%) reported numbness and 20% had reduced sensory perception (SWS SN Stage 2/3). Almost half (45%) had median neuropathy at the wrist and 7% had ulnar neuropathy. There was no association between the SWS SN stage and median or ulnar neuropathy.

CONCLUSIONS

Two neurological lesions should be investigated in patients presenting for HAVS assessment: compressive neuropathy and digital neuropathy. The prevalence of compressive neuropathies is high in patients being assessed for HAVS and therefore nerve conduction studies (NCS) should be included in HAVS assessment protocols. Comorbid proximal neuropathy does not affect the SWS SN stage; therefore, NCS and SWS SN seem to be measuring different neurological outcomes in HAVS patients.

Cryoglobulins and cold agglutinins for hand arm vibration syndrome

BACKGROUND

Hand arm vibration syndrome (HAVS) is a condition caused by hand transmitted vibration from the use of hand-held vibrating tools or workpieces. The disease affects the vascular, neurological and musculoskeletal systems. The vascular component of HAVS is a form of secondary Raynaud's phenomenon. Other causes of disease must be excluded before attributing the cause to hand transmitted vibration.

AIMS

To evaluate the prevalence, and utility of testing for, cryoglobulins and cold agglutinins in patients with HAVS symptoms.

METHODS

A retrospective cohort study of 1183 patients referred for HAVS clinical assessment at St. Michael's Hospital, Toronto, Canada, between 2014 and 2020. The standard operating procedure at the clinic includes a detailed clinical and exposure history, physical examination, objective investigations and blood tests. Data were retrieved from patient chart review and laboratory investigation results for all cases with cryoglobulin and cold agglutinin testing.

RESULTS

A total of 1183 patients had a serum cryoglobulin measurement. Eleven patients (1%) were positive. Seven positive results were 'low titre' (1% positive) and the other four results were 2%, 6%, 9% and 18%. The patient with a 9% positive cryoglobulin titre had previously diagnosed Sjögren's syndrome. There were no positive cold agglutinin tests in the 795 patients tested.

CONCLUSIONS

Routine testing for cryoglobulins and cold agglutinins in patients with HAVS symptoms is not recommended because test positivity rates are negligible. Testing may be considered if the clinical history or routine blood investigations suggest evidence of underlying cryoglobulinaemia or cold agglutinin disease.

Powered-hand tools and vibration-related disorders in US-railway maintenance-of-way workers

Maintenance-of-way workers in North America who construct railroad tracks utilize specialized powered-hand tools, which lead to hand-transmitted vibration exposure. In this study, the maintenance-of-way workers were surveyed about neuro-musculoskeletal disorders, powered-hand tools and work practices. Information about vibration emission data of trade specific powered-hand tools for the North American and European Union markets was searched online to obtain respective user information of manufacturer and compared to non-commercial international data banks. The survey showed that maintenance-of-way workers frequently reported typical hand-transmitted vibration-related symptoms, and appear to be at a risk for neuro-musculoskeletal disorders of the upper extremity. Of all of the powered-hand tools used by this trade, 88% of the selected tools exceeded a=5 m/s² and were above vibration magnitudes of common tools of other comparable industries. This may create a risk if these tools are used throughout an 8-h work day and management of vibration exposure may be needed. In the North-American market, limited or no vibration emission data is available from manufacturers or distributors. Vibration emission information for powered-hand tools, including vibration emission levels (in m/s²), uncertainty factor K, and the applied testing standard/norm may assist employers, users and occupational health providers to better assess, compare and manage risk.

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

BACKGROUND

Knowledge about the long-term course of the neurologic component of hand-arm vibration syndrome (HAVS) is scarce.

AIMS

To study the course and prognostic factors of the neurosensory component of HAVS over a period of 22 years.

METHODS

Forty 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.

RESULTS

Among 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.

CONCLUSIONS

This 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.

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

BACKGROUND

Vibration-induced white finger (VWF) is often assessed using the Stockholm Workshop Scale (SWS) and cold challenge plethysmography. However, long-term longitudinal studies using both methods are scarce.

