Objective tests exist to aid diagnosis of hand-arm vibration syndrome
BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7065.1148 (Published 02 November 1996) Cite this as: BMJ 1996;313:1148
- I J Lawson,
- K L Mcgeoch
- Regional medical officer Rolls-Royce, PO Box 31, Derby DE24 8BJ
- Senior medical officer Mitsui Babcock Energy, Renfrew PA4 8DJ
EDITOR,—We were pleased that the hand-arm vibration syndrome is included in the ABC of Work Related Disorders but would like to point out some of the more recent developments in the diagnosis of this syndrome.1 C M Jones rightly states that there is no single diagnostic test. The role of laboratory diagnostics such as cold provocation testing, measurement of vibrotactile and thermal thresholds, and aesthesiometry was extensively reviewed in a workshop held in Stockholm in 1994.2
Jones refers to attempts at inducing vasospasm by cooling the hand. A report by a working party of the Faculty of Occupational Medicine stated that simple cold provocation by immersion of the hands in cold water in an uncontrolled fashion followed by visual inspection of skin colour is of negligible value: it gives a high number of false negative results and should be abandoned.3 For acceptable cold provocation testing, minimum criteria for standard acclimatisation and standard challenge conditions should be fulfilled, an end point defined, and the sensitivity and specificity reported. Measurement of finger skin temperature with thermistors, thermocouples, or thermal imaging was considered to be a satisfactory technique, along with measurement of finger systolic blood pressure. Temperatures of </=10°C can lead to vasodilatation, making it difficult to interpret the results.
There is also evidence that multiple objective tests of the sensorineural component of the syndrome can improve accuracy when the condition is being staged according to the Stockholm scale.4 The Health and Safety Executive and subcommittees of the International Standard Organisation are currently attempting to standardise tests for both the vascular and sensorineural components of the syndrome.
It is true that there is still no gold standard, but the move to objectivity combined with a good occupational history should replace total reliance on the history, which may vary on different occasions.