Diagnosis of vascular injuries caused by hand-transmitted vibration

Abstract

As there is no single test with satisfactory diagnostic ability for VWF, at present it is reasonable to use the cold provocation tests as a part of the comprehensive approach to evaluate HAVS patients. In addition to the objective methods, the index of finger coldness may be useful while diagnosing the vascular component of HAVS.

Specific Features of Vibration-Induced Disorders

“…12 Thermistor thermometry of the limbs, combined with distal Doppler sonography and cold provocation test correlate signifi cantly with each other and with the stage of vibration disease 13 , making their application for objective assessment of autonomic neurovascular injuries in vibration disease appropriate. 14 С. Aström et al determine signifi cant correlation between whole-body vibrations exposure and the increased risk for musculoskeletal alterations in the neck, the shoulders and the wrists similar to those caused by local vibration impact as well as dependence on the cumulative time of exposure. 15 Whole-body vibration syndrome determines increased risk of low back pain syndromes with 16 The pathologic fi ndings in drivers included predominantly alterations in the spine, but also in the hands and wrists.…”

Review of Different Quantification Methods for the Diagnosis of Digital Vascular Abnormalities in Hand‐arm Vibration Syndrome

“…These include increased plasma level of thrombomodulin and von Willebrand factor, enhanced erythrocyte aggregation and hypodeformability, platelet activation, increased levels of thromboxane A 2 and intercellular adhesion molecules 8) . All these may be followed by narrowing of the arterial lumen with medial smooth muscle hypertrophy and diminished digital microcirculatory blood flow 3,7) .…”

“…loops/capillary dropouts 3,14) . Morphological alterations like tortuosity of the capillary loops and their elongation with disarrangement of capillary polarity (loss of parallel pattern) were also observed among VWF patients, whereas all controls had normal capillary morphology 13) .…”

“…With thermometry and thermography, various parameters of FST responses during and following cold provocation have been quantified by different researchers. Application of different parameters may lead to different conclusions in the same subject and influence the diagnostic significance of the test results 3) . As the vascular injury in VWF may be finger specific or even phalanx specific, measurements by thermocouple and thermistor may be highly influenced by the measurement site, as such point transducers can only quantify the surrounding blood flow from a limited area.…”

“…At present, to diagnose VWF or HAVS objectively, no gold standard test is available. Also, there is a growing controversy regarding the diagnostic ability of the widely used tests 3) . Currently, for diagnosing VWF, a medical interview by a qualified physician including a positive history of finger blanching attacks in persons occupationally exposed to hand-transmitted vibration is the best method 4) .…”