A consecutive sample of 97,537 miners seeking compensation for Hand-Arm Vibration Syndrome were examined in a medical assessment process which included documentation of age, hand dominance, Dupuytren's disease, years of vibration exposure, history of diabetes, smoking habits and units of alcohol consumption per week. The prime determinant of prevalence of Dupuytren's disease was age, and all other factors investigated were corrected for age. There was no statistically significant correlation between years of exposure to vibration and the prevalence of Dupuytren's disease. There was a statistically significant association with smoking, alcohol consumption and diabetes mellitus, with the heaviest smokers having an odds ratio (OR) of 1.31 (95% CI, 1.17, 1.47), the heaviest drinkers (in excess of 22 units a week) having an OR of 1.59 (95% CI, 1.47, 1.72) and diabetes mellitus patients having an increase in the odds of having Dupuytren's disease of 1.52 (95% CI 1.30, 1.77).

Assessment (staging) of workers exposed to vibration, based solely on a subjective history, has been shown to be unsatisfactory. The internationally agreed use of a sensorineural component in the Stockholm classification requires the use of sensory objective tests. Four hundred and twenty two subjects were assessed by a subjective history supplemented by multiple objective tests. These tests covered the vascular, sensorineural, musculoskeletal and dexterity aspects of hand-arm vibration syndrome. Tests to help with the differential diagnosis were also performed. Sensorineural tests are reported as are the associations between the subject's final Stockholm sensorineural staging and the subject's aesthesiometry, temperature threshold results, and grip strength. Scoring systems for these tests were evolved. Data showed that multiple sensory tests increased the accuracy of staging. Aesthesiometry, the temperature neutral zone tests, and grip strength were appropriate for the assessment of the sensory component, especially in separating sensorineural stages 0 and 1 from sensorineural stages 2 and 3. This is an important separation for an occupational physician monitoring subjects exposed to vibration. Analyses of the sensory tests clearly indicated that they need to be done on all digits. In this survey the sensorineural damage was greatest in the forefinger (second) and the little (fifth) fingers. No association was found between smoking and the final staging, aesthesiometry, temperature neutral zone thresholds, or grip strength.

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.

In the United Kingdom the diagnosis of Hand-arm Vibration Syndrome varies depending on the purpose of that diagnosis. The criteria differ in three situations. More than 100,000 miners and ex-miners with claims for HAVS have been examined using a Medical Assessment Process which included the use of standardised tests. This contract is unique but it has had significant effects on the two other processes. The Industrial Injuries Disablement Benefit Scheme provides a benefit that can be paid to an employed earner because of an accident or Prescribed Disease. New recommendations have been published to remove the anomalies in the present format for assessing HAVS. If implemented the new scheme will recognise the Stockholm Workshop Scales and workers with neurological problems will also be compensated. The Health and Safety Executive will issue new guidance in the near future on the hazards of hand-arm vibration. Health surveillance in the workplace will be fundamental and the HSE propose a tiered approach with levels 1 to 5. Specialist occupational nurses and doctors with training in the diagnosis and assessment of HAVS will be needed for levels 3 and 4. Only at this level may a diagnosis of HAVS be made. The Medical Assessment Process has demonstrated that it is possible to examine a large number of claimants in a standardised manner. The IIAC and HSE recommendations contain very important improvements on the existing positions in the UK and it must be hoped that they will be implemented in the near future.

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