Assessment of vibration induced white finger: reliability and validity of two tests

The reliability and validity of two tests (cold water and reactive hyperaemia) designed to confirm a patient's history of vibration induced white finger were studied. The cold water test is a measure of digital rewarming after hand immersion in cold water. Reactive hyperaemia consists of measuring digital rewarming after cold water immersion plus temporary ischaemia imposed on the hand. For ten weeks, ten healthy male volunteers were submitted once a week to both tests to study their reliability. The results showed a strong inter and intraindividual scattering. The mean value for the whole group, however, did not differ significantly from one week to the next. Fifty two subjects exposed to hand/arm vibration were submitted to both tests to estimate their validity. They were classified, according to their medical history, into three groups: A = no symptoms, B = tingling or numbess, or both, C = Raynaud's phenomenon. Both tests agreed with the clinical staging. For reactive hyperaemia, however, the differences between the groups were statistically significant only when the test was performed at 10 degrees C. These tests are more useful to study a group than an individual case. Time has no significant effect on the mean result of a group.     

Cold water immersion test in patients with vibration disease.

Peripheral vascular disorder is one of the most important symptoms in diagnosing vibration disease. Several kinds of tests have been introduced to evaluate the peripheral vascular function. Among those tests, cold water immersion test has been mostly applied. In Japan, the generally used method is to measure the skin temperature of one finger of the hand immersed up to the wrist joint in water at 5 degreesC for 10 minutes. However, because the suffering during the test is so severe and some unfavorable warning symptoms have been observed during group examinations, a safer and milder method is more desirable. In order to examine the applicability of the test by using water at 10 degreesC in comparison with that at 5 degreesC, and to know the degree of suffering during the tests, a comparative study was performed. Sixteen students and 29 patients with vibration disease joined in this study. The results suggest that water at 10 degreesC can be effective stimulus, if the immediate rewarming response is used for evaluation. The self-rating scores revealed that the suffering was milder in case of water of 10 degreesC than at 5 degreesC for both the students and the patients. And the patients seemed to suffer more from chest discomfort than the students.     

振动作业工人手部红外图像分析

目的研究振动作业人员手部红外摄像和冷水试验对手臂振动病周围循环功能的改变。方法通过对非接触振动的健康工人50名（对照组）、尚无发生振动性白指的振动作业工人50名（接振组）,在冷水负荷前后,用KY-333型远红外摄像仪进行手部红外摄像,研究手部周围循环功能的变化。结果冷水试验前两组工人手部红外图像差异无统计学意义（P〉0.05）;冷水试验后5 min和10 min接触振动组手指皮肤温度比对照组下降显著（P〈0.05和P〈0.01）,两组冷水试验后5min平均皮温分别为：右手（21.5±1.7）℃和（23.5±1.8）℃,左手（20.5±1.1）℃和（24.0±1.6）℃;接振组复温时间延长。结论手部红外摄像结合冷水试验对振动作业工人周围循环功能障碍具有早期识别意义。     

手部红外图像结合冷水试验对周围循环功能的评价

目的　研究手传振动对周围循环功能的影响及其评价方法。方法　振动作业工人３７ 名（ 接振组） ,非接振健康工人３０ 名（ 对照组） ,在冷水负荷前后,用ＫＹ３３３ 型远红外摄像仪进行手部红外摄像,对图像进行对比分析。结果　冷试前两组工人手部红外图像差异无显著性;冷水试验后手部红外图像变化显著,接振组手指皮肤温度下降,复温时间延长。结论　手部红外摄像结合冷水负荷试验可以评价周围循环机能障碍的早期变化     

振动作业者手部冷水试验红外图像测温

[目的]利用红外摄像结合冷水试验了解手臂振动对手部周围循环功能的影响。[方法]通过对振动作业工人50名（接振组），非接振健康工人50名（对照组），在冷水负荷前后，用KY-333型远红外摄像仪进行手部红外摄像，对图像分析并进行对比。[结果]冷水试验前，两组工人手部红外图像差异无统计学意义（P〉0．05）；冷水试验后接振组手指皮肤温度较对照组下降，复温时间延长（P〈0．01）。[结论]振动作业对手部周围循环功能有影响，红外摄像结合冷水试验可作为检查方法之一。     

Different conditions of cold water immersion test for diagnosing hand-arm vibration syndrome

