Proposal for hand-arm vibration exposure limits adopted for Japanese workers operating hand-held vibrating tools

On the basis of data presented in our previous reports, the current study was undertaken to estimate frequency-weighted hand-arm vibration exposure limits for various daily exposure times. The procedures for the present study were as follows. (1) The prevalence of vibration-induced white finger (VWF) as well as the vibration exposure were investigated in various groups of workers operating hand-held vibrating tools. The vibration magnitude of various tools was measured and the results were presented as the energy-equivalent frequency-weighted root-mean-square (m/s²?rms) acceleration. There was?a statistically significant positive correlation between the prevalence of VWF and the measured vibration magnitude (R ²=0.5, P<0.05). Hence, it was concluded that in decisions concerning quantitative recommendations for vibration exposure, the prevalence of VWF should be considered. (2) By a careful selection of available publications which contain useful information on duration of vibration exposure of ?2?h/day and the occurrence of VWF, a significant correlation between the prevalence of VWF and the vibration magnitude could be observed. The regression equation was estimated as: y=?18.5+4.6 (x), R ²=0.8. On the basis of this equation, it was speculated that the prevalence of VWF in workers using vibrating tools might be restricted to the prevalence of Raynaud’s phenomenon in the Japanese general population if the 2-h daily vibration exposure is about 4.5?m/s²?rms. (3) Regarding this speculation, the equation provided in the documentation of ISO 5349 was used and modified as: [(a _h,w) _eq,t =(a _h,w)_eq,2??(2/t)^1/2 (m/s²?rms)] and then the vibration limit values for daily exposure of 1?min to 8?h were calculated. (4) In order to achieve compatibility with standards of other countries, and to formulate an easy method for using the recommended values presented here, the daily exposure time of 8, 4, 2, 1 and 0.5?h were selected. The correspondence vibration magnitudes were in the range 2.2–9.0?m/s²?rms, and the lower limit (2.2?m/s²?rms) was assumed as the permissible vibration exposure limit for an 8-h working period. The proposed daily vibration limits were then compared with those recommended by other institutions.     

Effects of combined hand-arm vibration and cold on skin temperature

Summary Under laboratory conditions 14 healthy male subjects were exposed to hand-arm vibration (a_hzw = 6.3 m/s²) at different air temperatures (5°, 12°, 18° and 25°C). Static load (grip force 15 N, push force 40 N) was kept constant. Finger tip temperature as an indirect criterion of the peripheral blood circulation was measured. As expected, low air temperatures (5°, 12° and 18°C) cause a strong decrease of skin temperature. Under additional stress of vibration connected with static load, a further decrease of the mean skin temperature was noted. At this, static load proved to have a predominant influence on the acute diminution of skin temperature. The individual reaction to the stressors varied considerably. Field tests during practical work with a chain saw at low air temperatures showed results similar to those of the laboratory tests. The protective effect of a grip heating system could be demonstrated.Paper presented at the United Kindom and French joint meeting on Human Response to Vibration, 26–28 September 1988, INRS, Vandeuvre, France     

Epidemiological survey of shipyard workers exposed to hand-arm vibration

Summary All 169 caulkers employed at a ship yard were examined to determine the prevalence of vibration syndrome due to pneumatic portable tools (chipping hammer and grinders).Vibration measurements and medical investigations were performed in the field between September 1977 and July 1978.Vibration spectra recorded on pneumatic tools were compared to ISO Draft Proposal No. 5369. The chipping hammer produced the highest acceleration levels and exceeded the maximum ISO limits even for a short exposure time (30 min per shift).The results of medical investigations pointed out that 78.7% of caulkers experienced paresthesia in their hands, 31.3% Raynaud's phenomenon (or VWF), 20.1% presented with radiological signs of osteoarthritis at wrist and shoulders, 10.0% with olecranon exostoses, and 31.3% with cysts of the carpal bones.To diagnose VWF the skin temperature of the hands were recorded in all 169 caulkers and 60 controls at the shipyard. The basal skin thermometric map (recorded in 16 positions per hand) demonstrated an average difference of 2–2.5°C between the two populations.The thermometric curve, monitored every 3 min for 40 min after a provocative cold-test (immersion of hands and wrists in melting ice for 2 min), well differentiated workers exposed and not exposed to vibrations.The authors emphasize that skin temperature (before and after the coldtest) are suitable for epidemiological purposes to compare the prevalence rates of VWF in control-experimental groups.The results of this study were presented at the International Symposium on Man Under Vibration, Suffering, and Protection, Udine (Italy), 3–6 April 1979     

