Test battery for assessing vascular disturbances of fingers

Abstract

The diagnosis of vibration-induced white finger (VWF) is difficult, often relying on medical interview and history. The condition is characterized by an exaggerated vasoconstriction of digital arteries in response to cold. The complete closure of digital arteries is episodic and results in a characteristic blanching that is rarely observed by a clinician. Objective measurements of the response of the digital circulation to cold can assist in evaluating a patient for VWF. Finger systolic blood pressure (FSBP) following local cooling is a measure of cold-induced vasoconstriction in digital arteries and is an assessment of vasomotor tone. Low FSBPs following cooling are indicative of dysfunction. Finger skin temperature (FST) following hand cooling is a measure of cutaneous blood flow. The mechanism underlying the recovery of cutaneous blood flow following cooling is as yet not fully understood, but a delayed recovery is believed to arise from persistent vascular disturbances of the fingers or from a resulting in conflicting opinions concerning the utility of the measurements, a scarcity of comparable data from epidemiological investigations, and limited normative data to aid clinicians in decision-making. This review of evidence on which the tests are based is aimed at providing clinicians and researchers with an understanding of the factors that must be considered when conducting the tests, interpreting the results, and comparing results between different studies.

Diagnosis of vascular injuries caused by hand-transmitted vibration

“…As also reported in other studies, the lowest normal limit of %FSBP 15°C and %FSBP 10°C without additional body cooling were 60% at room temperatures of 21-23°C (Bovenzi 1992(Bovenzi , 1998, whereas with additional body cooling from cooling blanket the values were 58% under room temperatures of 15 and 19°C (Nielsen et al 1980;Olsen and Nielsen 1979;Olsen et al 1982;Olsen 2005). Lindsell (2005) mentioned that a limit of 60% can be applicable for both %FSBP 15°C and %FSBP 10°C , though at 15°C this value is likely to be less sensitive to VWF.…”

“…In VWF, all Wngers are not aVected or similarly aVected. The measurements of FST are also most likely WngerspeciWc (Lindsell and GriYn 2001), even phalanx-speciWc (Lindsell 2005). As a result, when assessing the VWF patients by measuring FST especially with point transducer like thermocouple or thermistor, the test results of digital circulation may be highly inXuenced by the measurement site.…”

“…FST and FSBP were measured in 22 control subjects and 24 individuals with vascular HAVS (SWS stages 2V and 3V). From that study no information is available regarding the period of adaptation to the test room temperature or the time interval between the FST and FSBP tests; inadequacy of these conditions might have inXuenced the test results, as in the assessment of peripheral vascular disorder patient's sympathetic tone at the onset of test is also important (Lindsell 2005). The researchers (Poole et al 2004) measured FSBP in the seated position, regarding which they pointed out that the postural diVerence inXuencing the autonomic nervous system control of peripheral blood pressure might be a contributory factor for the discrepancy in results.…”

“…The sequence of conducting the cold provocation tests also inXuences the FST responses. Lindsell (2005) suggested to perform the FST test before the FSBP test, while conducting these two cold provocation tests in the same session. An interval of 3 h between cold provocation tests has been recommended in ISO 14835-1 and -2 (2005a, b).…”

Cold Stress Dynamic Thermography for Evaluation of Vascular Disorders in Hand‐Arm Vibration Syndrome

“…Its neurovascular component is Vibration-induced White Finger (VWF), a type of secondary Raynaud's phenomenon (RP), which manifests itself as episodic blanching of the fingers in response to cold. Due to the episodic nature of this condition, an occupational health physician rarely observes the blanching; thus, VWF has often been diagnosed based only on patient's history together with a history of occupational exposure to vibration and the exclusion of other known causes of RP 1) . For the assessment of VWF, measurements of finger skin temperature (FST) and finger systolic pressure (FSP) in response to cold stress are most widely used [2][3][4] .…”