The cold water immersion test with finger skin temperature (FST) measurement is used to assess vascular disorders in hand-arm vibration syndrome (HAVS). The test method is currently being standardized within the International Organization for Standardization (ISO) in which a water temperature of 12°C for 5 min of hand immersion and an option of using a waterproof hand covering during immersion are proposed. It is necessary to evaluate the diagnostic significance of the test with FST measurement under different conditions to provide a proper management of HAVS patients. The aim of this article is to review research findings of this test with FST measurement and discuss test conditions influencing the results and diagnostic significance. Different conditions were employed, and the test results were shown to be influenced by water temperature, immersion time and other conditions such as room temperature, season, ischemia during immersion, and evaluation parameters. These factors need to be considered in the standardization of the cold water immersion test with FST measurement. It has been mentioned that a high water temperature, a short immersion time and other conditions should be chosen to expose a subject to minimal suffering during the test. A water temperature between 10°C and 15°C and a 5 min immersion might be suitable for the cold water immersion test. The reported sensitivity and specificity evaluating rewarming to the initial temperature for the test using a water temperature of 12°C and a 3 min immersion are 58% and 100%, respectively; these are low but similar to those for tlie water immersion test at 10°C. Therefore, the proposed cold water immersion test at 12°C for 5 min by the ISO (Draft International Standard) is the focus of much interest, and further studies are needed to obtain sufficient data for evaluating the diagnostic significance of the test. At present, the test needs to be used together with a test battery.     

Cold-stress tests involving finger skin temperature measurement for evaluation of vascular disorders in hand-arm vibration syndrome: review of the literature

Cold-stress tests are used for evaluating vascular disorders in the hand-arm vibration syndrome, and the value of such tests based on finger skin temperature measurement has been investigated. However, there is a wide difference in the test conditions among countries and researchers. Standardization of the cold-stress tests is currently under discussion within the International Organization for Standardization. We reviewed various aspects of the cold-stress tests involving finger skin temperature measurement, including water temperature, hand immersion time and other test conditions, and evaluated their diagnostic significance. Water temperature varied from 0 degrees C to 15 degrees C and hand immersion time varied from 0.5 min to 20 min. The cold-stress tests are associated with relatively severe suffering, thus, higher temperature of cold water and shorter time of immersion are desirable. To date, however, there has not been sufficient data indicating diagnostic value in a test method involving cold water at around 15 degrees C. Diagnostic value is also influenced by other test conditions, such as room temperature, season, use of ischemia during immersion. For standardization of the cold-stress test involving finger skin temperature measurement, these factors must be considered together with water temperature and immersion time.     

振动性白指—局部受冷和振动负荷后的末梢循环表现

本研究分为三个组:(1)振动白指组(29例);(2)振动无白指组(105例);(3)对照组(60例)。 研究表明:振动白指组冷水试验的白指再现率为10％,而振动无白指组和对照组无一例出现白指;Ⅰ期振动性白指患者的皮温恢复时间延长者占40％,而Ⅱ期和Ⅲ期振动白指患者皮温恢复时间延长者均为100％;振动白指组的指血流图平均波辐高度冷水试验后显著低于冷水试验前(P<0.01),而振动无白指组和对照组没有这种差异。 本文讨论上述试验在振动性白指诊断中的意义。     

Significance of finger coldness in hand-arm vibration syndrome

Objectives To evaluate the relationship between subjective symptoms of coldness in fingers and peripheral circulation in patients with hand-arm vibration syndrome (HAVS). Methods Thirty-five male patients confirmed to have HAVS as an occupational disease took part in this study. Their mean age was 62 years (SD 5) and all were chain-saw operators exposed to vibration for an average of 25 years. Their annual health examination included the history of their daily habits (smoking, drinking, and therapeutic exercise), report of subjective symptoms such as coldness, numbness and tingling in the fingers, and a physical examination; laboratory tests consisted of skin temperature measurement, and pain and vibration perception under conditions of cold provocation. A frequently used method of cold provocation, immersion of the left hand up to the wrist in water of 10°C for 10 min, was used. Results Finger coldness was classified into 3 groups according to its severity: mild group (n=8), moderate group (n=17) and severe group (n=10). There was no significant difference in age or occupational background between the groups. A significant association was found between finger coldness and prevalence of Raynaud's pheno menon (p<001, χ²). The mean skin temperature was significantly lower with the severity of finger coldness (ANOVA, p<0.05). In the cold provocation test, there was no significant difference between skin temperature and coldness at 5 min and 10 min after immersion, though a difference was observed immediately after immersion. No significant difference was observed in the relationship between finger coldness and vibrotactile threshold before, during or after the cold provocation test. Conclusions The severity of coldness in the fingers is significantly related to skin temperature. The severity of finger coldness reflects the extent of peripheral circulatory vasoconstriction. Coldness in the fingers may be a good warning of potential problems in peripheral, circulatory function.     