AIMS

To study the long-term course and prognostic factors of VWF assessed with the SWS and photoplethysmography (PPG), and to examine the effects of lifestyle on PPG score, regardless of VWF status.

METHODS

Forty male construction workers were examined with a test battery and clinical examination in 1994 and 2016/17.

RESULTS

At baseline, the sample comprised 27 workers with, and 13 without, symptoms of hand-arm vibration syndrome (HAVS). Thirty-five workers reported vibration exposure during follow-up. The mean age of the workers was 60 years (45-78) at follow-up. The paired t-test showed that PPG scores deteriorated from 1994 to 2017 in the 27 workers with HAVS in 1994 (mean difference 2.7 min, 95% confidence interval (CI) 0.2-5.2). However, there was no statistically significant change in SWS scores in these workers over time. Smoking and age were associated with PPG score deterioration. Vibration exposure during follow-up predicted SWS score deterioration: 1000 h of exposure predicted a deterioration stage of 0.09 (95% CI 0.03-0.16). Analysis of all 40 workers showed that 2017 PPG scores were associated with positive serum cotinine and self-reported smoking during follow-up.

CONCLUSIONS

Whereas age and smoking predicted a PPG deterioration, continued vibration exposure predicted worsening of white finger symptoms. The association of PPG score and smoking should be considered in diagnostic and prognostic factor evaluations.

Hand-arm vibration syndrome: Workers' experience with functional impairment and disability

STUDY DESIGN

Qualitative and descriptive study.

INTRODUCTION

Hand-arm vibration syndrome (HAVS) is a prevalent disease in Canada. There is little work on the perspectives of HAVS patients.

PURPOSE OF THE STUDY

Explore perceptions of disability and functional compromise in patients with HAVS.

METHODS

Semi-structured telephone interviews were conducted with HAVS patients and analysed using content analysis.

RESULTS

The 11 participants reported numbness, pain, and reduced dexterity, strength, and sensation. Participants noted that HAVS was an inevitable aspect of their work. They indicated frustration with their condition and viewed it as a disability. To overcome impairments risky strategies are often used. Participants reported lack of support to manage symptoms and overcome work disability.

DISCUSSION

HAVS related impairment is disabling. Workers require improved resources and support to address symptom management and safe strategies to minimize work disability.

CONCLUSION

HAVS patients experience functional, social, emotional, and psychological disability.

LEVEL OF EVIDENCE

Not applicable.

Health effects associated with occupational exposure to hand-arm or whole body vibration

Workers in a number of different occupational sectors are exposed to workplace vibration on a daily basis. This exposure may arise through the use of powered-hand tools or hand-transmitted vibration (HTV). Workers might also be exposed to whole body vibration (WBV) by driving delivery vehicles, earth moving equipment, or through use of tools that generate vibration at low dominant frequencies and high amplitudes, such as jackhammers. Occupational exposure to vibration has been associated with an increased risk of musculoskeletal pain in the back, neck, hands, shoulders, and hips. Occupational exposure may also contribute to the development of peripheral and cardiovascular disorders and gastrointestinal problems. In addition, there are more recent data suggesting that occupational exposure to vibration may enhance the risk of developing certain cancers. The aim of this review is to provide an assessment of the occupations where exposure to vibration is most prevalent, and a description of the adverse health effects associated with occupational exposure to vibration. This review will examine (1) various experimental methods used to measure and describe the characteristics of vibration generated by various tools and vehicles, (2) the etiology of vibration-induced disorders, and (3) how these data were employed to assess and improve intervention strategies and equipment that reduces the transmission of vibration to the body. Finally, there is a discussion of the research gaps that need to be investigated to further reduction in the incidence of vibration-induced illnesses and injuries.

Hand-arm vibration and the risk of vascular and neurological diseases-A systematic review and meta-analysis

Background

Increased occurrence of Raynaud’s phenomenon, neurosensory injury and carpal tunnel syndrome has been reported for more than 100 years in association with work with vibrating machines. The current risk prediction modelling (ISO-5349) for “Raynaud’s phenomenon” is based on a few studies published 70 to 40 years ago. There are no corresponding risk prediction models for neurosensory injury or carpal tunnel syndrome, nor any systematic reviews comprising a statistical synthesis (meta-analysis) of the evidence.

