Cold-Provocation Testing for the Vascular Component of Hand-Arm Vibration Syndrome in Health Surveillance

Abstract

Abstract: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°C for 5 min) in vascular hand-arm vibration syndrome (HAVS). Twentyone controls and 33 individuals with stages 2/3V HAVS were studied. The standard measurement of time to rewarm by 4°C (T4°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°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°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.

A non-invasive technique for the evaluation of peripheral circulatory functions in female subjects with Raynaud’s phenomenon

“…For instance, Poole et al 24 ) , used a cold provocation test of 15°C for 5 min. In another study by Harazin25 ) , two cold provocation tests of 14°C for 10 min, and 12°C for 5 min were used to compare the recovery of FST in healthy subjects.…”

Digital Rewarming Patterns After Median and Ulnar Nerve Injury

“…11,15 In patients exposed to vibration tools (e.g., forestry workers, construction workers), Raynaud's disease, complex regional pain syndrome, or digital replantations and amputations, several laboratory tests have been used to study digital blood flow and skin temperature, for example, laser Doppler flowmetry, 31,40 -47 plethysmography to measure the amount of blood inflow, 27,34,43 finger systolic blood pressure, 26,33,48 -50 thermocouples on the skin, 4,44,45,51,52 and infrared thermography. 23,36,43,[53][54][55][56][57][58][59] However, to our knowledge, rewarming has been evaluated in nerve injury patients only by Ruch 40 in recent injuries (Ͻ3 months old) using laser Doppler flowmetry and thermocouples and by Pulst 59 in recent injuries (1-19 months) using infrared thermography at 7 and 15 minutes after immersion of the hands in ice water. During the first 6 months after nerve repair, they observed vasodilatation of the area supplied by the nerve at room temperature and after cold stress testing because of loss of sympathetic activity.…”

Detection of inflammation from finger temperature profile in rheumatoid arthritis

“…According to the measurement protocol, it has been reported that using infrared thermography with a water temperature of 5°C for 1 min gives a good sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of digital vasospasm [27]. In [39], the authors used a cold provocation test in water 15°C for 5 min; it was not found to be statistically significantly different patients from controls. Ring [36] used a cooling time of 60 s in water temperature from 0 to 20°C for Raynaud's phenomenon.…”