GEMNE G, PYYKKO I, TA YLOR W, PELM EAR PL. Th e Stockholm Work shop scale for the classification of cold-induced Raynaud 's phenomenon in the hand -arm vibration syndrome (revision of the TaylorPelmear scale). Scand J Work Envi ron Health 13 (1987) 275-278. On the basis of experience accumulated over the past few years, a revision has been made in the currently used Ta ylor-Pelme ar scale for the staging of Raynaud's phenomenon in persons exposed to vibrat ion from hand-held tools, while retaining as much as possible of the well-established adva ntages of the scale for research and its pro ved usefulness for clinical and medicolegal purposes. The 0T and ON stages of symptoms ha ve been omitted, together with the parallel disab ility scale. A separat e staging for neurological disord ers connected with the syndrome was proposed and accepted at the workshop "Symptomatology and Diagnostic Methods in the Hand-Arm Vibration Syndro me," held in Stockholm in 1986. The criteria descriptions have been changed so as to minimize their reliance on seasonal fact ors. The new staging system -a stage°and four stages (1-4) with attacks of cold-induced Raynaud's phenom enon -clearly defines th e differences in the descrip tions of the stage criteria in order to improve their clinical usefulness. A numerical scoring based on the extent and distribut ion of finger blanch ing was not , however, introduced, whereas a score based on the numb er of af fected fingers on each hand was prop osed, co nsidered, and accepted .Key terms: hand-held vibrat ing tool s, Raynaud ' s phenomenon , vibration-ind uced white fingers, VWF.An assessment of the subjective symptoms of vascular and neurologi cal disturbances manifested in the handarm vibration syndrome is essential to clinical work and research. At the Stockholm workshop entitled "Symptomatology and Diagnostic Methods in the Hand -Arm Vibration Syndrome" a session was devoted to a discussion of this question . The startingpoint was a contribution by Taylor, who gave a comprehensive survey of the background of the curr ently used Ta ylor-Pelmear scale (10, 12) and the special considerations requ ired to carry out a correct staging. It also dealt with the usefulness of the scale for research, for practical clinical work, and for medicolegal purposes. Motives for revisionIt became clear from the discussions that this scale should be revised. The main reason commonly ex-

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A hand-arm vibration syndrome occurs in some workers who use hand held vibrating tools. It is recognised to consist of white fingers, diffusely distributed finger neuropathy, pain in the arm and hand, and a small excess risk of osteoarthrosis from percussion to the wrist and elbow. Carpal tunnel syndrome is mainly due to ergonomic factors other than vibration, but certain factors related to vibration may contribute to its development. A decrease in muscle power induced by vibration, and excessive hearing deficit have been postulated. (Occup Environ Med 1997;54:90-95)

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To evaluate neurological symptoms in the vibration syndrome, 55 patients with vascular and neurological symptoms in the hands who had been exposed to vibration were examined. Their exposure to vibration was estimated and neurological and vascular symptoms were evaluated according to symptom scales. Temperature thresholds were measured on the right thenar eminence and on the distal volar aspect of the second and third fingers held together on both sides. Vibration thresholds were measured dorsally on the second and fifth metacarpal bones and on the second and fifth fingers proximal to the nail roots. Subjects with advanced neurological symptoms had higher temperature and vibration thresholds than subjects with less advanced symptoms. No such relation was found between vascular symptoms and the outcome ofsensory testing. Thus neurological but not vascular symptoms are reflected by the outcome of quantitative sensory testing. In subjects with advanced neurological symptoms the tests gave a high proportion ofabnormal results, indicating that these tests may be used for the diagnosis of vibration syndrome on an individual basis. Patients with advanced vascular and neurological symptoms had higher exposure dose scores than patients with less advanced symptoms, indicating a dose response relation between vibration "dose" and neurological and vascular symptoms.Episodic numbness of fingers and paraesthesias in the hands and arms are frequently reported by operators ofhand held vibrating tools.' In advanced cases loss of sensory perception2 and reduced manipulative dexterity occur.3 These symptoms may cause more disability than vibration white finger. The latter disorder has been extensively studied with respect to dose response relations and to achieve objective verification of the disease. Neurological symptoms included in the hand-arm vibration syndrome have not been as extensively studied, perhaps because they have not always been separated from Raynaud's phenomenon. There is now evidence that the different components of vibration syndrome may develop independently.4This study was designed to evaluate results of quantitative sensory threshold measurements in relation to neurological and vascular symptoms and to vibration exposure in patients with suspected vibration syndrome.