Risk assessment of vibration exposure and white fingers among platers

Summary The dose-response relationship between vibration exposure and vascular disorders in the hands was examined in platers. The study was based on a cross section of 89 platers and 61 office workers divided according to exposure to vibration into four groups. Vibration exposure was assessed by measuring the acceleration intensity on a sample of tools, together with both subjective rating and objective measurements of the exposure time. The frequency-weighted energy equivalent acceleration for 4 h was 4.6–4.7 m/s². The point prevalence of white fingers was 42% for the plater category currently exposed with an odds ratio of 85. The time laps before contraction of white fingers (latency time) was four years for the 10th percentile, and was shorter than predicted according to the ISO-5349 standard. The prevalence of white finger symptoms staged according to the Taylor-Pelmear scale was comparable to the prevalences according to the Stockholm Workshop Scale. Vibration exposure was the dominant source of white fingers and each year of vibration exposure increased the odds ratio for white fingers by 11%. Distal circulation in the hands was assessed by a timed Allen test. The odds ratio for a positive Allen test was higher for the workers exposed to vibration compared to the non-exposed workers. The use of the timed Allen test is suggested in the clinical examination for vibration white fingers. The observed high risk for contracting white fingers could be prevented by exposure level reduction and/or restriction of exposure duration.     

Effectiveness of therapy with iloprost in hand-arm vibration syndrome

AIM: To evaluate the efficacy and tolerance of therapy with iloprost in hand-arm vibration syndrome. METHODS: We describe a clinical case of a male aged 53 years, who was a heavy smoker for 30 years and a mason working with vibrating tools since 1962. He presented with a history of 10 years of attacks of vasospasm, functional impairment and digital ulceration. He was diagnosed as having hand-arm vibration syndrome vascular stage 4 on the Stockholm Workshop 1986 Scale. Besides suspension from work and abstention from smoking, we began intravenous infusion of iloprost for 6 h in cycles of 3-6 consecutive days, arriving at a dose of 1.5-2.0 ng/kg/min. RESULTS: After eight cycles, he reported significant symptomatic and functional improvement. Iloprost was seen to be efficacious: the trophic skin lesions disappeared and his microcirculatory perfusion tests improved. There were no significant side effects. CONCLUSIONS: We suggest that the use of iloprost in the treatment of the most advanced stages of vascular hand-arm vibration syndrome warrants further study     

Combined effects of hand-arm vibration and noise on temporary threshold shifts of hearing in healthy subjects

 Object: To investigate whether hand-arm vibration and noise have a combined effect on temporary threshold shift (TTS) of hearing among healthy subjects. Method and design: Nineteen healthy subjects with an average age of 25.7 (SD 7.7) years were exposed to vibration (30 m/s², 60 Hz), noise [90 dB(A)] and both, respectively. The subject’s right hand was placed on the plate of a vibrator and the right ear exposed to noise via headphones. Subjects were exposed to vibration and/or noise for 3 min and after a 1-min pause the exposure was repeated five times. Hearing thresholds at 1, 4 and 6 kHz were measured during the time periods before, between (during pauses) and after exposure. Results: Exposure to vibration alone caused almost no hearing threshold changes at every frequency tested. But exposure to noise or a combination of vibration and noise caused a significant increase in TTSs at 4 and 6 kHz. Moreover, exposure to a combination of vibration and noise caused significantly higher TTSs than exposure to noise at 4 and 6 kHz. Conclusion: The present results demonstrate the combined effects of hand-arm vibration and noise on hearing: simultaneous exposure to hand-arm vibration and noise can enhance the TTS of hearing more than noise exposure, though hand-arm vibration alone may hardly affect TTS. Received: 14 May 1996/Accepted: 20 September 1996     

Assessment of autonomic nervous activity in hand-arm vibration syndrome patients using time- and frequency-domain analyses of heart rate variation