Objectives

Our aim was to provide a systematic review of the literature on the association between Raynaud’s phenomenon, neurosensory injuries and carpal tunnel syndrome and hand-arm vibration (HAV) exposure. Moreover the aim was to estimate the magnitude of such an association using meta-analysis.

Methods

This systematic review covers the scientific literature up to January 2016. The databases used for the literature search were PubMed and Science Direct. We found a total of 4,335 abstracts, which were read and whose validity was assessed according to pre-established criteria. 294 articles were examined in their entirety to determine whether each article met the inclusion criteria. The possible risk of bias was assessed for each article. 52 articles finally met the pre-established criteria for inclusion in the systematic review.

Results

The results show that workers who are exposed to HAV have an increased risk of vascular and neurological diseases compared to non-vibration exposed groups. The crude estimate of the risk increase is approximately 4–5 fold. The estimated effect size (odds ratio) is 6.9 for the studies of Raynaud’s phenomenon when including only the studies judged to have a low risk of bias. The corresponding risk of neurosensory injury is 7.4 and the equivalent of carpal tunnel syndrome is 2.9.

Conclusion

At equal exposures, neurosensory injury occurs with a 3-time factor shorter latency than Raynaud’s phenomenon. Which is why preventive measures should address this vibration health hazard with greater attention.

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.

Health-care barriers for workers with HAVS in Ontario, Canada

BACKGROUND

Hand-arm vibration syndrome (HAVS) becomes irreversible unless it is identified early and progression prevented.

AIMS

To describe the health-care-seeking behaviours of workers with HAVS and barriers to health care.

METHODS

We invited all patients assessed for HAVS between 15 January and 27 March 2013 at a hospital-based occupational health clinic (OHC) in Ontario, Canada, to complete a questionnaire asking why and from whom they sought health care, reasons they waited to seek care and barriers they encountered in accessing care. We analysed the data using descriptive statistics.

RESULTS

Forty-one (82%) patients agreed to participate. Thirty-seven had confirmed HAVS; 30 (84%) were Stockholm workshop vascular stage 2 or greater and 35 (97%) were sensorineural stage 1 or greater. The commonest employment sectors were construction [21 (57%)] and mining [6 (17%)]. The main reasons for seeking treatment were pain [11 (30%)], finger numbness [8 (22%)] and functional limitations [5 (14%)]. The commonest initial point of health care was the family physician [23 (66%)]. The mean wait between symptom onset and seeking treatment was 3.4 years, while the mean time between onset and OHC assessment was 9 years. Reasons for delay in seeking care were ignorance of the seriousness and irreversibility of HAVS and ability to continue to work. Family physicians suspected HAVS in 17% of cases and recommended job modification in 34%.

CONCLUSIONS

Workers with HAVS in Ontario delay seeking health care. Primary care physicians often fail to recognize HAVS. Barriers to health care include ignorance of HAVS and of the importance of prevention.

A cross sectional study on hand-arm vibration syndrome among a group of tree fellers in a tropical environment

This study aimed to explore the clinical characteristics of hand arm vibration syndrome (HAVS) in a group of tree fellers in a tropical environment. We examined all tree fellers and selected control subjects in a logging camp of central Sarawak for vibration exposure and presence of HAVS symptoms utilizing vibrotactile perception threshold test (VPT) and cold water provocation test (CWP). None of the subjects reported white finger. The tree fellers reported significantly higher prevalence of finger coldness as compared to the control subjects (OR=10.32, 95%CI=1.21-87.94). A lower finger skin temperature, longer fingernail capillary return time and higher VPT were observed among the tree fellers as compared to the control subjects in all fingers (effect size >0.5). The VPT following CWP of the tree fellers was significantly higher (repeated measures ANOVA p=0.002, partial η(2)=0.196) than the control subject. The A (8) level was associated with finger tingling, numbness and dullness (effect size=0.983) and finger coldness (effect size=0.524) among the tree fellers. Finger coldness and finger tingling, numbness and dullness are important symptoms for HAVS in tropical environment that may indicate vascular and neurological damage due to hand-transmitted vibration exposure.

