Sensorineural objective tests in the assessment of hand-arm vibration syndrome.

Abstract

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.

Exposure‐response relationship between hand‐arm vibration and vibrotactile perception sensitivity

“…Few studies have addressed the question of vibration exposure and vibrotactile perception. Vibrotactile perception thresholds among vibration exposed workers have been measured in relation to the staging of HAVS [Hayward and Griffin, 1986;McGeoch et al, 1994] and in comparison to other methods of assessing vibration-neuropathy [Sakakibara et al, 1996]. Other investigators have focused on the distribution of vibrotactile impairment in the hands of vibration-exposed patients .…”

Relationship between self-reported upper limb disability and quantitative tests in hand-arm vibration syndrome

“…Quantitative tests such vibrotactile and thermal perception thresholds, hand-grip strength and manipulative dexterity have been widely used in HAVS assessment. Lawson and McGeoch [1,6,20] have derived and applied a system within which the use of such tests is clearly defined and integral to assessing Stockholm workshop staging. This was closely related to the 'standardization' of quantitative tests, such as vibrotactile and thermal perception, in the UK [12,21].…”

“…A battery of established quantitative tests have been applied in the assessment of vibration exposed individuals including vibrotactile and thermal perception thresholds, Purdue pegboard and grip strength [6,7]. The vibrotactile and thermal perception tests assess specific receptor and sensory nerve damage in the hand/fingers.…”

Can a battery of functional and sensory tests corroborate the sensorineural complaints of subjects working with vibrating tools?

“…McGeoch et al (1994) reported much more severe symptoms (25% at stage SN2 and 9% at stage SN3); the population however, was much older and had had, on average, 25 years of exposure to vibration.…”