Hand-arm vibration syndrome among travertine workers: a follow up study.

In a six year follow up study of the handarm vibration syndrome, 62 stoneworkers operating hand held vibrating tools in 10 travertine quarries and mills were first investigated in 1985 and then in 1991. The frequency weighted acceleration of vibration from the rock drills and stone hammers used by the travertine workers exceeded 20 m/s2, indicating a hazardous work activity according to the proposal of the EC directive for physical agents. A clinical examination and a cold provocation test were repeated with the same procedures as those adopted at the time of the first survey. The stoneworkers were divided into groups according to current work state: active stoneworkers who continued to use powered tools during the follow up (n = 21, median exposure time 22 years), and ex-stoneworkers with retirement vibration free intervals of three years (n = 22, median exposure time 27.5 years) and of six years (n = 19, median exposure time 20 years). In the group of active stoneworkers, a 38% onset a new cases of vibration-induced white finger (VWF) was found during the follow up (p < 0.01). Among the retired stoneworkers affected with VWF (n = 24), one recovered from VWF, one showed improvement, 20 remained stationary, and two deteriorated. The ex-stoneworkers experienced no significant change in sensorineural disturbances and a decrease in musculoskeletal symptoms of the upper limbs. At the cold provocation test, the currently active stoneworkers with VWF showed, on a group basis, a delayed finger rewarming time between the two examinations (p = 0.002). An abnormal response to cold provocation persisted in the fingers of the ex-stoneworkers with VWF, even in those reporting subjective improvement. These findings indicate a tendency towards the irreversibility of sensorineural and VWF symptoms in a group of ex-stoneworkers with prolonged exposure to high vibration levels in the past. The increased occurrence of VWF in the active stone workers after a few extra years of vibrating tool usage argues for an urgent implementation of preventive measures in the stone industry.