Different Conditions of Cold Water Immersion Test for Diagnosing Hand-Arm Vibration Syndrome

The cold water immersion test with finger skin temperature (FST) measurement is used to assess vascular disorders in hand-arm vibration syndrome (HAVS). The test method is currently being standardized within the International Organization for Standardization (ISO) in which a water temperature of 12°C for 5 min of hand immersion and an option of using a waterproof hand covering during immersion are proposed. It is necessary to evaluate the diagnostic significance of the test with FST measurement under different conditions to provide a proper management of HAVS patients. The aim of this article is to review research findings of this test with FST measurement and discuss test conditions influencing the results and diagnostic significance. Different conditions were employed, and the test results were shown to be influenced by water temperature, immersion time and other conditions such as room temperature, season, ischemia during immersion, and evaluation parameters. These factors need to be considered in the standardization of the cold water immersion test with FST measurement. It has been mentioned that a high water temperature, a short immersion time and other conditions should be chosen to expose a subject to minimal suffering during the test. A water temperature between 10°C and 15°C and a 5 min immersion might be suitable for the cold water immersion test. The reported sensitivity and specificity evaluating rewarming to the initial temperature for the test using a water temperature of 12°C and a 3 min immersion are 58% and 100%, respectively; these are low but similar to those for the water immersion test at 10°C. Therefore, the proposed cold water immersion test at 12°C for 5 min by the ISO (Draft International Standard) is the focus of much interest, and further studies are needed to obtain sufficient data for evaluating the diagnostic significance of the test. At present, the test needs to be used together with a test battery.

Test Battery for Assessing Vascular Disturbances of Fingers

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 delayed release of vasospasm, or both. There are various methods of conducting both of these tests, 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.

Test battery for assessing vascular disturbances of fingers

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.

Cold-Induced Vasodilation in Prepubertal Boys, Young and Older Men / 体力科学

The present study was attempted to examine whether the cold-induced vasodilation is affected by maturation and aging. Twelve prepubertal boys (10-11 yrs), 15 young men (18-26 yrs), and 8 older men (66-78 yrs) immersed their middle finger in ice-water for 15 min under air condition of 27°C and 40% RH. Before the immersion, no age-related differences were observed in skin temperature of middle finger (T<SUB>fin</SUB>) . The time required for the first rise of T<SUB>fin</SUB> after the immersion (TTR) was significantly longer in the older men than in the boys and young men. T<SUB>fin</SUB> at the first rise after the immersion (TFR), highest value of Tfin after the first rise (HST) and the mean value of T<SUB>fin</SUB> during the immersion (MST) were significantly lower in the boys than in the young men. The integral value of T<SUB>fin</SUB> from the onset of cold-induced vasodilation to the end of the immersion (CIVD<SUB>index</SUB>) was significantly lower in the boys and older men than in the young men. TTR, TFR, HST, MST, and CIVD<SUB>ifldex</SUB> did not correlate significantly with maximal oxygen uptake, mean skinfold thicknesses at seven body sites, and length and girth of the middle finger. Oral temperature (Tor) did not change between before and after the immersion regardless of age, although the Tar in the boys was significantly higher than in the young and older men. There were no age differences in the relationship of thermal sensation or pain sensation and T<SUB>fin</SUB>. These results suggest that boys and older men have inferior cold-induced vasodilation compared to young men, and that the mechanisms of inferior cold-induced vasodilation are different in these two groups.

Evaluation of Finger Skin Temperature by Cold Provocation Test for Diagnosis of Hand-Arm Vibration Syndrome / 대한산업의학회지

OBJECTIVES: Various objective tests have been widely used worldwide for diagnosing the hand-arm vibration syndrome. Among these, the cold provocation test has been frequently used to confirm the presence of Raynaud's phenomenon. This study was carried out in order to evaluate finger skin temperature by cold provocation test(10 degrees C for 10 minute) for the diagnosis of hand-arm vibration syndrome METHODS: Fifty-eight workers who had been exposed to local vibration were examined. Information concerning age, occupation, types of vibration tools used, presence of subjective symptoms such as vibration induced white finger(VWF), and numbness and tingling were collected. The subjects were classified into three groups according to their symptoms(Vascular, Neural, and No symptom group). In order to examine the applicability of the cold provocation test using water at 10 degrees C for 10 minute, we compared finger skin temperature between the groups. RESULTS: The mean value of the finger skin temperature at 5 minutes and 10 minutes after cold provocation as well as the recovery rate in the vascular group were significantly lower than that seen in the other groups. CONCLUSIONS: The evaluation of finger skin temperature by cold provocation test is very useful method for the diagnosis of hand-arm vibration syndrome. The test results will assist in confirming the diagnosis of the hand-arm vibration syndrome.

