Annals of Occupational and Environmental Medicine

Review

Technetium-99m hand perfusion scintigraphy (Raynaud’s scan) as a method of verification in hand arm vibration syndrome: a review: Taewoong Ha, Hyeoncheol Oh, Jungwon Kim; Ann Occup Environ Med 2022;34:e26. Published online October 11, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e26

Abstract Abstract in Korean PDF PubReader ePub

It is important to assess the blood flow of fingers in the verification of hand-arm vibration syndrome. In the Republic of Korea, most assessments of the blood flow in the fingers are performed using a cold provocation test with finger skin color change. However, this test is a non-objective method with a relatively low sensitivity, leading to possible social and legal problems. Thus, we reviewed the characteristics of several tests that assess the blood flow in the fingers. Among these tests, using the radioactive isotope method, Raynaud’s scan has a relatively higher sensitivity and specificity than other tests, provides objective results, and is approachable in many hospitals. So we suggest using Raynaud's scan as an alternative test when cold provocation test with finger skin color change is negative in vibration exposed worker.

테크네튬-99m 레이노 스캔을 이용한 수완진동 증후군 진단 리뷰
수완진동증후군의 검증에서는 손가락의 혈류를 평가하는 것이 중요하다. 대한민국에서는 레이노증후군의 업무관련성 평가 시 대부분 손가락의 혈류량 평가를 냉각부하 손가락 피부색 변화 검사만으로 시행하고 있다. 그러나 이 검사는 상대적으로 민감도가 낮은 주관적인 검사방법으로 사회적, 법적 문제가 발생할 수 있다. 따라서 우리는 손가락의 혈류를 평가할 수 있는 여러 검사의 특성을 검토하였다. 이 검사 방법들 중, 방사성 동위원소법을 이용한 레이노스캔은 객관적인 결과를 제공하며 다른 검사방법들에 비하여 상대적으로 민감도와 특이도가 높고 많은 병원에서 접근성이 좋다. 따라서 진동노출작업자에서 냉각부하 손가락 피부색 검사 결과가 음성인 경우 대안검사로서 레이노스캔을 사용할 것을 제안한다.

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Raynaud’s Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment
Hirut Yadeta Ture, Nan Young Lee, Na Ri Kim, Eon Jeong Nam
Vascular Specialist International.2024;[Epub] CrossRef

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Research Article

Application of cold intolerance symptom severity questionnaire among vibration-exposed workers as a screening tool for the early detection of hand-arm vibration syndrome: a cross-sectional study: A Ram Kim, Dae Yun Kim, Ji Soo Kim, Heun Lee, Joo Hyun Sung, Cheolin Yoo; Ann Occup Environ Med 2019;31:6. Published online March 1, 2019; DOI: https://doi.org/10.1186/s40557-019-0284-x

Abstract PDF PubReader ePub

Background

The detection rate of hand-arm vibration syndrome (HAVS) is very low in South Korea compared with other countries. The absence of uniform consensus and guidelines for diagnosing HAVS has been presumed to be one of the reasons. The HAVS has various manifestations including cold intolerance and its severity can be measured using the cold intolerance symptom severity (CISS) questionnaire. This study aimed to determine whether the CISS questionnaire, being used as a screening tool, can aid in the early detection of HAVS.

Methods

A total of 76 male workers with vibration-induced symptoms were enrolled as the final study participants. To compare the CISS score of healthy individuals, 41 men who had never been exposed to local vibration were included in the study. In addition to the former medical questionnaire, the participants answered the CISS questionnaire. A statistical analysis was conducted to identify the association of CISS scores with vibration induced symptom and to determine its cut off value.

Results

The reliability of the CISS questionnaire was proven to be good, with a total Cronbach’s alpha of 0.922. The mean CISS score of the exposed group increased in every vascular stage [stage 0 = 42.6 (18.5); stage 1 = 59.4 (14.1); and over stage 2 = 60.2 (21.6)]. They were significantly higher than that of the non-exposed group. The result was fairly consistent with those in the sensorineural stage. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of 30 were 88.5, 65.3, 76.1, 82.1 and 0.769, respectively. From the result of logistic regression, the adjusted odds ratio of both components increased by the CISS score grouped by 30s.