A 4 degrees C-1 min method of cold water immersion test for peripheral circulatory function in fingers]

To assess the validity of a new simplified cold water immersion test (4 degrees C-1 min method) for peripheral circulatory function, comparison was made with the conventional method (10 degrees C-10 min method). These two different methods of cold immersion test were applied to 23 patients with vibration disease and 24 healthy men. Observation was made on finger skin temperature by a thermistor and complaints in the hand by a 5-step self-reported scale method every minute during the test. The patterns of recovery of skin temperature after cold immersion in each group were similar in both methods. Pain in the hand in the 4 degrees C-1 min method was less than that in the 10 degrees C-10 min method. The recovery rate at 5 min in the patients with Raynaud's phenomenon was lower than that in those without Raynaud's phenomenon in the 4 degrees C-1 min method (p < 0.01). However, no significant differences were noted in 10 degrees C-10 min method. The results suggest that the new method is feasible in detecting the response of vasodilation after immersion. In the recovery rate at 5 min after immersion, near values of the sensitivity and specificity were observed between 50% cut-off values in the 4 degrees C-1 min method and 30% value in the 10 degrees C-10 min method. Thus, the 4 degrees C-1 min method is considered to be more useful to evaluate the physiological response after cold immersion than the 10 degrees C-10 min method.     

Clinical evaluation of vibration-exposed complainants in field surveys

The time constraints on research workers in the field inevitably limit the depth and quality of evaluations, which have two essential components, a questionnaire on the medical and work history and simple clinical tests conducted within a reasonable time frame. The questionnaire should include subject identification and age, personal and family history, past and present occupational history, and past and present hand-arm symptoms. The clinical tests, following a physical examination of the neck and upper limbs, should seek to evaluate the cardiovascular and neurological systems in the hands and arms. Tests to demonstrate the patency of the major vessels, and the response of the digital vessels following immersion in cold water, are feasible and practical, as are neurological tests to determine skin sensitivity to touch and vibration. Grip strength should be evaluated, as well as hearing loss by audiometry. Some errors in diagnosis occur with the use of such screening tests, but subsequent hospital investigations have usually confirmed their overall reliability. It is concluded that with improved instrumentation the evaluation of vibration-exposed workers at initial and follow-up examinations can only improve, as will the validity of the counseling of workers and machine manufacturers to reduce the risk.     

手传振动工人冷水复温率影响因素的多因素Logistic回归分析

目的 检测和评估手传振动企业的手传振动危害,初步分析手传振动作业工人冷水复温率的影响因素。 方法 以广东省五家企业的接振工人为研究对象,现场检测振动接触水平,测定冷水复温率。通过问卷调查,了解不同岗位接振工人的一般情况。分析性别、年龄、吸烟、饮酒、高血压、接振剂量、不同岗位与冷水复温异常率的关联。 结果 所检测的48个接振岗位操作中有31个岗位的振动水平A (4)超过我国国家标准规定的5 m/s2,超标率64.6%。按国际上A (8)的分级标准,有28个点达到或超过Ⅰ级危险度。经单因素χ2检验,年龄、吸烟指数、高血压、接振剂量对冷水复温异常影响的差异有统计学意义(P均< 0.05)。Logistic回归分析发现,年龄≥ 40岁与冷水复温率关联的比值比(OR)=1.865(P < 0.05)。吸烟指数> 600与冷水复温率关联的OR=2.474(P < 0.05)。高血压与冷水复温率关联的OR=1.231(P < 0.05)。饮酒指数≤ 600与冷水复温率关联的OR=0.395(P < 0.05)。中剂量组、高剂量组与冷水复温率的关联的OR值分别为1.232、2.135(P均> 0.05)。 结论 所调查的企业手传振动危害严重。年龄、吸烟、高血压是影响冷水复温率异常的危险因素,饮酒指数≤ 600是保护因素。接振剂量与冷水复温异常无明显相关。     