[Features of systemic hemostasis in arterial hypertension with vibration disease in accordance with vibration type]

Study covered systemic hemostasis in 69 males aged 47.6 +/- 2.1 years with 1 stage arterial hypertension and 1 stage vibration disease, exposed to various types of occupational vibration at work. Those exposed to bump vibration demonstrated an increase in platelets aggregation with all aggregation inductors, if compared to reference values, increased generaton and activity of von Willebrand factor, moderately depressed fibrinolysis system with increased serum content of fibrin and fibrinogen degradation products and decreased anticoagulation factors activity. Those exposed to rotation vibration demonstrated less changes.

[Chronic fatigue syndrome in patients with vibration disease]

The article presents study results that demonstrate chronic fatigue syndrome in patients with vibration disease. Clinical manifestations of chronic fatigue syndrome are characterized by changes in the emotional-volitional and cognitive areas. Application of nootropic drug cortexin increases the efficiency of rehabilitation in patients with vibration disease with chronic fatigue syndrome.

A proposed theory on biodynamic frequency weighting for hand-transmitted vibration exposure

The objective of this study is to propose a theory on the biodynamic frequency weighting for studying hand-transmitted vibration exposures and vibration-induced effects. We hypothesize that the development of a vibration effect is the result of two consecutive but synergistic processes: biodynamic responses to input vibration and biological responses to the biomechanical stimuli resulting from the biodynamic responses. Hence, we further hypothesize that the frequency-dependency (W) of the effect generally includes two components: a biodynamic frequency weighting (W1) and a biological frequency weighting (W2), or W=W1• W2. These hypotheses are consistent with the stress and strain analysis theory and methods widely used in structural dynamics and biomechanics. The factorization may make it easier to study the complex frequency-dependency using different approaches: the biodynamic frequency weighting depends on the passive physical response of the system to vibration, and it can thus be determined by examining the biodynamic response of the system using various engineering methods; on the other hand, the biological frequency weighting depends on the biological mechanisms of the effects, and it can be investigated by studying the psychophysical, physiological, and pathological responses. To help test these hypotheses, this study reviewed and further developed methods to derive the finger biodynamic frequency weighting. As a result, preliminary finger biodynamic frequency weightings are proposed. The implications of the proposed theory and the preliminary biodynamic frequency weightings are also discussed.

Joël's breaker: forty years of European vibration prevention

Although the risks associated with vibration exposure have been known for a long time, the importance of risk prevention has increased in Europe since the implementation of the Machine Directives in 1989 (1989/392/EC) and the Vibration Directive in 2002 (2002/44/CE). These Directives challenged manufacturers to design low-vibration tools, and employers to manage the site-specific risks of vibration exposure. Field experience has shown that many companies using vibrating tools have never carried out a risk-management program, and that they continue to ignore their responsibilities in the Vibration Directive. Because of this, European States are now developing alternative approaches to prevention, which typically shift the balance of risk management responsibility entirely onto employers. The ongoing challenge will be to increase workplace awareness of, and attention to, the risks of vibration exposure.

Frequency weighting for vibration-induced white finger compatible with exposure-response models

An analysis has been performed to derive a frequency weighting for the development of vibration-induced white finger (VWF). It employs a model to compare health risks for pairs of population groups that are selected to have similar health outcomes from operating power tools or machines with markedly different acceleration spectra (rock drills, chain saws, pavement breakers and motorcycles). The model defines the Relative Risk, RR(f(trial)), which is constructed from the ratio of daily exposures and includes a trial frequency weighting that is applied to the acceleration spectra. The trial frequency weighting consists of a frequency-independent primary frequency range, and subordinate frequency ranges in which the response to vibration diminishes, with cut-off frequencies that are changed to influence the magnitude of RR(f(trial)). The frequency weighting so derived when RR(f(trial)) = 1 is similar to those obtained by other methods (W(hf), W(hT)). It consists of a frequency independent range from about 25 Hz to 500 Hz (-3 dB frequencies), with an amplitude cut-off rate of 12 dB/octave below 25 Hz and above 500 Hz. The range is compatible with studies of vasoconstriction in persons with VWF. The results provide further evidence that the ISO frequency weighting may be inappropriate for assessing the risk of developing VWF.

