A systematic review of diagnostic performance of quantitative tests to assess musculoskeletal disorders in hand-arm vibration syndrome.

The purpose was to systematically review the published reports for the clinical utility of quantitative objective tests commonly used for diagnosing musculoskeletal disorders in hand-arm vibration syndrome (HAVS). Two reviewers independently conducted a computerized literature search in PubMed and Scopus using predefined criteria, and relevant papers were identified. The articles were screened in several stages and considered for final inclusion. Quality of the selected papers was evaluated by a modified QUADAS tool. Relevant data were extracted as necessary. For this review, only 4 relevant studies could be identified for detailed examination. Grip strength, pinch strength, and Purdue pegboard tests were commonly used with their reported sensitivity and specificity ranging between 1.7 to 65.7% and 65.2 to 100%, 1.7 to 40% and 94 to 100%, and 44.8 to 85% and 78 to 95%, respectively. A considerable difference across the studies was observed with respect to patient and control populations, diagnostic performance and cut-off values of different tests. Overall, currently available English-language limited literature do not provide enough evidence in favour of the application of grip strength and pinch strength tests for diagnosing musculoskeletal injuries in HAVS; Purdue pegboard test seems to have some diagnostic value in evaluating impaired dexterity in HAVS.

Diagnostic performance of cold provocation test with hands immersion in water at 10°C for 5 min evaluated in vibration-induced white finger patients and matched controls.

PURPOSE: This study aimed to explore the diagnostic ability of the cold provocation test with hands immersion in water at 10°C for 5 min in diagnosing vibration-induced white finger (VWF). METHODS: Finger skin temperature (FST) was measured in 20 VWF patients and 20 matched healthy controls, at palmar side of the distal phalanges of fingers from both hands before, during, and after hands immersion in water at 10°C (for 5 min with waterproof coverings put on both hands). Data from 4 fingers (except thumb) were evaluated at five time points: just before immersion, last minute during immersion, and at 5th, 10th, and 15th min during the post-immersion or recovery period. RESULTS: A positive group difference between patients and controls was revealed during the recovery period. During recovery at 95 and 70% specificity, the sensitivity ranged from 20 to 30% and 50 to 70% for evaluation with average FST for 4 fingers and 15-35% and 60-65% for evaluation with minimum FST among 4 fingers, respectively. Overall, evaluation of absolute FST at 15th min of recovery offered better diagnostic ability. CONCLUSIONS: The cold provocation test with hands immersion in water at 10°C for 5 min could discriminate VWF patients from healthy controls; however, this test has a limited diagnostic value in diagnosing patients with VWF.

Impaired manual dexterity and neuromuscular dysfunction in patients with hand-arm vibration syndrome.

Manual dexterity and hand functional difficulties in daily life in hand-arm vibration syndrome (HAVS) were investigated in 29 male patients with HAVS and 30 male controls without occupational exposure to hand-arm vibration. Manual dexterity was assessed by measuring the performance time of picking up and transferring 30 red beans, one by one, from one plate to another. Vibrotactile perception thresholds at 125 Hz and grip strength were also examined. Hand functional difficulties in daily life were surveyed with a questionnaire. The HAVS patients had an increased vibrotactile threshold, decreased grip strength, and low performance in transferring beans. Low performances with transfer times over 53 s (2SD from the mean in the controls) were found in 66% of the HAVS patients and 3% of the controls. Bean transfer times in the patients were correlated with an increasing vibrotactile threshold and decreasing grip strength. The transfer times of the patients were also associated with hand functional difficulties such as picking up coins, turning the pages of a newspaper, buttoning clothes, and pouring from a teapot. The patients with a prolonged transfer time over 60 s (3SD from the mean in the controls) were most likely to have hand functional difficulties. The present findings suggest that measurement of the bean transfer time will serve to assess manual dexterity among HAVS patients, and that impaired manual dexterity in patients may be associated with impaired sensory feedback and muscular dysfunction in the fingers and hands.

Medial plantar nerve conduction velocities among patients with vibration syndrome due to rock-drill work.

OBJECTIVE: The present study was aimed at clarifying the effect of vibration syndrome (VS) on the peripheral nervous system in the lower extremities of patients with VS due to rock-drill work. METHODS: Fifty-three patients with VS due to previous exposure to vibration from rock-drilling work and 55 age-matched controls were examined for sensory nerve conduction velocities in the medial plantar nerve (SCV-P). The patient group was divided into three subgroups, outdoor rock-drill workers with vibration-induced white finger (VWF) (N = 10), tunnel workers with VWF (N = 27) and tunnel workers without VWF (N = 16). RESULTS: ANOVA of SCV-P for the four groups showed F = 3.23 (dF = 3, 104, p = 0.0253). A significant difference was found between the controls and outdoor rock-drill workers with VWF group (p = 0.0261) by multiple comparison using Scheffe's method. CONCLUSION: These findings suggest that peripheral nervous system function in the lower extremities of patient with VS is affected by cold exposure and circulatory disturbance manifested as VWF.