Objectives: The aim of the present study was to non-invasively assess autonomic nervous activity, using time- and frequency-domain analyses of heart rate variation (HRV), and to investigate the relationship between indices of HRV and duration of exposure to vibration (DEV), time since retirement from work involving vibration (TR) and time undergoing treatment (TT) in a group of patients with hand-arm vibration syndrome (HAVS). Subjects and methods: Twenty one HAVS patients who were no longer exposed to vibration and were undergoing standard treatment for HAVS, and 10 healthy control subjects, similar to the patients in age, height, weight and number of current smokers and drinkers, volunteered for this study. Indices of HRV [time-domain indices (the mean of R-R intervals, standard deviation and coefficient of variation) and normalized units of frequency-domain indices [low frequency (LF) and high frequency (HF) components], indicating parasympathetic nervous activity, were calculated from 2 min electrocardiographic data recorded during spontaneous breathing by subjects in supine rest. Results: The LF and HF components of the patients were significantly lower than those of the healthy controls (P < 0.05). When Pearson correlation analysis was applied for the patient group, using indices of HRV with age, weight, height, DEV, TR and TT, the LF components positively related to TR and TT (P < 0.01). The patients were thus divided into three groups as follows, according to TR: group A (≤1 year), group B (>1 to <5 years) and group C (≥5 to ≤10  years), or according to TT: group X (≤1 year), group Y (>1 to <5 years) and group Z (≥5 to ≤10  years). The LF components of the groups A and X were significantly lower than that of the healthy controls (P < 0.01). The HF components of the groups A and X were also significantly lower than that of the healthy controls (P < 0.05). Conclusions: The findings of the present study indicate decreased cardiac parasympathetic activity in the HAVS patients in comparison to the healthy controls. The TT and TR significantly influenced the HRV results in these patients; however, the DEV did not. The findings also indicate that treatment and cessation of exposure to vibration might have a beneficial effect on the cardiac parasympathetic activity in HAVS patients. Received: 18 March 1999 / Accepted: 14 June 1999     

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     

The sensitivity and specificity of thermometry and plethysmography in the assessment of hand-arm vibration syndrome

Background Finger plethysmography and thermometry are objectivemeasures used to assess the vascular aspect of hand–armvibration syndrome (HAVS). Research to date shows poor correlationbetween these tests and Stockholm Workshop Scale (SWS) vascularstage. Clinicians, researchers and compensation boards requireobjective means to diagnose and quantify HAVS. Aims To define the specificity and sensitivity of thermometryand plethysmography using the SWS as the reference criterion.A secondary goal was to consider cut points for the tests optimizingsensitivity and specificity. Methods A cross-sectional analysis was conducted on HAVS patientsseen at an occupational medicine specialty clinic. Plethysmographyand thermometry were analyzed using SWS vascular stage as theoutcome variable. Logistic regression controlled for age, smokingand time since last vibration exposure and use of vasoactivemedications. The sensitivity and specificity of the combinedtests were calculated using varying cut points. Results A total of 139 patients consented to participate inthe study. Plethysmography stage 1 or greater showed the highestsensitivity (sensitivity 94% and specificity 15%). Specificitywas optimized combining plethysmography stage 3 and thermometrystage 3 (specificity 98% and sensitivity 23%). Maximal diagnosticaccuracy was achieved by plethysmography alone setting the criteriafor a positive test as being stage 1 or greater (70%). Conclusions Neither plethysmography nor thermometry either aloneor in combination demonstrated sufficient sensitivity and specificityto serve as an objective correlate for SWS vascular stage. Allcombinations of plethysmography and thermometry showed a lowerspecificity than sensitivity indicating that the SWS may beless sensitive in detecting vascular pathology than the objectivetests.     

Delivery of health surveillance for hand-arm vibration in the West Midlands

BACKGROUND: Concerns about provider competence and quality of hand-arm vibrations (HAVs) health surveillance programmes were identified by Health & Safety Executive (HSE) inspectors. AIMS: To evaluate health surveillance programmes and compare them with published HSE guidance. To identify deficiencies and areas for improvement in the health surveillance programmes. METHODS: A proforma was developed for the study and used on a sample of 10 local occupational health providers. RESULTS: All 10 organizations were aware of current HSE guidance for health surveillance for HAVs but only a minority (30%) were following it. Occupational health provider training, written procedures and health surveillance delivery were all identified as areas requiring improvement. CONCLUSIONS: The majority of organizations were not following HSE guidance. Occupational health providers undertaking health surveillance for HAV require specific training.     