Conclusions

The self-reported CISS questionnaire, used to measure the degree of cold intolerance, showed high agreement with the Stockholm classification of HAVS. Hence, we recommend the use of this questionnaire to assess the level of cold intolerance among vibration-exposed workers and detect individuals who are at risk of vibration-induced impairment with a cutoff value of 30.

Trial registration

IRB No. 2018–07–040-001. Registered on 4 September 2018.

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Multicenter Prospective Randomized Comparison of Ultrasound-Guided Stellate Ganglion Versus Thoracic Paravertebral Block for Sympathetic Blockade in Chronic Upper Extremity Pain
Jeongsoo Kim, Joon Cha, Sheung Nyoung Choi, Gang Heo, Yongjae Yoo, Jee Youn Moon
Anesthesia & Analgesia.2024;[Epub] CrossRef
A Scoping Review on Occupational Noise Mitigation Strategies and Recommendations for Sustainable Ship Operations
Kresna Febriyanto, Joana Cristina Cardoso Guedes, Luis João Rodrigues Das Neves Correia Mourão
International Journal of Environmental Research and Public Health.2024; 21(7): 894. CrossRef
Cold intolerance and hand-arm vibration syndrome
Roger Anthony Cooke, Ian James Lawson
Occupational Medicine.2022; 72(3): 152. CrossRef
Botulinum Toxin Type A for Lumbar Sympathetic Ganglion Block in Complex Regional Pain Syndrome: A Randomized Trial
Yongjae Yoo, Chang-Soon Lee, Jungsoo Kim, Dongwon Jo, Jee Youn Moon
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Hand-arm vibration management: an operational health and safety strategy framework
David John Edwards, Igor Martek, Obuks Ejohwomu, Clinton Aigbavboa, M. Reza Hosseini
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Understanding and Measuring Long-Term Outcomes of Fingertip and Nail Bed Injuries and Treatments
Kenneth R. Means, Rebecca J. Saunders
Hand Clinics.2021; 37(1): 125. CrossRef

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Original Article

The General Characteristics and Results of the Cold Provocation Test in the Risk Group of HAVS: Jae Kook Yoon, Chang Sun Sim, Myoung Soon Oh, Joo Hyun Sung, Ji Ho Lee, Choong Ryeol Lee, Yangho Kim, Cheol In Yoo, Hun Lee; Korean Journal of Occupational and Environmental Medicine 2012;24(3):207-216. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.207

Abstract PDF

OBJECTIVES
The cold provocation test for diagnosing the vascular component in hand-arm vibration syndrome (HAVS) is likely to be accepted as an objective test, and a few studies have been performed. However, controversy has continued regarding the diagnostic performance of this method. Although objective methods such as plethysmography and laser doppler flowmetry have been studied, they have not received as much attention as other diagnostic methods. Therefore, our study aim was to spread the awareness of HAVS by reporting the results of the cold provocation test in a hand-transmitted vibration exposure group.
METHODS
The study subjects were 549 workers who had been exposed to hand-transmitted vibrations and reported symptoms in their hands. While the subject immersed both their hands in 10degrees C water for 10 minutes, the skin temperature of 10 fingers was recorded from pre-immersion time to 20 minute postimmersion including 10 minutes immersion time. The recovery rates were calculated from the recorded skin temperatures. The 'decreased recovery rate' criteria were less than 30% at 5 minutes post-immersion and 60% at 10 minute post-immersion.
RESULTS
Of the subjects, 69.1% and 30.9% had more severe symptoms in the right and left hands, respectively. The mean finger skin temperature of the right hand after cold-water immersion for 10 minutes was approximately 10degrees C, which increased gradually with time, but they did not reach the baseline temperature at 20 minutes post-immersion. The deviations of the skin temperature in the subjects were higher in the recovery phase than in the baseline and cold immersion phase. The 3rd finger of both hands showed the lowest 5-minute recovery rate among the fingers examined, and the left 4th finger and right 3rd finger showed the lowest 10-minute recovery rate. Of the subjects, 37.6% and 10.4% of subjects showed a lower recovery rate at 5 and 10 minutes in at least one finger, respectively, while 10.2% showed a lower recovery rate at both 5 and 10 minutes simultaneously in at least one finger.
CONCLUSIONS
The larger deviations in the recovery phase than in the other phases indicated that interindividual differences are more prominent in the recovery phase. There might be no benefit in observing the finger skin temperature for an additional 10 minutes after 10 minutes post-immersion. Overall, approximately 10% of the subjects in the HAVS risk group had HAVS.

