Thermal perception thresholds among young adults exposed to hand-transmitted vibration

  • T. Nilsson
  • L. Burström
  • M. Hagberg
  • R. Lundström
Original Article



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.


QST 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.


  1. Bartlett G, Stewart JD, Tamblyn R, Abrahamowicz M (1998) Normal distributions of thermal and vibration sensory thresholds. Muscle Nerve 21(3):367–374PubMedCrossRefGoogle Scholar
  2. Bird SJ, Brown MJ, Spino C, Watling S, Foyt HL (2006) Value of repeated measures of nerve conduction and quantitative sensory testing in a diabetic neuropathy trial. Muscle Nerve 34(2):214–224PubMedCrossRefGoogle Scholar
  3. Bovenzi M, Zadini A, Franzinelli A, Maiorano M, Mancini R (1992) Sensorineural disorders in forestry workers using chain saws. In: 6th International conference on hand arm vibration. BG, BonnGoogle Scholar
  4. Chong PS, Cros DP (2004) Technology literature review: quantitative sensory testing. Muscle Nerve 29(5):734–747PubMedCrossRefGoogle Scholar
  5. Claus D, Hilz MJ, Hummer I, Neundorfer B (1987) Methods of measurement of thermal thresholds. Acta Neurol Scand 76(4):288–296PubMedCrossRefGoogle Scholar
  6. Concato J, Feinstein AR, Holford TR (1993) The risk of determining risk with multivariable models. Ann Intern Med 118(3):201–210PubMedGoogle Scholar
  7. Doeland HJ, Nauta JJ, van Zandbergen JB, van der Eerden HA, van Diemen NG, Bertelsmann FW, Heimans JJ (1989) The relationship of cold and warmth cutaneous sensation to age and gender. Muscle Nerve 12(9):712–715PubMedCrossRefGoogle Scholar
  8. Ekenvall L, Gemne G, Tegner R (1989) Correspondence between neurological symptoms and outcome of quantitative sensory testing in the hand-arm vibration syndrome. Br J Ind Med 46(8):570–574PubMedGoogle Scholar
  9. Ekenvall L, Lindblad LE, Carlsson A, Etzell BM (1988) Afferent and efferent nerve injury in vibration white fingers. J Auton Nerv Syst 24(3):261–266PubMedCrossRefGoogle Scholar
  10. Ekenvall L, Nilsson BY, Falconer C (1990) Sensory perception in the hands of dentists. Scand J Work Environ Health 16(5):334–339PubMedGoogle Scholar
  11. Ekenvall L, Nilsson BY, Gustavsson P (1986) Temperature and vibration thresholds in vibration syndrome. Br J Ind Med 43(12):825–829PubMedGoogle Scholar
  12. England JD, Asbury AK (2004) Peripheral neuropathy. Lancet 363(9427):2151–2161PubMedCrossRefGoogle Scholar
  13. Fruhstorfer H, Lindblom U, Schmidt WC (1976) Method for quantitative estimation of thermal thresholds in patients. J Neurol Neurosurg Psychiatry 39(11):1071–1075PubMedGoogle Scholar
  14. Gelber DA, Pfeifer MA, Broadstone VL, Munster EW, Peterson M, Arezzo JC, Shamoon H, Zeidler A, Clements R, Greene DA et al (1995) Components of variance for vibratory and thermal threshold testing in normal and diabetic subjects. J Diabetes Complications 9(3):170–176PubMedCrossRefGoogle Scholar
  15. Gerr F, Letz R (1994) Covariates of human peripheral nerve function: II. Vibrotactile and thermal thresholds. Neurotoxicol Teratol 16(1):105–112PubMedCrossRefGoogle Scholar
  16. Golja P, Kacin A, Tipton MJ, Eiken O, Mekjavic IB (2004) Hypoxia increases the cutaneous threshold for the sensation of cold. Eur J Appl Physiol 92(1–2):62–68PubMedCrossRefGoogle Scholar
  17. Golja P, Tipton MJ, Mekjavic IB (2003) Cutaneous thermal thresholds—the reproducibility of their measurements and the effect of gender. J Therm Bio 28:341–346CrossRefGoogle Scholar
  18. Hagander LG, Midani HA, Kuskowski MA, Parry GJ (2000) Quantitative sensory testing: effect of site and pressure on vibration thresholds. Clin Neurophysiol 111(6):1066–1069PubMedCrossRefGoogle Scholar