Assessment of the hand-arm vibration syndrome: thermometry, plethysmography and the Stockholm Workshop Scale

BACKGROUND: The Stockholm Workshop Scale (SWS) provides a staging scheme for hand-arm vibration syndrome (HAVS) based on subjective history. Cold provocation finger thermometry and plethysmography are commonly used objective tests for the vascular component of HAVS. AIM: To examine the correlation between the cold provocation tests and SWS vascular stage. A secondary goal was to evaluate the correlation between cold provocation finger plethysmography and thermometry testing. METHODS: Patients investigated for HAVS at St Michael's Hospital, Toronto, Ontario, were subjected to the same protocol including a questionnaire, clinical assessment and objective testing. Spearman correlation coefficients were calculated for the vascular tests with the SWS and for the vascular tests themselves. Logistic regression models controlled for age, smoking, use of vasoactive medications and time since last vibration exposure. RESULTS: One hundred and thirty-nine patients investigated for HAVS consented to participate in the study. The correlation coefficients for plethysmography (rho = 0.14) and thermometry (rho = 0.18) with the SWS were not statistically significant. Plethysmography and thermometry results were significantly correlated (rho = 0.47, P < 0.001). Logistic regression showed plethysmography and thermometry to weakly predict SWS vascular stage (OR 1.5 and 1.3, respectively). None of the potential confounders had a significant effect in the models. CONCLUSION: The results of plethysmography and thermometry did not significantly correlate with SWS vascular stage in this study. The objective tests did correlate with each other, suggesting that they are reliable measures of similar phenomena likely related to underlying vascular pathology.     

A medical assessment process for a large volume of medico-legal compensation claims for hand-arm vibration syndrome

BACKGROUND: The judgement on preliminary issues of nine lead cases of suspected hand-arm vibration syndrome (HAVS) in former coal miners in the UK ruled that there was evidence of damage and breach of duty of care (Armstrong and Others v. British Coal, 1996). In anticipation of > 120 000 cases and at significant cost, a handling agreement was prepared in 1999. This recommended a single medical assessment process (MAP) to determine general damages for which almost 200 doctors attended 2 days of training. AIMS: This paper outlines the assessment process and the results to date. METHODS: Seventeen test centres across the UK were commissioned. Standardization of the performance by both the doctors and technicians within individual examination centres and across all centres was necessary. A pragmatic solution using 'best available assessment techniques', whilst at the same time coping with the large number of claimants, was required. Doctors were trained to administer questionnaires for clinical symptoms, past medical history and occupational history, and a standardized clinical assessment pro-forma. Three standardized tests were used: vibrotactile thresholds, thermal aesthesiometry and cold water provocation testing. A modification of the Stockholm Workshop Scales and scoring system was adopted. At time of writing, 52 490 claimants had been assessed by the MAP. RESULTS: Analysis of results showed that 5% were assessed at 0SN, 15% at 1SN, 18% at 2SN (early), 28% at 2SN (late), 33% at 3SN, 21% at 0V, 13% at 1V, 38% at 2V and 28% at 3V. CONCLUSION: It is concluded that the MAP is a practical and time-efficient tool for assessing a large volume of claimants with suspected HAVS. Further analysis of the process and staging is required to confirm its validity as a medico-legal examination.     

A comparison between two methods of aesthesiometric assessment in patients with hand-arm vibration syndrome.

Hand-arm vibration syndrome (HAVS) is caused by prolonged exposure to vibration. The diagnosis and assessment of disease severity are subjective at present. The aim of this study was to determine sensorineural dysfunction in patients with HAVS using two methods of aesthesiometric assessment. We recruited three groups of age-matched subjects: 20 subjects diagnosed as having HAVS, 15 manual workers and 15 sedentary workers. We measured both two-point discrimination and depth sense perception using an aesthesiometer. We found that the two-point discrimination wheel was more accurate than the depth sense perception wheel at detecting levels of sensorineural dysfunction in subjects with HAVS. The increased sensitivity of the two-point disc would suggest that it should be used in preference to the depth sense disc for the assessment of sensorineural dysfunction in patients with HAVS.     