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Technetium-99m hand perfusion scintigraphy (Raynaud’s scan) as a method of verification in hand arm vibration syndrome: a review
Taewoong Ha, Hyeoncheol Oh, Jungwon Kim
Annals of Occupational and Environmental Medicine.2022;[Epub] CrossRef
Trend of Human Vibration Research in Korea
Hee-Sok Park
Journal of the Ergonomics Society of Korea.2013; 32(4): 293. CrossRef

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Original Article

Effect of Hand Transmitted Vibration on the Auditory System: Jae Kook Yoon, Cheol In Yoo, Ji Ho Lee; Korean Journal of Occupational and Environmental Medicine 2011;23(1):18-30. Published online March 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.1.18

Abstract PDF

OBJECTIVES
This study was undertaken to estimate the effect of hand transmitted vibration exposure for long time period on the auditory system in shipyard grinder workers.
METHODS
From 2006 to 2009, the study was carried out on 87 grinder workers for hand transmitted vibration exposure group, with 81 welders who were served as the control group. All subjects were male; at baseline, none of the participants had ear disease or diabetes mellitus. Auditory threshold at different frequencies ranged from 0.25 kHz to 8 kHz for both ear was recorded; the following were also collected from the subjects: age, exposure duration, noise exposure level of investigation year, total cholesterol, systolic/diastolic blood pressure, and smoking history.
RESULTS
In comparison of two groups, mean of age, exposure duration, noise level, total cholesterol, systolic/diastolic blood pressure, smoking rate were not significantly different between the groups. Auditory thresholds of 0.25, 0.5 kHz frequencies in both ear, 1 kHz frequency in right ear, and 8 kHz frequency in left ear were higher in hand-transmitted vibration exposure group than that in the control group at a statistically significant level. After stratification by age 50 years, there were no significant differences between the two groups in less than 50-years old age group, but auditory threshold of 0.25, 0.5, 1 and 8 kHz frequency were significantly different between the two groups in above 50-years old age group. The differences between two groups ranged from 0.4 dB(HL) to 6.7 dB(HL). Multiple linear regression analysis showed that hand transmitted vibration exposure was significant only in 0.25, 0.5 kHz frequency and the regression coefficients of vibration exposure ranged from 3.826 to 5.028 in those frequencies.
CONCLUSIONS
The differences of hearing threshold between two groups only in the 50-years old group were possibly owing to changed peripheral vascular system with autonomic nervous system, and significances only in low frequencies such as 0.25, 0.5 kHz probably mean that hand vibration exposure have been transmitted to auditory organ over long term. Collectively, older people can be more susceptible to hearing loss in the presence of hand transmitted vibration exposure and auditory threshold at low frequency may be more affected by the hand transmitted vibration exposure than high frequency.

Citations

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The Health Effect of Hand Arm Transmitted Vibration
Jung-Wan Koo
Journal of the Ergonomics Society of Korea.2013; 32(4): 303. CrossRef

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Original Article

Epidemiologic Characteristics of Hand-Arm Vibration Syndrome through Occupational Disease Surveillance System in Busan, Ulsan, Kyungnam Province: Young hee Choi, Cheol In Yoo, Ji Ho Lee, Choong Ryeol Lee, Hun Lee, Young Wook Kim, Chang Ho Chae, Sang Baek Koh, Euna Kim, Lu Jin Lee, Yang ho Kim; Korean Journal of Occupational and Environmental Medicine 2003;15(3):261-268. Published online September 30, 2003; DOI: https://doi.org/10.35371/kjoem.2003.15.3.261

