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Correspondence to Dr Eva Tekavec, Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00 Lund, Sweden; [email protected]
WHAT IS ALREADY KNOWN ON THIS TOPIC
Neural, vascular and musculoskeletal manifestations in the hands and upper extremities caused by exposure to vibration from hand-held tools, often in synergy with hand intensive work and forceful grips, are collectively denoted as hand-arm vibration syndrome (HAVS).
The Stockholm Workshop scale (SWS) is used to grade the severity of injury and for medicolegal purposes.
An updated version suggested from expertise in the field has been proposed, the International Consensus Criteria (ICC).
WHAT THIS STUDY ADDS
A systematic difference was found between the two scales such that individuals with stage 2 or 3 HAVS according to the SWS were graded lower with the ICC.
The most prevalent symptom among workers with HAVS was numbness (91%), followed by increased cold intolerance (86%).
Small nerve fibres were affected more often than large fibres.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Correct diagnosis and grading are crucial in managing the individual’s health and for workers’ compensation claims, and thus also in a broader socioeconomic context. If implementing the ICC grading system, there is a need for also updating the interpretation of the scale.
Awareness and consideration of early symptoms and signs of injury by healthcare professionals is of the utmost importance for secondary prevention. Greater attention should be paid to cold intolerance and affected nerves of both small-fibre and large-fibre type should be clinically examined.
Background
Hand-arm vibration injury is characterised by adverse health manifestations in mainly digital nerves and blood vessels.1 Neurosensory symptoms include numbness, tingling, pain/discomfort on cold exposure (cold intolerance),2 and impaired perception of touch, vibration and temperature. The vascular symptoms are characterised by finger blanching when exposed to cold or dampness, often referred to as ‘white fingers’.3 It is a condition with considerable negative health impact that affects daily life and has a poor prognosis.4 Therefore, the early detection of injury is crucial to implement preventive strategies.
Classification systems have been used to grade the severity of vibration injury in clinical examinations, research and for medicolegal purposes since the 1970s. In 1987, the Stockholm Workshop scale (SWS)5 replaced...