Frequency-dependence of psychophysical and physiological responses to hand-transmitted vibration

This invited paper reviews experimental studies of the frequency-dependence of absolute thresholds for the perception of vibration, equivalent comfort contours, temporary changes in sensation caused by vibration, and reductions in finger blood flow caused by hand-transmitted vibration. Absolute thresholds depend on the contact conditions but for a typical hand grip the thresholds show greatest sensitivity to acceleration around 125 Hz. The frequency-dependence of discomfort caused by hand-transmitted vibration depends on vibration magnitude: similar to absolute thresholds at low magnitudes, but the discomfort at higher magnitudes is similar when the vibration velocity is similar (at frequencies between about 16 and 400 Hz). Hand-transmitted vibration induces temporary elevations in vibrotactile thresholds that reflect the sensory mechanisms excited by the vibration and are therefore highly dependent on the frequency of vibration. Hand-transmitted vibration reduces finger blood flow during and after exposure; when the vibration velocity is similar at all frequencies there is more vasoconstriction at frequencies greater than 63 Hz than at lower frequencies. A single frequency weighting cannot provide a good indication of how all effects of hand-transmitted vibration depend on vibration frequency. Furthermore, a single frequency weighting provides only an approximate indication of any single response, because many factors influence the frequency-dependence of responses to hand-transmitted vibration, including the magnitude of vibration, contact conditions, and individual differences. Although the frequency weighting in current standards extends from 8 to 1,000 Hz, frequencies greater than 400 Hz rarely increase the weighted value on tools and there is currently little psychophysical or physiological evidence of their effects.

Epidemiological evidence for new frequency weightings of hand-transmitted vibration

This paper provides an overview of the exposure-response relationship for the vascular component of the hand-arm vibration syndrome, called vibration-induced white finger (VWF). Over the past two decades, several epidemiological studies have shown a poor agreement between the risk for VWF observed in various occupational groups and that predicted by models included in annexes to International Standard ISO 5349 (ISO 5349:1986, ISO 5349-1:2001). Either overestimation or underestimation of the occurrence of VWF have been reported by investigators. It has been argued that the current ISO frequency-weighting curve for hand-transmitted vibration, which assumes that vibration-induced adverse health effects are inversely related to the frequency of vibration between 16 and 1250 Hz, may be unsuitable for the assessment of VWF. To investigate this issue, a prospective cohort study was carried out to explore the performance of four alternative frequency weightings for hand-transmitted vibration to predict the incidence of VWF in groups of forestry and stone workers. The findings of this study suggested that measures of vibration exposure which give relatively more weight to intermediate and high frequency vibration produced better predictions of the incidence of VWF than that obtained with the frequency weighting currently recommended in International Standard ISO 5349-1:2001.

Relative Performance of Frequency Weighting W(h) and Candidates for Alternative Frequency Weightings for Predicting the Occurrence of Hand-transmitted Vibration-induced Injuries

Exposure to hand-transmitted vibration is usually assessed according to International Standard ISO 5349-1:2001 using the frequency weighting W(h). This paper compares eight frequency weightings that might be used to supplement or replace W(h). The comparison is based on a data from two databases, one containing over 7200 measured hand-arm vibration (HAV) spectra from a wide range of industrial machines the other recording exposure history and injury for workers referred to the Health and Safety Laboratory. Acceleration spectra from the machinery database are analysed to give weighted values for the alternative frequency weightings. These weighted values are compared and then used to estimate a set of alternative lifetime vibration dose values for subjects in the referral database. Statistical comparison of these lifetime dose values against assessments of hand-arm vibration syndrome (HAVS) and sensorineural HAVS prevalence suggests that values based the two weightings W(h) and W(h50lp) (the W(h) weighing low-pass filtered at 50 Hz) provide the strongest indicators for developing these injuries. For vascular HAVS there was no clear evidence to advocate any individual frequency weighting. For all injury categories the strongest relationships were for the first power of acceleration magnitude.