  19. Hansson P (1994) Possibilities and pitfalls of combined bedside and quantitative somatosensory analysis in pain patients, In: Boivie J et al (eds) Touch, temperature and pain in health and disease, IASP, Seattle, pp 113–132Google Scholar
  20. Hilz MJ, Glorius S, Beric A (1995) Thermal perception thresholds: influence of determination paradigm and reference temperature. J Neurol Sci 129(2):135–140PubMedCrossRefGoogle Scholar
  21. Hilz MJ, Stemper B, Axelrod FB, Kolodny EH, Neundorfer B (1999) Quantitative thermal perception testing in adults. J Clin Neurophysiol 16(5):462–471PubMedCrossRefGoogle Scholar
  22. Hirosawa I (1983) Original construction of thermo-esthesiometer and its application to vibration disease. Int Arch Occup Environ Health 52(3):209–214PubMedCrossRefGoogle Scholar
  23. Hirosawa I, Watanabe S, Fukuchi Y, Nishiyama K, Hosokawa M (1983) Availability of temperature sense indices for diagnosis of vibration disease. Int Arch Occup Environ Health 52(3):215–222PubMedCrossRefGoogle Scholar
  24. Kelly KG, Cook T, Backonja MM (2005) Pain ratings at the thresholds are necessary for interpretation of quantitative sensory testing. Muscle Nerve 32(2):179–184PubMedCrossRefGoogle Scholar
  25. Kojo I, Pertovaara A (1987) The effects of stimulus area and adaptation temperature on warm and heat pain thresholds in man. Int J Neurosci 32:875–880PubMedCrossRefGoogle Scholar
  26. Lang PM, Schober GM, Rolke R, Wagner S, Hilge R, Offenbacher M, Treede RD, Hoffmann U, Irnich D (2006) Sensory neuropathy and signs of central sensitization in patients with peripheral arterial disease. Pain 124:190–200PubMedCrossRefGoogle Scholar
  27. Lin YH, Hsieh SC, Chao CC, Chang YC, Hsieh ST (2005) Influence of aging on thermal and vibratory thresholds of quantitative sensory testing. J Peripher Nerv Syst 10(3):269–281PubMedCrossRefGoogle Scholar
  28. Lindsell CJ, Griffin MJ (1999) Thermal thresholds, vibrotactile thresholds and finger systolic blood pressures in dockyard workers exposed to hand-transmitted vibration. Int Arch Occup Environ Health 72(6):377–386PubMedCrossRefGoogle Scholar
  29. Liou JT, Lui PW, Lo YL, Liou L, Wang SS, Yuan HB, Chan KH, Lee TY (1999) Normative data of quantitative thermal and vibratory thresholds in normal subjects in Taiwan: gender and age effect. Zhonghua Yi Xue Za Zhi (Taipei) 62(7):431–437Google Scholar
  30. Lundborg G (2004) Nerve injury and repair regeneration, reconstruction, and cortical remodeling, 2nd edn. Elsiever Churchill Livingstone, PhiladelphiaGoogle Scholar
  31. Maeda S, Sakakibara H (2002) Thermotactile perception thresholds measurement conditions. Ind Health 40(4):353–361PubMedCrossRefGoogle Scholar
  32. Magda P, Latov N, Renard MV, Sander HW (2002) Quantitative sensory testing: high sensitivity in small fiber neuropathy with normal NCS/EMG. J Peripher Nerv Syst 7(4):225–228PubMedCrossRefGoogle Scholar
  33. McGeoch KL, Gilmour WH (2000) Cross sectional study of a workforce exposed to hand-arm vibration: with objective tests and the Stockholm workshop scales. Occup Environ Med 57(1):35–42PubMedCrossRefGoogle Scholar
  34. Meh D, Denislic M (1994) Quantitative assessment of thermal and pain sensitivity. J Neurol Sci 127(2):164–169PubMedCrossRefGoogle Scholar
  35. Miscio G, Guastamacchia G, Brunani A, Priano L, Baudo S, Mauro A (2005) Obesity and peripheral neuropathy risk: a dangerous liaison. J Peripher Nerv Syst 10(4):354–358PubMedCrossRefGoogle Scholar
  36. Nilsson T, Lundstrom R (2001) Quantitative thermal perception thresholds relative to exposure to vibration. Occup Environ Med 58(7):472–478PubMedCrossRefGoogle Scholar