Abstract PDF: OBJECTIVES
The objectives of this study were to estimate the epidemiologic characteristics of hand-arm vibration syndrome (HAVS) due to occupational exposure of hand transmitted vibration and to identify the occupations and industries where such exposures arises, and the main sources of exposure.
METHODS
In April 2001 the Busan, Ulsan, and Kyung-Nam Province occupational disease surveillance system was established to measure the incidence and prevalence of work-related HAVS and other occupational diseases in these Korean provinces. Occupational physicians of nine hospitals in Busan, Ulsan, and Kyung-nam Province were involved in this project between April 2001 and November 2002. Physicians collected information through questionnaires and interviews. Information gathered included age, occupation, types of vibration tools used and presence of subjective symptoms such as vibration-induced white finger (VWF), numbness and tingling.
RESULTS
A total 192 cases were reported with 188 males and 4 females. The shipbuilding industry was the most common type of industry and grinders were the most common source of exposure. Symptoms of neurological disorder were more common than those of vascular disorder.
CONCLUSIONS
The authors concluded that exposure to hand transmitted vibration is common and that HAVS is one of the most common occupational diseases in Korea. However, the range and extent of hand transmitted vibration and the overall prevalence of HAVS in Korea is still unknown. More extensive research on this syndrome in order to priorite necessary preventive measures is required.

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Original Article

Evaluation of Health Exams on Local Vibration Illness among Shipyard Workers: Yeong Su Ju, Hong Ryul Choi, Mi Kyung Kim, Hong Sohn, Sun Ja Jeon, Sung Il Cho, Hyong Sik Kim; Korean Journal of Occupational and Environmental Medicine 1998;10(4):413-427. Published online December 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.4.413

Abstract PDF

A hand-arm vibration syndrome, local vibration illness, occurs in some workers who use hand held vibration tools. It consists of white fingers, diffusely distributed finger neuropathy, pain in the hand and arm, and a small excess risk of osteoarthritis. This study is aimed to identify effective methods to confirm local vibration illness among various health exams, which are mentioned in worker's special health exam regulation. In addition, this study is aimed to quantitatively assess the daily vibration exposure level as a major determinant of vibration illness. The subjects, 46 vibration workers, were selected according to the results of the first special health exam about vibration hazards at shipbuilding industry in 1997. They all had experiences of work related blanching of fingers. Fifteen controls, who had no vibration exposure at all, were also recruited to compare their test results with the results of vibration workers. We adopted 1 subjective and 6 objective tests to evaluate the effectiveness and feasibility for confirming local vibration illness. These tests were history taking of subjective symptoms according to the Stockholm classification, checking blood pressure of finger, checking grasp power, checking finger skin temperature, nail-bed pressing test, vibration perceptional threshold test, and skin prick test for pain perception. Among these, checking skin temperature, nail-bed pressing test, and vibration perception test included cold water provocations. We also estimated some vibration exposure levels of hand held vibration tools by using previously published data from one automobile company. In conclusion, history taking of subjective symptoms according to the Stockholm classification, nail-bed pressing test, and vibration perceptional threshold test were discovered to be effective to diagnose local vibration illness. Furthermore, vibration perceptional threshold on right fingers showed a dose-response relationship to daily vibration exposure levels. The parameter beta was 0.0005(+/-0.0002), and statistically significant by REM (random effects model).

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Assessment on the Actual Vibration Exposure of Workers Engaging in Vibration Induced Works
Kab-Bae Kim, Eun-Kyo Chung, Ki-Ho You, Jae-Kil Jang
Transactions of the Korean Society for Noise and Vibration Engineering.2012; 22(10): 940. CrossRef

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Original Article

Quantitative Sensory and Vascular Tests in the Assessment of Hand-Arm Vibration Syndrome: Seung Wan Kang, Eun Il Lee, Yong Tae Yum, Hae Joon Kim; Korean Journal of Occupational and Environmental Medicine 1996;8(2):210-222. Published online September 30, 1996; DOI: https://doi.org/10.35371/kjoem.1996.8.2.210

