Hand-arm vibration syndrome: a new clinical classification and an updated British standard guide for hand transmitted vibration.

Editorial Hand-arm vibration syndrome: a new clinical classification and an updated British standard guide for hand transmitted vibration Raynaud's phenomenon of occupational origin known in the 1950s as "the vibration syndrome" or "vibration induced white finger (VWF)" has, in the 1980s, been renamed "the hand-arm vibration syndrome ." This occupational hazard has, since 1890, afflicted operators using hand held pneumatic tools (chipping and grinding), chain saws and strimmers, jackleg drills, and electrically driven rotating tools. The government has considered this vibration syndrome as an occupational hazard since 1950,' finally accepting the condition as a prescribed disease (No Al 1) in 1985.2 The 35 year delay was due to the trivial nature of the injury in most cases, the difficulty of distinguishing occupational from non-occupational causes (primary Raynaud's disease), and the absence of the basic pathophysiological processes underlying cold induced white finger attacks. After prescription the greatest challenge to examining physicians and vascular surgeons lies in the assessment, classification, and prognosis in vibration induced cases. Since 1967 the Taylor-Pelmear stage classification3 has been used internationally with the emphasis on the deficient and sensitive digital circulation by recording the number, extent and duration of white finger attacks. In the early (stage 1) phase there is no evidence of reduced work performance, loss of employment, or interference with social, home, or hobby activities. The degree of blanching is minor, being confined to the finger tips. In advanced cases (stage 3) there is blanching of digits to the finger roots, with loss of fine touch and manual dexterity with restrictions at work, in the home, and cessation of hobbies where reduced environmental temperatures provoke numerous attacks daily. With continued exposure to vibration ulceration and tissue necrosis of the finger tips indicate occlusion of the digital arteries.4 This early classification requires updating since, over the years, deficiencies have arisen; the assessment is largely dependent on the subjects' own history of attacks, an in-built seasonal component-attacks more frequent in the winter-raised difficulties in hot and cold climates, quantifying disablement and impairment such as "clumsiness" and "loss of dex-terity" were impossible without objective tests, and distinguishing intermediate injury (stage 2) with different examiners gave varying results. Clinical examinations were further complicated by the absence of specific and precise objective tests defining the deficiencies in the arterial, sensory, and musculo-skeletal systems. It was possible, however, to carry out field surveys of vibration exposed populations by occupational history questionnaires, …