RESUMO
OBJECTIVES: In order to determine find out the best methods for a more objective detection of neurologic abnormality in early hand arm vibration syndrome(HAVS), early with analyzing the validity of each of the detection methods was analyzed. We evaluated the relationships between the sensorineural stage of Stockholm-revised vibration syndrome classification and the results of several tests. METHODS: 497 workers were investigated for symptom, exposure duration, the types of tools used, and medical history from January 2000 to December 2007. Pain sense threshold, vibrotactile threshold, hand grasp force, finger grasp force, and a finger tapping frequency test were performed by the workers. RESULTS: The grinder(67.3%) was the most commonly used tool and the mean exposure duration was 14.8 years. Although the pain sense and vibrotactile threshold level tended to increase according to sensorineural stage of the Stockholm classification, there was statistically significant difference in the vibrotactile threshold of 125, 250 Hz (p=0.006~0.038) but not in the pain sense threshold. Hand and finger grasp force tended to decrease according to the sensorineural stage of Stockholm classification and there was statistically significant difference(p=0.041,<0.001, 0.034) only on the right hand side. The tapping frequency also generally decreased according to the sensorineural stage of the Stockholm classification and there was statistically significant difference (p=0.002~0.019) only on the left hand side. CONCLUSIONS: Although there is no single standardized method that can objectively diagnose the sensorineural component of early HAVS early, the combination of subjective symptoms, the sensorineural stage of Stockholm classification, the pain and vibrotactile threshold test, the hand and finger grasp force, and the finger agility (tapping) test can objectively detect sensorineural component of HAVS early.
Assuntos
Braço , Dedos , Mãos , Força da Mão , Síndrome da Vibração do Segmento Mão-Braço , VibraçãoRESUMO
OBJECTIVES: In order to determine find out the best methods for a more objective detection of neurologic abnormality in early hand arm vibration syndrome(HAVS), early with analyzing the validity of each of the detection methods was analyzed. We evaluated the relationships between the sensorineural stage of Stockholm-revised vibration syndrome classification and the results of several tests. METHODS: 497 workers were investigated for symptom, exposure duration, the types of tools used, and medical history from January 2000 to December 2007. Pain sense threshold, vibrotactile threshold, hand grasp force, finger grasp force, and a finger tapping frequency test were performed by the workers. RESULTS: The grinder(67.3%) was the most commonly used tool and the mean exposure duration was 14.8 years. Although the pain sense and vibrotactile threshold level tended to increase according to sensorineural stage of the Stockholm classification, there was statistically significant difference in the vibrotactile threshold of 125, 250 Hz (p=0.006~0.038) but not in the pain sense threshold. Hand and finger grasp force tended to decrease according to the sensorineural stage of Stockholm classification and there was statistically significant difference(p=0.041,<0.001, 0.034) only on the right hand side. The tapping frequency also generally decreased according to the sensorineural stage of the Stockholm classification and there was statistically significant difference (p=0.002~0.019) only on the left hand side. CONCLUSIONS: Although there is no single standardized method that can objectively diagnose the sensorineural component of early HAVS early, the combination of subjective symptoms, the sensorineural stage of Stockholm classification, the pain and vibrotactile threshold test, the hand and finger grasp force, and the finger agility (tapping) test can objectively detect sensorineural component of HAVS early.
Assuntos
Braço , Dedos , Mãos , Força da Mão , Síndrome da Vibração do Segmento Mão-Braço , VibraçãoRESUMO
BACKGROUND: There have been many studies on hand-arm vibration syndrome (HAVS) for almost a century. The Stockholm Workshop scale has been accepted as a useful tool in diagnosing HAVS. Although they are not standard tests for diagnosis, cold provocation test and plethysmography of the fingers are commonly used as objective measurements to confirm the vascular component of HAVS. However, there are only a handful of case reports and studies worldwide on Raynaud's phenomenon in the toes. We report the case of a patient with HAVS who developed Raynaud's phenomenon in the toes after the vibration exposure had ceased. To our knowledge, this is the first report of this entity in Korea. CASE REPORT: A 58-year-old male, who had been diagnosed with HAVS in 2003, first noticed white toes in the summer of 2006 after immersing his feet in cold water. He had been working as a rock drill operator since 1976 for almost 30 years and had symptoms on his fingers since 1992. He underwent the cold provocation test, photoplethysmography, Nerve conduction velocity, and basic laboratory tests to rule out other causes of secondary Raynaud's phenomenon. To describe the severity of his feet, it could be classified as vascular stage 2 and sensorineural stage 1 if we were to apply the Stockholm Workshop scale. CONCLUSIONS: The patient showed vibration-induced white toes, and we would like to share the results of objective findings related to his condition. When diagnosing HAVS, symptoms of the feet should be assessed by the occupational and environmental medicine physicians. Further studies are needed to standardize test methods to diagnose "vibration-induced white toes."