The relationship between clinical and standardized tests for hand–arm vibration syndrome

BackgroundThermotactile thresholds and vibrotactile thresholds are measured to assist the diagnosis of the sensorineural component of the hand–arm vibration syndrome (HAVS).ObjectivesThis study investigates whether thermotactile and vibrotactile thresholds distinguish between fingers with and without numbness and tingling.MethodsIn 60 males reporting symptoms of the hand–arm vibration syndrome, thermotactile thresholds for detecting hot and cold temperatures and vibrotactile thresholds at 31.5 and 125 Hz were measured on the index and little fingers of both hands.ResultsIn fingers reported to suffer numbness or tingling, hot thresholds increased, cold thresholds decreased, and vibrotactile thresholds at both 31.5 and 125 Hz increased. With sensorineural symptoms on all three phalanges (i.e. numbness or tingling scores of 6), both thermotactile thresholds and both vibrotactile thresholds had sensitivities greater than 80% and specificities around 90%, with areas under the receiver operating characteristic curves around 0.9. There were correlations between all four thresholds, but cold thresholds had greater sensitivity and greater specificity on fingers with numbness or tingling on only the distal phalanx (i.e. numbness or tingling scores of 1) suggesting cold thresholds provide better indications of early sensorineural disorder.ConclusionsThermotactile thresholds and vibrotactile thresholds can provide useful indications of sensorineural function in patients reporting symptoms of the sensorineural component of HAVS.

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Assessment of thermotactile and vibrotactile thresholds for detecting sensorineural components of the hand–arm vibration syndrome (HAVS)

Yao

Griffin

2017

“…One of the questions that came out of the Delphi was the degree of association between the frequency and extent of blanching, so data previously described (Poole et al 2016 ) on patients with HAVS referred to the Health and Safety Laboratory in England for high-level health surveillance with standardised quantitative sensory tests (QSTs) were re-analysed by case for frequency of vasospastic episodes per week and extent of blanching as described by Griffin. Results were presented as scatter plots and Spearman’s rho tests calculated for the dominant and non-dominant hands.…”

Section: Methodsmentioning

confidence: 99%

“…Another question was the number of sensory modalities that needed to be tested and whether it was necessary to include both thermal and vibration perception tests. To inform this decision, data from a previous study (Poole et al 2016 ) were re-analysed to ascertain the proportions of cases with abnormalities of thermal (hot and cold) and vibration (31.5 and 125 Hz) perception. The method of scoring the results of the QSTs was the same as that reported by others (Lawson and McGeoch 2003 ; McGeoch et al 2004 , HSE 2005 ); however, non-specific scores of < 4 in each hand were ignored.…”

Section: Methodsmentioning

confidence: 99%

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

Poole

Bovenzi

Nilsson

et al. 2018

Self Cite

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.

“…This was compared with the number of abnormal thermal (hot and cold) and vibration perception (31.5 and 125 Hz) thresholds in the index and little fingers of the same hand. On the same day, thermal aesthesiometry was undertaken according to the method described by Lindsell and Griffin 2003 and vibration perception according to ISO 13091-2 (2003) and as described (Poole et al 2016). Thresholds > 48.5 °C for hot or < 19.0 °C for cold; > 0.4 m/s 2 for 31.5 Hz or > 1.0 m/s 2 for 125 Hz were taken as abnormal (HSE 2005;Lindsell and Griffin 2003), making the maximum QST score per finger four.…”

Section: Analysis and Statisticsmentioning

confidence: 99%

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

Poole

Robinson

Frost

2020

Self Cite

Objective To determine if heavy manual work affects sensory perception in the digits and whether Semmes-Weinstein monofilaments (SWM) can be used as a screening tool to detect sensory neuropathy in the digits of workers exposed to hand-transmitted vibration (HTV). Methods A cross-sectional study of office workers, heavy manual workers not exposed to HTV and workers with handarm vibration syndrome (HAVS). Sensory perception was measured in the digits by SWM using a forced-choice method to determine variability by sex, age, hand and digit. Frequency distributions were used to determine limit values and linear weighted kappa for intra-digit variability. Poisson regression was used to explore the relationship between sensory perception by SWM and abnormalities of thermal and vibration perception in the hands of workers with HAVS. Results The sensory perception threshold of office workers did not vary by hand or digit. It was significantly lower in women < 30 than women aged ≥ 30 years. The 95th percentile for heavy manual workers was 1.00 (95% CI 0.60-1.00) and significantly higher than for office workers at 0.16 (95% CI 0.16-0.16). Heavy manual workers > 50 years had the highest threshold at 1.40 (95% CI 1.00-2.00). Weighted kappa for reliability was 0.63 (95% CI 0.53-0.70). A mean SWM threshold of ≥ 1.0 gram-force had a 79% sensitivity and 64% specificity for detecting abnormalities of thermal and vibration perception in the ipsilateral index and little fingers of workers with HAVS. Conclusions SWM are a useful screening tool for detecting sensory loss in the digits of workers exposed to HTV.