A clinical assessment of seventy-eight cases of hand-arm vibration syndrome.

After the obtainment of an occupational history the following objective tests were carried out: esthesiometry, light touch, pain, temperature appreciation, Tinel's and Phalen's test, grip strength, Allen's test, and cold provocation (10-12 degrees C for 1 min). The 78 subjects were categorized (Taylor-Pelmear classification) according to the number, severity, and extent of the blanching attacks; sensory loss; musculoskeletal complaints; and interference with work and domestic and social activities. Four of the subjects had unequal hand assessments. It was not possible to correlate stage assessment with the objective tests on an individual basis. On a group basis, staging correlated with esthesiometry using the improved designs of Carlson et al. Cold provocation produced white finger attacks in only 50% of the cases. In some work processes (road ripping) of the subjects, damage to digital arteries and nerves was confined to the thumb and index and middle fingers. Four subjects had advanced tissue necrosis of the fingertips resulting from the use of hand-held pneumatic percussive tools. There was no evidence to support the view that the hand-arm vibration syndrome affects the central autonomic nervous system.