The diagnosis of disorders caused by hand-transmitted vibration: Southampton Workshop 2000.

OBJECTIVES To identify the current state of knowledge, current uncertainties and future needs related to the diagnosis of disorders associated with the use of vibratory hand-held tools. METHOD An international workshop was convened with invited experts, medical doctors, scientists and engineers familiar with hand-transmitted vibration and the diagnosis of vascular, neurological and musculoskeletal disorders. This paper records the general conclusions from four panel discussions. RESULTS For the most common vascular disorder (vibration-induced white finger), the principal symptom and sign involves attacks of well-demarcated finger blanching (Raynaud's phenomenon); low finger systolic blood pressure following cooling is indicative of vibration-induced white finger and zero finger systolic blood pressure can confirm an attack of Raynaud's phenomenon. For neurological disorders, some symptoms can exist without detectable signs and some signs can exist without symptoms; numbness and tingling are commonly reported but neurological changes may be present without these symptoms. The pathogenesis of musculoskeletal disorders in users of vibratory tools is not clear; symptoms may include pain that may not be associated with abnormal results in objective tests. For both neurological and musculoskeletal disorders, a thorough neuromuscular and skeletal examination is required; diagnosis must consider the work history and medical history, the results of physical examination and any objective tests in addition to other factors (e.g. age, smoking, alcohol, systemic disorders, medication and neurotoxic agents) that might have contributed to symptoms, signs and test results. CONCLUSIONS While vibration-induced white finger is caused by vibration, some neurological and musculoskeletal disorders are the result of work with vibratory tools where the separate roles of vibration, repetitive movements, grip and push forces, non-neutral postures and any other ergonomic stressors are often unclear. Such disorders may be more easily identified as being caused by the work rather than by exposure to hand-transmitted vibration per se. A person found to have developed disorders induced by either vibration or the work situation should not be returned to the same vibration exposure or work without any changes expected to lessen the risks.