Pain, nerve dysfunction and fatigue in a vibration-exposed population

The long term use of hand-held vibrating tools may cause vasospastic and neuromuscular problems. Symptoms include painful blanching of the fingers at low temperatures, intermittent paresthesia and numbness, impaired dexterity, a tendency to drop tools, and an increasing inability to identify small objects by touch alone. Neurological as well as vasospastic problems are graded according to the Stockholm workshop scales. Accurate and early diagnosis is particularly important (e.g., in vibration-exposed patients presenting a carpal tunnel syndrome, it is necessary to distinguish whether compression of the median nerve occurs at the digital, skin receptor or carpal tunnel levels). A variety of improved diagnostic techniques are discussed.