[Cognitive disorders in occupational diseases of after contact period, associated with cardiovascular problems]

Vibration disease patients with chronic uranium intoxication in after contact period demonstrate moderate cognitive disorders of amnestic multifunctional type in 100% of cases. Individuals having occupational diseases due to physical, toxic and radiation hazards, associated with cardiovascular problems, in after contact period manifest mostly with visual-spatial functions, short-term, operative, visual and aural memory disorders. Visual-spatial functions, short-term, operative, visual and aural memory are decreased more in patients with remote period of chronic uranium intoxication.

[Prevalence and clinical manifestations of metabolic syndrome in vibration disease]

Among 70 vibration disease patients (58 males and 12 females, average age 48 +/- 8.4 yr; 1 grade--85.7% and 2 grade--14.3%), prevalence of abdominal obesity equalled 34.3%. Arterial hypertension (with preferentially 3 grade, risk 3-4--42.5%) was diagnosed in 94.3% of the examinees, of which 27.3% concurrent with IHD. Dyslipidemia were seen in 58.6%. Various combinations of metabolic syndrome were seen in 24.3% of the examinees.

[Systemic approach to organization of prevention and treatment of vibration disease]

Results of follow-up in 2012 miners including vibration disease sufferers proved efficiency of systematic approach to prevention and treatment management in those patients--lower morbidity and economic losses prevention were seen.

[Prevention of upper limbs diseases in workers subjected to occupational hazards]

Study covered 120 personal computer users, 98 jewelry female polishers, 64 metallic ships body assemblers. Objective investigations revealed joints pain on palpation, joints function disorders, hypoesthesia of finger tips. After prevention measures based on low-intensity laser rays, the joints functions recovered, hands edema disappeared, hypoesthesia cleared.

Diagnosing soft tissue rheumatic disorders of the upper limb in epidemiological studies of vibration-exposed populations

OBJECTIVES

To investigate approaches adopted to diagnose soft tissue rheumatic disorders of the upper limb (ULDs) in vibration-exposed populations and in other settings, and to compare their methodological qualities.

METHODS

Systematic searches were made of the Medline, Embase, and CINAHL electronic bibliographic databases, and of various supplementary sources (textbooks, reviews, conference and workshop proceedings, personal files). For vibration-exposed populations, qualifying papers were scored in terms of the provenance of their measuring instruments (adequacy of documentation, standardisation, reliability, criterion-related and content validity). Similar criteria were applied to general proposals for whole diagnostic schemes, and evidence was collated on the test-retest reliability of symptom histories and clinical signs.

RESULTS

In total, 23 relevant reports were identified concerning vibration-exposed populations--21 involving symptoms and 9 involving examination/diagnosis. Most of the instruments employed scored poorly in terms of methodological quality. The search also identified, from the wider literature, more than a dozen schemes directed at classifying ULDs, and 18 studies of test-retest reliability of symptoms and physical signs in the upper limb. Findings support the use of the standardised Nordic questionnaire for symptom inquiry and suggest that a range of physical signs can be elicited with reasonable between-observer agreement. Four classification schemes rated well in terms of content validity. One of these had excellent documentation, and one had been tested for repeatability, agreement with an external reference standard, and utility in distinguishing groups that differed in disability, prognosis and associated risk factors.

CONCLUSIONS

Hitherto, most studies of ULDs in vibration-exposed populations have used custom-specified diagnostic methods, poorly documented, and non-stringent in terms of standardisation and supporting evidence of reliability and/or validity. The broader literature contains several question sets and procedures that improve upon this, and offer scope in vibration-exposed populations to diagnose ULDs more systematically.

