International consensus criteria for diagnosing and staging hand–arm vibration syndrome

Abstract

PurposeIn the 30 years since the Stockholm Workshop Scale (SWS) was published, the scientific literature on hand–arm vibration syndrome (HAVS) has grown and experience has been gained in its practical application. This research was undertaken to develop an up-to-date evidence-based classification for HAVS by seeking consensus between experts in the field.MethodsSeven occupational physicians who are clinically active and have had work published on HAVS in the last 10 years were asked to independently take part in a three-round iterative Delphi process. Consensus was taken when 5/7 (72%) agreed with a particular statement. Experts were asked to provide evidence from the literature or data from their own research to support their views.ResultsConsensus was achieved for most of the questions that were used to develop an updated staging system for HAVS. The vascular and neurological components from the SWS are retained, but ambiguous descriptors and tests without adequately developed methodology such as tactile discrimination, or discriminating power such as grip strength, are not included in the new staging system. A blanching score taken from photographs of the hands during vasospastic episodes is recommended in place of self-recall and frequency of attacks to stage vascular HAVS. Methods with the best evidence base are described for assessing sensory perception and dexterity.ConclusionsA new classification has been developed with three stages for the clinical classification of vascular and neurological HAVS based on international consensus. We recommend it replaces the SWS for clinical and research purposes.

Sensory perception testing by monofilaments in the digits of controls and workers with HAVS

“…From these data the cut-off from normal, or 95th percentile for male heavy manual workers should be 1.0 g-f, and for men ≥ 50 years 1.4 g-f. The latter threshold is in keeping with the 95th percentile of 2 g-f for heavy manual workers not exposed to HTV in Italy (Poole et al 2019). Based on this, the regression line in Fig.…”

“…There were no significant differences in the 95th percentiles of sensory perception by age, digit or hand dominance. Of the 124 hands that were classified and neurologically staged according to the ICC (Poole et al 2019); 4 were stage 0; 66 were stage 1; 36 were stage 2 and 18 were stage 3.…”

“…All of them were examined by CJMP and as appropriate confirmed to have neurological HAVS. They were then staged according to the International Consensus Criteria (ICC) (Poole et al 2019), which unlike the Stockholm Workshop Scale, is prescriptive in how sensory perception loss should be determined. No cases of neurological HAVS were excluded during the collection period unless they were associated with median or ulnar nerve neuropathy.…”

“…The diagnosis of sensory neuropathy in the digits of workers exposed to hand-transmitted vibration (HTV) is challenging. The use of Semmes-Weinstein monofilaments (SWM) has been recommended by the Health and Safety Executive (HSE) in Guidance L140 on hand-arm vibration (HSE 2005) and in the latest classification of hand-arm vibration syndrome (HAVS) (Poole et al 2019). SWM may also be used by diabetologists and hand surgeons.…”

Organische und funktionelle Durchblutungsstörungen der Hand – differenzialdiagnostische Aspekte

“…Neuropsychologische Assessments, wie der Purdue-pegboard-Test ▶ Tab. 3 Stadieneinteilung der vaskulären und neurologischen Komponente nach internationalen Konsensus-Kriterien (ICC 2018) [modifiziert nach [29]]. [47,48].…”