手臂振动对手部红外图像影响的研究

对３７名手臂振动作业工人和３０名健康对照工人,在冷水试验和振动负荷试验前后,以ＫＹ－３３３型远红外摄像仪进行手都红外摄像,比较研究其图像变化。结果表明,试验前两组基础指温差异不显著;试验后接振组指温下降明显。复温时间延长,冷试后５ｍｉｎ、１０ｍｉｎ;振动负荷后即刻、５ｍｉｎ差异显著。红外图像的改变,有助于振动职业危害的亚临床研究。     

Effect of prior exposure to hand-transmitted vibration on cold response of digital arteries

Objectives To investigate whether prior exposure to hand-transmitted vibration on the day of a cold provocation test affects the cold response of digital arteries. Methods Each of ten healthy men attended two experimental sessions in which their right hands were exposed for 60 min to either contact force alone (5 N) or a combination of contact force (5 N) and 125-Hz vertical vibration with an acceleration magnitude of 64 m s⁻² r.m.s. (unweighted). Finger systolic blood pressure (FSBP) during local cooling to 10°C was measured in the second right finger (exposed hand) and the second left finger (unexposed hand) before exposure and at 30 and 70 min after the end of both exposure conditions. Results Analysis of repeated measures of FSBP during local cooling by means of an autoregressive model revealed no significant difference in cold-induced vasoconstriction of the digital arteries between exposure to contact force alone and combined exposure to contact force and vibration. There were no significant changes in the cold response of digital arteries over time in either the right or the left hand after exposure of the right hand to either the contact force alone or the combined contact force and vibration. Conclusions The results of this experimental study of the influence of prior vibration exposure on the cold test results suggest that in healthy men recent exposure to contact force and moderate levels of hand-transmitted vibration does not affect the response of finger circulation to cold provocation. These findings may be of practical importance for the definition of test conditions in the field, especially the length of time required between the last occupational exposure to tool vibration and the commencement of objective vascular testing.     

手传振动作业工人暴露水平及手臂损伤影响因素分析

目的 检测和评估某新型制造企业中手传振动水平,初步探讨手传振动作业工人手臂损伤症状的影响因素。 方法 以某企业振动作业工人为研究对象,现场检测振动暴露水平,并问卷调查工人一般情况和手臂症状,测定冷水复温率;分析高血压、高血压家族史及体质指数与冷水复温率和手臂症状的关联。 结果 所测振动水平4 h等能量频率计权加速度值A (4)为4.28~15.09(7.97±3.04) m/s2;81.3%的工人自述有手臂症状;77.5%的工人冷水复温率异常。高血压、高血压家族史和体质指数≥ 28与冷水复温率关联的比值比(OR)及95%可信区间(95% CI)在校正年龄、吸烟和饮酒后分别为1.12(0.60~5.79)、0.84(0.20~3.10)和0.64(0.36~3.56);高血压、高血压家族史和体质指数≥ 28与工人手臂自觉症状关联的OR值及95% CI在校正年龄、吸烟和饮酒后分别为1.80(0.86~7.19)、1.02(0.77~4.81)和0.75(0.68~5.27)。 结论 该新型制造企业中手传振动危害严重。尚未发现高血压、高血压家族史和高体质指数与工人手臂损伤有明显关联。     

A minireview of studies conducted in Japan using finger-skin temperature during cold-stress tests for the diagnosis of hand-arm vibration syndrome

For the diagnosis of the hand-arm vibration syndrome, cold-stress tests using different water temperatures and periods of hand immersion have been investigated in Europe, North America, and Japan. In recent years, peripheral circulation and sensory tests, including finger-skin temperature measurement involving immersion of one hand in cold water at 10 °C for 10 min, have been widely accepted in Japan. On the other hand, standardization of the vascular assessment method is under discussion at the International Organization of Standardization. We reviewed research findings from Japan concerning finger-skin temperature measurement during the cold-stress test, especially factors influencing the test results and the diagnostic significance. For establishment of the cold-stress test for epidemiology studies of the hand-arm vibration syndrome, standardization of the environmental factors influencing the test results and reporting of its sensitivity and specificity are needed. Received: 2 July 1998 / Accepted: 17 January 1999     

