Thermal perception thresholds among young adults exposed to hand-transmitted vibration
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Quantitative sensory testing assesses non-invasively the function of the sensory pathways from receptors to cortex. Studies of workers exposed to vibration support evidence that neuro-sensory hand-arm vibration syndrome also encompasses neuropathy of the small-diameter nerve fibres.
To assess the risk of disturbed thermal perception developing among young adults exposed to vibration and hand-intensive manual work. The aim also encompasses the study of alternative covariates in small-diameter nerve fibre neuropathy assessment.
This cross-sectional multi-centre study comprised 202 males and females from vocational school programs in auto mechanics, construction and catering. The testing included a baseline questionnaire, a clinical examination focusing on upper extremity disorders and quantitative somatosensory testing. Thermal perception thresholds were assessed, on both hands, second and fifth digits, using a modified Marstock method for warmth and cold.
Reduced thermal perception sensitivity was found for digit II compared to digit V, for females compared to males, and between the two study centres. Subjects exposed to vibration at work showed reduced sensitivity to temperature compared to non-vibration exposed. In univariate analyses odds ratios of 1.06 (95% CI 1.006–1.118) and 1.02 (95% CI 0.971–1.078) for reduced perception to cold for the right and left hands, respectively, was found for vibration. This association was lost in multivariate analyses. The study centre was the strongest confounding influence.
Sensitivity to temperature appears to be reduced despite the subjects short exposure-time and low exposure to vibration. The effect is small in relation to other confounding factors. A low agreement between the modalities indicates the need for separate tests for cold and warmth. Hand-side, age, stature, and BMI were not important for thermal perception but study centre, gender and choice of digit were. Conventional electro-diagnostic investigations are inadequate for evaluating the status of the small-fibre afferent systems leaving QST of thermal perception as the preferred diagnostic tool.
KeywordsQST Thermal-perception Hand-arm vibration Occupational
The authors are indebted to the EU project VIBRISKS and Göteborg university for their participation in the 2nd International Workshop on Diagnosis of Injuries Caused by Hand-transmitted Vibration, held in Göteborg 6–7 September 2006, at which the paper was presented. This research is supported by the European Commission under Framework 5 Quality of Life and Management of Living Resources Programme—Project No. QLK4-2002-02650 (VIBRISKS) and AFA insurance (project number T-10:02, Young machine operators). Testing was performed by Asta Lindmark and Christina Ahlstrand. Lars Gerhardsson participated in interviews and examinations.
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