Combined Effect of Vibration Intensity, Grip Temperature, Noise and Pushing Power on Grip Forces and Skin Temperatures of Fingers / 예방의학회지

Recent studies reveal that grip forces during the hand-arm vibration are most significant for the genesis of vibration-induced white finger syndrome. Therefore, exerted grip forces and skin temperatures or fingers were regarded as dependent variables in experiments and the effects of grip temperature, noise, pushing force, vibration and the combined effect of vibration and pushing force were studied. The objectives or the present study were, first, to varify and compare the changes of grip force affected by grip temperature, noise, pushing force, vibration and the combined effect of vibration and pushing force and, second, to observe the reaction of finger skin temperature affected by above factors. Forty-six healthy male students(25.07+/-2.85) participated in five systematically permuted trials, which endured 4 minutes each other. Experiments were executed in a special chamber with an air temperature of 21 C. In each experiments, the subjects were exposed to five experiment types: (l) grip force of 25 N only, (2) pushing force of 50 N, (3) acceleration of vibration 7.1m/sec2(z-direction), (4) pink noise or 95 dB(A) and (5) combination of pushing force 50 N and acceleration of vibration 7.1m/sec2. A repeated-measures analysis of variance(ANOVA) was performed on the grip force to test whether it was affected by noise, pushing force, vibration and pushing force. The present results show that vibration was significantly related to the increase of grip force, but the other factors, such as pushing force, noise and grip temperature had no significant influence on the increase of grip force and that the reaction of finger skin temperature were significantly affected by the skin temperature at start of experiment and grip temperature, not grip force and other experimental conditions. Therefore, we suggest that the management for decreasing the grip force is meaningful to prevent the occurrence of Hand-arm vibration syndrome (HAVS).

Study of cold-induced vasodilation due to cold exposure / 体力科学

This study was carried out to examine the following. 1) For 20 adult males in summer, cold-induced vasodilation (CIVD) immersed in ice water (ice water CIVD) and CIVD exposed to cold air of 0°C, -5°C and -10°C (cold air CIVD) were compared. The blood pressure was measured and examined during the course of measuring ice water CIVD and -10°C cold air CIVD. 2) -10°C cold air CIVD was measured in summer and in winter for 40 males.<BR>The results for 1) and 2) are summarized as follows.<BR>1. Definite effects of the difference in thermal transmission rate was observed between cold air CIVD and ice water CIVD. Finger skin temperature fell as the temperature at cold air CIVD dropped to 0, -5 and -10°C. At -10°C cold air CIVD where the drop of skin temperature was greatest, the temperature at first rise (TFR) was higher, time of temperature rise (TTR) was longer and amplitude of temperature (AT) was greater, compared with the respective values at ice water CIVD. However, no difference was observed in mean skin temperature (MST) during the exposure. Individual difference in values at cold air CIVD was greater than that at ice water CIVD.<BR>2. The time of maximum rise of blood pressure response after cold exposure was 5 minutes at ice water CIVD and 20 minutes at -10°C cold air CIVD. The rate of blood pressure rise at -10°C cold air CIVD was significantly greater. The time when the rise of blood pres-sure reached the maximum was identical with the time when the skin temperature became lowest.<BR>3. At -10°C cold air CIVD, MST and TFR were higher and TTR shorter in winter than those in summer. At ice water CIVD, the values in summer were higher for MST and TFR and shorter for TTR as mentioned previously.<BR>4. The temperature before -10°C cold air CIVD (TB) showed a significant correlation with MST and TFR, though not with TTR.<BR>5. A comparison of these results with Watanuki et al.'s report reveal some differences.