The clinical consequence of using less than four sensory perception examination methods in the Swedish surveillance system for Hand-Arm vibration syndrome

Abstract

Objectives The Swedish surveillance system aiming to reveal undetected Hand‐Arm Vibration Syndrome (HAVS) in workers exposed for vibrations is regulated by the provision AFS 2019:3. The goal for the surveillance system is to diagnose HAVS, as well as to find workers at risk for developing HAVS due to other conditions. The national guidelines stipulate examination using at least two out of four hand sensory examination methods (SEM); monofilament (touch), two‐point discrimination (discriminative), tuning fork (vibrotactile), and Rolltemp (thermotactile). The aim of this study was to examine the clinical consequence of using less than four of these SEMs. Methods We collected data on SEMs from the medical records of all individuals that went through the specific surveillance medical check‐up in a large occupational health service for 1 year. We then calculated the number of workers found with HAVS when using one, two, or three SEMs, and compared with the result from using all available SEMs. Results Out of 677 examined individuals, 199 had positive findings in at least one SEM. The detection rate for these findings was on average 47% when using one SEM, 71% using two SEMs, and 88% using three SEMs (out of 100% detection when all four SEMs were used). Conclusions If fewer than four sensory examination methods are used for surveillance of HAVS, many workers with incipient injuries may stay undetected. This may lead to further exposure resulting in aggravation of injury.

Vibration related symptoms and signs in two groups of exposed workers

“…The opposite pattern was observed among the truck mechanics where few reported this kind of problem. Antonson et al 32 compared four examination methods among workers with the hand arm vibration syndrome. The detection rate for 2-PD was 35%, for monofilament 54%, for tuning fork 17% and for Rolltemp 66%.…”

Evaluation of Hand-Arm Vibration Syndrome Owing to Nerve Conduction Study and Cumulative Exposure Index—A 2.5-Year Cohort Study

“…3,4 Additionally, excess vibration exposure (VE) can cause polyneuropathy. [5][6][7][8][9][10] In the history of vibration disorders, the main symptoms of Raynaud's phenomenon, numbness and dullness of the senses, were first described by Loriga in 1911. 11 In Japan, HAVS, particularly VWF, has occurred in forestry workers since around 1950, when chain saws started being widely used, and vibration damage caused by chainsaws in the national forests came under public scrutiny especially in the 1960s.…”

“…Vibration-induced white finger (VWF) is a well-known secondary Raynaud phenomenon and the most well-established manifestation of HAVS 3,4 . Additionally, excess vibration exposure (VE) can cause polyneuropathy 5–10 …”