Exposure-response relationship in the hand-arm vibration syndrome: an overview of current epidemiology research

Abstract

The complex of vascular, neurologic, and osteoarticular disorders occurring in the upper limbs of vibration-exposed workers is called hand-arm vibration syndrome. There is epidemiologic evidence for an increased occurrence of peripheral sensorineural disorders in occupational groups working with vibrating tools. An excess risk for wrist osteoarthrosis and for elbow arthrosis and osteophytosis has been reported in workers exposed to shocks and low-frequency vibration of high magnitude from percussive tools. However, there are too few epidemiology data to enable reliable conclusions to be drawn about exposure-response relationships for both sensorineural disturbances and bone and joint disorders caused by hand-transmitted vibration. Cross-sectional and longitudinal epidemiology studies have shown that occupational exposure to hand-transmitted vibration from a great variety of hand-held tools is significantly associated with an increased occurrence of digital vasospastic disorders called vibration-induced white finger (VWF). The proposal of an exposure-response relationship for VWF has been included in an annex to the international standard ISO 5349. The findings of several epidemiology studies have shown a poor agreement between the risk for VWF observed in various occupational groups and that predicted by the ISO 5349 model. Both overestimation and underestimation of the occurrence of VWF have been reported by investigators. It has been argued that the current ISO frequency-weighting curve for hand-transmitted vibration may be inappropriate for the assessment of vibration-induced adverse vascular effects. Alternative exposure-response relationships for VWF have been suggested in recent epidemiology studies. The epidemiology data used to construct current exposure-response relationships for vibration-induced injuries are primarily derived from cross-sectional studies. Future epidemiology research should be based on prospective cohort studies because the design characteristics of such studies permit the study of cause-effect relationships and the formulation of etiologic hypotheses.

A prospective cohort study investigating an exposure–response relationship among vibration-exposed male workers with numbness of the hands

“…Bovenzi requests prospective cohort studies to establish this relationship. (3). We believe that the present study may be an important contribution to our knowledge in this area.…”

“…Cases of HAVS have been reported mainly in countries with colder climates but also in tropical regions (2). The most evident sensorineural symptoms are tingling and numbness of the hand, and it has been tentatively suggested that the earliest symptoms are more likely to be neurological, preceding vascular symptoms (3).…”

“…Evidence for an exposure-response relationship for HAV exposure and neurological (sensorineural) symptoms is not very strong (3,4). There are few longitudinal studies investigating this relationship and most of the reported studies have been cross-sectional (5)(6)(7).…”

“…The majority of those with HAVS are considered to suffer from neurological symptoms, and the main interest in this study is for the neurological component of HAVS as the vascular disorder has been more extensively investigated (3,8).…”

Study of the biodynamic response of the foot to vibration exposure

“…Intrinsic variables can include population type (age, sex, size, and health), experience, body posture, and types of activities [16]. Conversely extrinsic variables can include vibration magnitude, vibration frequency, vibration axis, vibration input position, vibration duration, and other influences such as noise, heat, acceleration, and light [16,18,19]. When evaluating the biodynamic response of the human body to vibration, an understanding of the resonant frequency and transmissibility is required.…”