  37. Rolke R, Baron R, Maier C, Tolle TR, Treede RD, Beyer A, Binder A, Birbaumer N, Birklein F, Botefur IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihofner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B (2006a) Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 123(3):231–243PubMedGoogle Scholar
  38. Rolke R, Magerl W, Campbell KA, Schalber C, Caspari S, Birklein F, Treede RD (2006b) Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain 10(1):77–88PubMedCrossRefGoogle Scholar
  39. Sakakibara H, Maeda S, Yonekawa Y (2002) Thermotactile threshold testing for the evaluation of sensory nerve function in vibration-exposed patients and workers. Int Arch Occup Environ Health 75(1–2):90–96PubMedGoogle Scholar
  40. Sanden H, Edblom M, Hagberg M, Wallin BG (2005) Bicycle ergometer test to obtain adequate skin temperature when measuring nerve conduction velocity. Clin Neurophysiol 116(1):25–27PubMedCrossRefGoogle Scholar
  41. Sarlani E, Farooq N, Greenspan JD (2003) Gender and laterality differences in thermosensation throughout the perceptible range. Pain 106(1–2):9–18PubMedCrossRefGoogle Scholar
  42. Shukla G, Bhatia M, Behari M (2005) Quantitative thermal sensory testing—value of testing for both cold and warm sensation detection in evaluation of small fiber neuropathy. Clin Neurol Neurosurg 107(6):486–490PubMedCrossRefGoogle Scholar
  43. Shy ME, Frohman EM, So YT, Arezzo JC, Cornblath DR, Giuliani MJ, Kincaid JC, Ochoa JL, Parry GJ, Weimer LH (2003) Quantitative sensory testing: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 60(6):898–904PubMedCrossRefGoogle Scholar
  44. Söderberg K, Sundström I Poromaa, Nyberg S, Bäckström T, Nordh E (2006) Psychophysically determined thresholds for thermal perception and pain perception in healthy women across the menstrual cycle. Clin J Pain 22(7):610–616PubMedCrossRefGoogle Scholar
  45. Susser E, Sprecher E, Yarnitsky D (1999) Paradoxical heat sensation in healthy subjects: peripherally conducted by A delta or C fibres? Brain 122(Pt 2):239–246PubMedCrossRefGoogle Scholar
  46. Taylor W, Ogston SA, Brammer AJ (1986) A clinical assessment of seventy-eight cases of hand-arm vibration syndrome. Scand J Work Environ Health 12(4 Spec No):265–268PubMedGoogle Scholar
  47. Toibana N, Sakakibara H, Hirata M, Kondo T, Toyoshima H (2000) Thermal perception threshold testing for the evaluation of small sensory nerve fiber injury in patients with hand-arm vibration syndrome. Ind Health 38(4):366–371PubMedCrossRefGoogle Scholar
  48. Virokannas H, Virokannas A (1995) Temparature and vibration perception thresholds in workers exposed to hand-arm vibration. Cent Eur J Public Health 3(Suppl):66–69PubMedGoogle Scholar
  49. Yarnitsky D, Sprecher E (1994) Thermal testing: normative data and repeatability for various test algorithms. J Neurol Sci 125(1):39–45PubMedCrossRefGoogle Scholar
  50. Zamyslowska-Szmytke E (1998) Efficacy of vibration, electric current and thermal perception tests in diagnosis of hand-arm vibration syndrome. Int J Occup Med Environ Health 11(3):247–254PubMedGoogle Scholar
  51. Zaslansky R, Yarnitsky D (1998) Clinical applications of quantitative sensory testing (QST). J Neurol Sci 153(2):215–238PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • T. Nilsson
    • 1
    • 3
  • L. Burström
    • 1
  • M. Hagberg
    • 2
  • R. Lundström
    • 1
  1. 1.Department of Public Health and Clinical Medicine, Occupational and Environmental MedicineUmeå UniversityUmeåSweden
  2. 2.Occupational and Environmental Medicine Sahlgrenska Academy and University HospitalUniversity of Gothenburg (UGOT)GothenburgSweden
  3. 3.Department of Occupational MedicineSundsvall HospitalSundsvallSweden

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