[Hand-arm vibration syndrome and upper limbs diseases in the forest workers of Italia meridionale]

Vibration exposure of the hand-arm system is associated with an increased risk of upper-limb vascular, neurological and musculoskeletal lesions, or hand-arm vibration syndrome (HAVS). The prevalence of occupational HAVS and upper-limb disorders was studied among 278 Forestry Service workers in Sicily and Calabria. Subjects who used chain-saws (18 weeks/year) had a greater prevalence of peripheral sensory-neural disturbances (28%), upper-limb musculoskeletal disorders (33%) and carpal tunnel syndrome (19%) compared with 260 manual workers from the same Corps not exposed to hand-transmitted vibration. Raynaud's phenomenon was comparable in exposed and control subjects (5.3% vs. 4.7%.) Upper-limb neuropathies were significantly associated with energy-equivalent frequency-weighted acceleration; exposure duration; and cumulative vibration dose (m2/s4h). The variable "years of work with vibrating tools" was strongly associated with peripheral neuropathies; carpal tunnel syndrome; and upper-limb musculotendinous syndromes. Data suggest that in Sicily and Calabria, where the climate is milder than in other areas of Italy, forestry work with hand-held vibrating tools does not entail a greater prevalence of peripheral vascular disorders (Raynaud's phenomenon), while the prevalence of occupational upper-limb neurological and musculoskeletal disorders, in which combined ergonomic and mechanical risk factors have a large pathogenic role, is significantly increased.

The Hand-Arm Vibration International Consortium (HAVIC): Prospective Studies on the Relationship Between Power Tool Exposure and Health Effects

OBJECTIVES

The Hand-Arm Vibration International Consortium (HAVIC) is a collaboration of investigators from Europe and North America studying health effects from hand-arm vibration (HAV). Features include prospective design, cross-cohort exposure, and health assessment methods.

METHODS

Two new cohorts (dental hygienists and dental hygiene students), two existing cohorts (Finnish forest workers, and Swedish truck cab assemblers), and a previous population (US shipyard workers) are included. Instruments include surveys, quantitative medical tests, physical examination, and work simulation and data logging to assess exposure. New methods were developed for nerve conduction and data logging.

RESULTS

Findings on the relationship between nerve conduction and skin temperature in HAV-exposed subjects resulted in a new approach to subject warming.

CONCLUSIONS

Integrating established cohorts has advantages over de novo cohort construction. Complex laboratory tests can be successfully adapted for field use.

[The functional condition of the heart in arterial hypertension in patients with vibration disease]

Changes in intra- and extracardial hemodynamics associated with arterial hypertension (AH) in people with vibration-related pathology exposed to vibration (18 subjects) or during early postcontact period (21 subjects) were studied. Adaptive hemodynamic changes, such as elements of heterometric cardial function autoregulation and hyperkinetic circulation, were found in people with AH during working with vibration or during early post-contact period vs. AH patients who were not exposed to hazardous industrial factors.

[Occupational diseases-related autonomic system cardioneuropathy in Chelyabinsk region]

Cardiovascular diseases appear to be the most frequent complication and death cause in patients with various forms of occupational diseases. Autonomous nervous system could play significant role in genesis of those complications.

Hand-arm vibration syndrome (HAVS) and musculoskeletal symptoms in the neck and the upper limbs in professional drivers of terrain vehicles--a cross sectional study

This study compares the prevalence of symptoms of Hand-arm vibration syndrome (HAVS) and musculoskeletal symptoms in the neck and the upper limbs, between professional drivers of terrain vehicles and a referent group. 769 male professional drivers of forest machines, snowmobiles, snowgroomers and reindeer herders and 296 randomly selected male referents completed a questionnaire about symptoms of HAVS and musculoskeletal symptoms in the neck and the upper limbs. They also gave information about their lifetime exposure duration driving terrain vehicles and their nicotine use. Prevalence odds ratios (POR) were determined and adjusted for age and nicotine use. Results show that there is a relation between exposure to driving terrain vehicles and some of the symptoms of HAVS (POR: 1.2-6.1). Increased odds of musculoskeletal symptoms in neck, shoulders and wrists were also found (POR 1.2-6.4), and it seemed to be related to the cumulative exposure time.