Risk of hand-arm vibration syndrome according to occupation and sources of exposure to hand-transmitted vibration: A national survey

BACKGROUND: Although some occupational sources of hand-transmitted vibration (HTV) have been extensively investigated, the risks associated with others are poorly characterized. METHODS: A questionnaire was mailed to a community sample of 12,240 men aged 16- 64 years and 906 men from the armed forces. Questions covered current occupation, sources of HTV, numbness or tingling in the fingers in the past week, and finger blanching. In the 5,364 respondents who had been at work in the past week, associations between symptoms and exposures were examined by logistic regression, with odds ratios converted into prevalence ratios (PRs). RESULTS: Altogether, 513 men (10%) reported cold-induced finger blanching and 769 (14%) sensory symptoms in the fingers. The risk of blanching was increased in builders (PR 2.4, 95% CI 1.0-5.2), carpenters and joiners (PR 1.9, 95% CI 1.0-3.4), motor mechanics (PR 2.3, 95% CI 1.1-4.6), and laborers (PR 2.8, 95% CI 1.3-6.0); while the risk of sensory symptoms was elevated in laborers (PR 4.0, 95% CI 2.3-6.6) and plant operatives (PR 3.5, 95% CI 1.9-5.9). Use of hand-guided mowers, concrete breakers, chain saws, and jig saws was significantly associated with symptoms. CONCLUSIONS: Little attention has been paid to the risks of vibration injury in construction workers, woodworkers, motor mechanics, and laborers, or to the risks from mowers, jig saws and several other common vibratory tools. These should be a focus for further investigation and preventive measures.     

Review of objective tests for the hand--arm vibration syndrome

The Health and Safety Executive has recommended health surveillancefor all workers in jobs identified as giving rise to significantrisk of the hand-arm vibration syndrome. Objective tests arenot routinely recommended for workplace surveillance but mayhave a role in the assessment of accurate staging or if decisionson an individual's continuing exposure is in question. Thispaper covers the use of multiple objective tests, the collectionof routine data, a proposed scoring system for the sensorineuralcomponent and discusses the role of cold provocation testingin the diagnosis of the vascular component.     

Dependency of temporary threshold shift of vibratory sensation in fingertip on 1/3 octave-band hand-arm vibration exposure period

Objectives  To investigate the dependency of temporary threshold shift of vibratoty sensation (TTS_v) in fingertip on hand-arm vibration exposure period. Methods  Six healthy students were instructed to grip a vibrating or nonvibrating handle in the experimental room. The gripping force was 40 N. The vibratory sensation threshold at 125 Hz was measured before and after the exposure in the exposed middle fingertip. The exposure vibration was vertical and the 1/3 octave-band vibration with had a central frequency of 200 Hz and an intensity of 39.2 m/s². The exposure periods were 8, 15, 30, 60, 120, 240 and 600 s. TTS_v,t was evaluated as the difference in vibratory sensation threshold between immediately before and t seconds after the exposure. Results  TTS_v recovered exponentially as in several previous studies and its use enabled us to estimate the time constant and TTS_v,0. TTS_v,0 with vibration exposure was significantly larger than that without it. The regression analysis of the relationship between vibration exposure period (T) and TTS_v,0 (T) for each subject confirmed the good fit of the equation TTS_v,0(T)=B₀+B₁ ^*Log₁₀(T), where B₀ and B₁ are the calculated constants (adjusted R²=0.56–0.87). The time constants did not show such a clear dose effect relationship of exposure period as TTS_v,0. Conclusion  The dependency of TTS_v,0 on vibration exposure period was asymptotically proportional to the logarithm of gripping period. To more quantitatively confirm the relationship of the time constants for recovering time course of TTS_v, it may be necessary to improve the measurement method for TTS_v.     

The effects of combined exposure to road traffic noise and whole body vibration on types of attention among men

Background: Noise and vibration are considered as harmful physical agents in the environment which have adverse effects on cognitive performance. One of the occupations at risk is driving, where there is a possibility of simultaneous exposure to road traffic noise and whole body vibration (WBV) transferred through the vehicle. This study aims to assess the effects of single and combined exposure to road traffic noise and WBV on different types of attention in men. Methods: The experiment was conducted on 24 men in 4 steps, executed on each participant inside an acoustic room. After recording a number of various attention scores at background conditions (27 dBA noise, no vibration) the participants were given single and combined exposure to noise levels at 55 and 85 dBA and vibration magnitude of 0.65 and 0.95 m/s² r.m.s. Results: As for combined exposure to noise and vibration, increasing vibration acceleration and noise levels at the same time compared to background condition caused a rise in the score of all visual attention types among groups exposed to low vibration acceleration and those exposed to medium acceleration and low noise. Nevertheless, when noise level and vibration acceleration is increased at the same time compared to background, auditory attention type scores mostly fell among groups with similar vibration accelerations. Conclusions:Overall, single and combined exposure to environmental stressors under investigation had a predominantly negative effect on auditory attention while the effects on visual attention were inconclusive. Definitive conclusions however require further systematic and comprehensive experiments.     