Abstract PDF

This study was conducted on 103 male workers exposed to local vibration (exposure workers) and 23 male clergical workers not exposed to local vibration (reference workers) to evaluate the effect of local vibration in a automobile industry workers who had used vibratory tools such as electric bolt impacter or grinder. The assessment methods of this study were some tests recommended by Wasserman and Taylor. None of reference workers complained sensorineural symptoms, but 43.7% of exposed workers complained over one of those symptoms. The proportion of non-recovery type, which means that there was no full recovery of temperature of finger tips, was from 0% to 31. 3% in reference workers and from 10.7% to 15.5% in exposure workers. There was statistically significant difference of recovery time of plethysmogram after cold provocation between mean recovery time of 0.44 minutes in reference workers and that of 3.05 minutes in exposure workers. The proportion of bad plethysmogram was from 0% to 4.4% in reference workers and from 3.9% to 7.8% in exposure workers. There was statistically significant difference of discrimination sense between mean length of 2.04 mm in reference workers and that of 2.9 mm in exposure workers. There were also statistically significant difference of pain sense between mean weights of from 5.02 g to 5.26 g in reference workers and those of from 6.81 g to 7.6 g in exposure workers. By the results of multiple stepwise regression analysis the statistically significant variable affecting discrimination and pain sense was exposure and those affecting vibration sense were exposure and age. We concluded that exposure of local vibration in automobile workers was significaritly associated with decrease of sensorineural sense regardless of age and other, possible related variables.

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Trans‐Cranial Doppler and Peripheral Sensory Threshold Tests for Carbon Disulfide Poisoning
Eunil Lee, Hun‐Jong Chung, Soon‐Duck Kim, Jong‐Tae Park, Donggeun Sul, Myung‐Hyun Kim
Journal of Occupational Health.2001; 43(6): 307. CrossRef

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Original Article

Nailfold capillary microscopy for evaluating hand-arm vibration syndrome: Lee, Chan Boo , Sung, Joo Hyun , Park, Jung Hun , Yoo, Cheol In , Sim, Chang Sun , Oh, Ji Seon , Lee, Hun; Ann Occup Environ Med 2014;26(1):27-27.; DOI: https://doi.org/10.1186/s40557-014-0027-y

Abstract: OBJECTIVES
We evaluated nailfold capillary abnormalities in patients with hand-arm vibration syndrome using nailfold capillary microscopy.
METHODS
Fifty workers who underwent a special health examination because of exposure to hand-arm vibration at Ulsan University Hospital in 2012 (exposed group) and a control group of 50 white-collar employees were evaluated through a questionnaire survey regarding their present tasks, types of tools used, vibration exposure duration, use of protective wear, and medical history. Then, an occupational physician performed a physical examination for any hand deformities, skin problems, or motor and sensory dysfunctions of the upper extremities. The nailfold capillary morphologies (tortuous, crossing, bushy, meandering, branching, hemorrhage, avascular area, enlarged, and giant), capillary dimensions (afferent, top, venous, total width, and length), and specific counts (crossing and branching) on both fourth fingers were determined by a rheumatologist. Thereafter, the exposed subjects were assessed according to the Stockholm workshop classification scale. In total, 8 and 6 subjects in the exposed and control groups, respectively, were excluded from the study because of poor capillary microscopic image quality. In addition, 24 subjects in the exposed group with Stockholm vascular stage 0 were excluded. Finally, capillary morphology, dimensions, and specific counting were compared between the exposed (n = 18) and control groups (n = 44).
RESULTS
The exposed group had significantly greater crossing capillaries and abnormal capillary numbers that included crossing capillaries (crossing, branching, bushy, and meandering) but smaller branching and abnormal capillary numbers that excluded crossing capillaries (branching, bushy, and meandering) than the control group did. No significant difference in capillary dimensions was observed between the two groups. Despite the adjustment for age, smoking status, and underlying diseases, the statistical significance was unchanged. In the specific counting of the type of capillaries, the exposed group had a significantly higher total crossing count but fewer total branching count than the control group did. However, no statistical significance resulted after adjustment for age, smoking status, and underlying diseases.
CONCLUSIONS
In this study, the exposed group had significantly more crossing capillaries and a higher crossing count than the control group did.

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