高压氧治疗职业性手臂振动病的疗效分析

目的 探讨高压氧治疗职业性手臂振动病(hand-arm vibration disease,HAVD)的临床疗效和安全性。 方法 2010年1月至2013年8月,选择108例职业性手臂振动病患者,随机分为高压氧综合治疗组(HBO组)和常规中西医治疗组(对照组),对照组予改善循环、营养神经、针灸、理疗等中西医综合治疗,HBO组在常规中西医治疗基础上同时进行高压氧治疗。治疗结束后比较两组患者的临床资料、神经肌电图、冷水复温试验指标及不良反应情况。 结果 两组治疗后的症状和体征均有改善。HBO组治疗手麻症状、痛觉减退、触觉减退、振动觉减退的总有效率优于对照组,差异均有统计学意义(P<0.05)。HBO组正中神经、尺神经的运动传导速度、运动远端潜伏期、感觉传导速度改善情况均优于对照组,差异均有统计学意义(P<0.05)。HBO组左、右手的5 min、10 min复温试验总有效率优于对照组,差异均有统计学意义(P<0.05)。 结论 HBO联合中西医治疗职业性HAVD疗效显著,能改善患者临床症状、体征、冷水复温率、神经肌电图,且较为安全,值得推广应用。     

Responses of sympathetic nervous system to cold exposure in vibration syndrome subjects and age-matched healthy controls

Summary Plasma norepinephrine and epinephrine in vibration syndrome subjects and age-matched healthy controls were measured for the purpose of estimating the responsibility of the sympathetic nervous system to cold exposure. In preliminary experiment, it was confirmed that cold air exposure of the whole body was more suitable than one-hand immersion in cold water. In the main experiment, 195 subjects were examined. Sixty-five subjects had vibration syndrome with vibration-induced white finger (VWF+ group) and 65 subjects had vibration syndrome without VWF (VWF- group) and 65 controls had no symptoms (control group). In the three groups, plasma norepinephrine levels increased during cold air exposure of whole body at 7° ± 1.5°C. Blood pressure increased and skin temperature decreased during cold exposure. Percent increase of norepinephrine in the VWF+ group was the highest while that in VWF- group followed and that in the control group was the lowest. This whole-body response of the sympathetic nervous system to cold conditions reflected the VWF which are characteristic symptoms of vibration syndrome. Excluding the effects of shivering and a cold feeling under cold conditions, it was confirmed that the sympathetic nervous system in vibration syndrome is activated more than in the controls. These results suggest that vibration exposure to hand and arm affects the sympathetic nervous system.     

Circulatory disturbances of the foot in vibration syndrome

Summary Circulatory disturbances of the foot in patients with vibration syndrome were studied by measuring the skin temperature of both index fingers and great toes through a 3-min immersion of the right foot in cold water at 10°C. Subjects included 11 patients with vibration-induced white finger (VWF) [VWF(+) group], 12 patients without VWF [VWF(–) group], and 20 healthy referents not exposed to vibration. Patients were all male chain saw operators who had scarcely been exposed to vibration of the foot. The prevalence of coldness felt in the upper and lower extremities was > 90% in the VWF(+) group, about 60% in the VWF(–) group, and < 10% in the referents. The extent of the coldness was greatest in the VWF (+) group. The skin temperature of both fingers and toes was lowest in the VWF(+) group, somewhat higher in the VWF(–) group, and highest in the referents both before and after immersion. These findings indicate that patients with vibration syndrome, especially those with VWF, have circulatory disturbances in the foot as well as in the hand. The disturbances in the foot may be related to long-term repeated vasoconstriction in the foot induced by hand-arm vibration through the sympathetic nervous system.     

Preliminary study on the assessment of peripheral vascular response to cold provocation in workers exposed to hand-arm vibration using laser Doppler perfusion imager

Measurements of changes in finger skin blood flow with laser Doppler perfusion imaging (LDPI) in response to cold provocation test (10 degrees C, 10 min) were performed in 12 men suffering from vibration induced white finger (VWF) and 13 exposed controls. The mean perfusion values in both groups reduced markedly as a result of immersion of the hand in cold water. In the controls, however, the mean value increased gradually until the end of the cold provocation, while that in the VWF subjects remained at the lowest level. After removal of the hand from the cold water, the skin blood perfusion in the controls recovered rapidly and nearly reached the baseline value. In the VWF subjects, it had a slight increase immediately following the cold immersion but no tendency to rise as the time span increased. Analysis of covariance controlling for possible confounders revealed that the VWF subjects had significantly lower perfusion values compared to the controls in the last several minutes of the cold provocation and the following recovery. These findings suggest that the LDPI technique enables visualizing and quantifying the peripheral vascular effects of cold water immersion on the finger skin blood perfusion and thus has the potential of providing more detailed and a&curate information that may help detect the peripheral circulatory impairment in the fingers of vibration-exposed workers.