The analysis of sensitivity, specificity, positive predictive value and negative predictive value of cold provocation thermography in the objective diagnosis of the hand-arm vibration syndrome

The diagnosis of digital artery vasospasm in the hand-arm vibration syndrome (HAVS) is clinically based, and the need for an accurate objective test to support the diagnosis has been highlighted. This study aims to analyse the potential of cold provocation thermography (CPT) to fulfill this role. CPT was performed on two groups of subjects: 10 controls and 21 patients with Raynaud's phenomenon (RP) secondary to HAVS. After taking a pre-cooling image, patients donned latex gloves and immersed their hands in water at a temperature of 5 degrees C for 1 min. The patients removed their hands from the water and discarded the gloves, and further images were taken every 30 s for 10 min. On each image, the temperatures of the tip and base were analysed for each digit. The sensitivity, specificity, positive and negative predictive values for fingertip temperatures only, fingertip and fingerbase temperatures combined, and fingertip temperature, fingerbase temperature and temperature gradient combined were determined. Patients with RP secondary to HAVS demonstrated significantly lower finger tip and base temperatures and lower digital temperature gradients at all time intervals when compared with controls (P < 0.01, Student's t-test). CPT has good sensitivity, specificity, positive predictive value and negative predictive value; it strongly supports the clinical diagnosis of digital vasospasm.     

Hand-arm symptoms related to impact and nonimpact hand-held power tools

 Hand and arm symptoms among workers using impact and non-impact hand-held power tools were investigated in a cross-sectional study and a 5-year follow-up study. The study population consisted of concrete workers (n=103), truck assemblers (n=234), electricians (n=101), platers (n=140) and lumberjacks (n=102). Of the original 680 subjects, we followed up 312 after 5 years. A questionnaire concerning ongoing hand and arm symptoms, daily exposure to hand-held power tools, type of tool used, and individual factors was administered. More workers using low-frequency impact tools than workers using non-impact tools reported symptoms in the elbows and shoulders. Elbow symptoms were accentuated in the cross-sectional study, while shoulder symptoms were accentuated in the follow-up study. Wrist symptoms were reported by more of those working with high-frequency impact tools than of those using only non-impact tools when the analyses were controlled for age, years in the occupation and smoking habits. A possible explanation of the results found in this study is that low-frequency impact vibration is transmitted to the upper arm, and thus the elbow and shoulder are at risk, while high-frequency impact vibration is attenuated in the hand and wrist and may predominantly cause symptoms there. Received: 7 June 1995 / Accepted: 2 May 1996     

Prevalence of vibration-induced white finger and assessment of vibration exposure among travertine workers in Italy

Summary Among 76 stonedrillers and stonecutters/chippers working in the Rapolano travertine quarries (Tuscany, Italy), 27 subjects (35.5%) were affected with vibration-induced white finger (VWF). The median latent period for VWF was ten years (range 0.1–26 years). A VWF prevalence of 8% was found among 60 comparable controls (P < 0.0001). Vibration measurements showed that the frequency-weighted accelerations for two rock-drills and two small chipping hammers ranged from 19.7 to 36.4 m/s². Weighted accelerations between 2.4 and 4.1 m/s². were measured on the handles of a vertical grinder and a hand cutter. Vibration data, daily exposure time and total duration of exposure period were used to calculate two indicators of vibration dose such as the four-hour, energy-equivalent, frequency-weighted acceleration (m/s²) and the vibration exposure level (dB). A significant association between the vibration exposure level and the severity of VWF stages was observed among the travertine operators. The dose-effect relationship proposed by ISO 5349 was not suitable for the data of the present study because it overestimates the risk due to hand-transmitted vibration in the travertine workers. Finally, the results of a cold test indicated that the rewarming time of fingertips to room temperature was more prolonged in the operators with VAT than in those without VWF and in the controls.