Cold-provocation testing for the vascular component of hand-arm vibration syndrome in health surveillance

The aim was to investigate whether the use of infra-red thermography (I-R) and measurement of temperature gradients along the finger could improve the diagnostic accuracy of cold-provocation testing (15 degrees C for 5 min) in vascular hand-arm vibration syndrome (HAVS). Twenty-one controls and 33 individuals with stages 2/3V HAVS were studied. The standard measurement of time to rewarm by 4 degrees C (T4 degrees C) and temperature gradients between the finger tip, base and middle (measured using I-R) were calculated. Receiver Operating Characteristics (ROC) analysis to distinguish between the two groups revealed that for T4 degrees C the area under the ROC curve was not statistically significantly different from 0.5 (0.64 95% confidence interval 0.49-0.76). The difference between the tip and middle portion of the finger during the sixth minute of recovery was the most promising gradient with an area of 0.76 (95% confidence interval 0.62-0.87), and sensitivity and specificity of 57.6% and 85.7% respectively. However, this was not significantly different from that for the time to rewarm by 4 degrees C. In conclusion, the cold-provocation test used in this study does not appear to discriminate between individuals with stage 2/3V HAVS and controls and this is not improved by the measurement of temperature gradients along the fingers using I-R.

Hand-arm vibration syndrome in South African gold miners

BACKGROUND

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.

AIMS

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Health risks from occupational exposures to mechanical vibration

Health effects of occupational exposure to hand-transmitted vibration (HTV) and whole-body vibration (WBV) are reviewed. Excessive exposure to HTV from powered processes or tools is associated with an increased occurrence of symptoms and signs of disorders in the vascular, neurological and musculoskeletal systems of the upper limbs. This complex set of disorders is called hand-arm vibration syndrome. Long-term occupational exposure to intense WBV is associated with an increased risk for disorders of the lumbar spine and the connected nervous system. With a lower probability, the neck-shoulder, the gastrointestinal system, the female reproductive organs, the peripheral veins, and the cochleo-vestibular system are also assumed to be affected by WBV. However, there is weak epidemiological support for WBV-induced disorders of organ systems other than the lower back. In addition to the health effects of human vibration, this review provides information on methods for the protection and health surveillance of vibration-exposed workers according to the European Directive 2002/44/EC on mechanical vibration.

Hand-arm vibration syndrome with use of anti-vibration chain saws: 19-year follow-up study of forestry workers

OBJECTIVES

Hand-arm vibration syndrome (HAVS) consists of vascular and neurological component. Musculoskeletal component has not been delineated yet. In the present follow-up study, we evaluated the prevalence of HAVS and the cumulative exposure to vibration among a cohort of forestry workers. Special interest was given to numbness and musculoskeletal disorders of upper extremity and neck in forestry workers.

METHODS

A follow-up study starting from 1976 was conducted among forestry workers in Suomussalmi in Finland. Total exposure of hand-arm vibration was recorded during 11 cross-sectional surveys. The last study was carried out in 1995. The lifetime dose of vibration energy was calculated. A cohort of 52 forest workers participated to all 11 cross-sectional surveys 1976-1995. HAVS and musculoskeletal disorders were evaluated.

RESULTS

The prevalence of active vibration white finger (VWF) decreased from 13 to 4% in the cross-sectional study. In the cohort VWF decreased from 17 to 8% and numbness increased from 23 to 40%. Rotator cuff syndrome (P=0.034) and epicondylitis (P=0.004) associated with numbness. Regional neck pain was diagnosed in 38% of workers and associated with low back pain. In modeling VWF, the lifelong vibration energy (OR 1.03, CI 1.01-1.05), and smoking (OR 7.36, CI 1.07-50.76) were significant. Numbness was modeled by pain in upper extremities (OR 12.43, CI 2.42-63.80) and neck pain (5.97, CI 1.25-28.39), not by lifelong vibration energy. Right rotator cuff syndrome was modeled by age (OR 2.58, CI 1.04-6.41) and lifelong vibration energy (OR 1.04, CI 1.00-1.07).

CONCLUSIONS

The prevalence of VWF constantly decreased. Numbness did not follow the vibration exposure profile. Numbness also associated with upper extremity musculoskeletal disorders. Hand-arm vibration associated with the right rotator cuff syndrome in forestry workers.