Abstract
Background: Upper limb disorders (ULDs) are common, and so are the difficulties with regard to their specific diagnoses. According to diagnostic consensus criteria, specific diagnoses include neuropathy and muscular- and connective-tissue disorders (MCDs). There is a need for valid objective diagnostic tools to reveal underlying mechanisms for specific diagnoses. Objective: To investigate the possible differences in vibration perception threshold (VPT) and tolerance to suprathreshold stimulation (STS) between controls and specific diagnostic ULD patient groups with uni- and bilateral neuropathy and/or MCD. Methods: In 161 ULD patients and 40 controls, the VPT of the median, ulnar, and radial nerves innervating the hand was examined by vibrometry using the “method of limits”. The tolerance to STS of the anterior forearm was tested in 128 of the patients and all controls. Results: The ULD patients in all diagnostic groups had significantly higher VPT (P<0.05) in all the nerves in limbs, with and without diagnoses compared with controls. Only patient groups defined with neuropathy demonstrated significantly higher VPT in the limb with diagnoses compared with the contralateral limb without diagnoses. The highest VPTs were found in the patient group with unilateral neuropathy and MCD, and for the radial nerve, VPT was significantly higher than that for patients with unilateral MCD alone. These findings were confirmed by almost similar findings in STS responses. Conclusions: The ULD patients generally demonstrated increased VPT compared with controls, indicating a neurogenous component independent of specific ULD diagnosis. Contralateral significant findings in limbs without diagnoses compared with controls indicate central neurogenous affection and/or the possibility of certain exposures elevating VPT before a positive status of a limb diagnosis is attained. Significantly higher VPT values in limbs with neuropathy diagnoses compared with limbs without and not in MCD alone, may indicate peripheral sensibilization or nerve affection only in the group with a specific diagnosis of neuropathy. These findings underline the importance of specific diagnoses among ULD patients.
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References
Andersson GBJ (1999) Epidemiological features of chronic low-back pain. Lancet 354:581–585
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 340:307–310
Dellon AL (1980) Clinical use of vibratory stimuli to evaluate peripheral nerve injury and compression neuropathy. Plast Reconstr Surg 65(4):466–476
Ellemann K, Nielsen KD, Poulsgaard L, Smith T (1999) Vibrotactilometry as a diagnostic tool in ulnar nerve entrapment at the elbow. Scand J Plast Reconstr Hand Surg 33:93–97
Fagius J, Wahren LK (1981) Variability of sensory threshold determination in clinical use. J Neurol Sci 51:11–27
Feuerstein M, Miller VL, Burrell LM, Berger R (1998) Occupational upper extremity disorders in the federal workforce. Prevalence, health care expenditures, and patterns of work disability. J Occup Environ Med 40:546–555
Franzblau A, Werner RA (1999) What is carpal tunnel syndrome? (Editorial). J Am Med Assoc 282:186–187
Gelberman RH, Szabo RM, Wiliamson RV, Dimick MP (1983) Sensibility testing in peripheral nerve compression syndromes. J Bone Joint Surg (Am) 65:632–638
Gerr F, Letz R (1988) Reliability of a widely used test of peripheral cutaneous vibration sensitivity and a comparison of two testing protocols. Br J Ind Med 45:635–639
Gerr F, Letz R, Hershman D, Farraye J, Simpson D (1991) Comparison of vibrotactile thresholds with physical examination and electrophysiological assessment. Muscle Nerve 14:1059–1066
Gerr F, Letz R, Harris-Abbott D, Hopkins LC (1995) Sensitivity and specificity of vibrometry for detection of carpal tunnel syndrome. J Occup Environ Med 37:1108–1115
Goldberg JM (1979) Standardised method of determining vibratory perception thresholds for diagnosis and screening in neurological investigation. J Neurol Neurosurg Psychiatry 42:793–803
Greening J, Lynn B (1998a) Minor peripheral nerve injuries: an underestimated source of pain. Man Ther 3(4):187–194
Greening J, Lynn B (1998b) Vibration sense in the upper limb in patients with repetitive strain injury and a group of at-risk office workers. Int Arch Occup Environ Health 71:29–34
Greening J, Lynn B (2000) Possible causes of pain in repetitive strain injury. In: Devor M, Rowbotham MC, Wiesenfeld-Hallin Z (eds) Proceedings of the 9th world congress on pain. Seattle, pp 697–710
Grunert BK, Wertsch JJ, Matloub HS, McCallum-Burke S (1990) Reliability of sensory threshold measurement using a digital vibrogram. J Occup Med 32(2):100–102
Hagberg M, Wegman DH (1987) Prevalence rates and odds ratios of shoulder–neck diseases in different occupational groups. Br J Ind Med 44:602–610
Halonen P (1986) Quantitative vibration perception thresholds in healthy subjects of working age. Eur J Appl Physiol 54:647–655
Harrington JM, Carter JT, Birrell L, Gompertz D (1998) Surveillance case definitions for work related upper limb pain syndromes. Occup Environ Med 55:264–271
Hilz MJ, Axelrod FB, Hermann K, Haertl U, Duetsch M, Neundorfer B (1998) Normative values of vibratory perception in 530 children, juveniles and adults aged 3–79 years. J Neurol Sci 14:219–225
Imai T, Matsumoto H, Minami R (1990) Asymptomatic ulnar neuropathy in carpal tunnel syndrome. Arch Phys Med Rehabil 71:992–994
Jensen BR, Pilegaard M, Momsen A (2002) Vibrotactile sense and mechanical functional state of the arm and hand among computer users compared with a control group. Int Arch Occup Environ Health 75:332–340
Kaergaard A, Andersen JH (2000) Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis. Occup Environ Med 57:528–534
Lundborg G, Sollerman C, Strömberg T, Pyykko I (1987) A new principle for assessment of vibrotactile sense in vibration-induced neuropathy. Scand J Work Environ Health 13:375–379
Lundborg G, Dahlin LB, Lundstrom R, Necking LE, Stromberg T (1992) Vibrotactile function of the hand in compression and vibration-induced neuropathy. Sensibility index—a new measure. Scand J Plast Reconstr Surg Hand Surg 26(3):275–279
Overgaard E, Brandt LPA, Ellemann K, Mikkelsen S, Andersen JH (2004) Tingling/numbness in the hands of computer users: neurophysiological findings from the NUDATA study. Int Arch Occup Environ Health 77:521–525
Parker KG (1996) Ergonomics programs. Current issues related to safety and health. Orthop Phys Ther Clin N Am 5:325–345
Pilegaard M, Jensen BR (2005) An 18-month follow-up study on vibrotactile sense, muscle strength and symptoms in computer users with and without symptoms. Int Arch Occup Environ Health 78:486–492
Polanyi MFD, Cole DC, Beaton DE, Chung J, Wells R, Abdolell M, Beech-Hawley L, Ferrier SE, Mondloch MV, Shields SA, Smith JM, Shannon HS (1997) Upper limb work-related musculoskeletal disorders among newspaper employees: cross-sectional survey results. Am J Ind Med 32:620–628
Sluiter JK, Rest KM, Frings-Dresen MH (2001) Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders. Scand J Work Environ Health 27(Suppl. 1):1–102
Strauch B, Lang A, Ferder M, Keyes-Ford M, Freeman K, Newstein D (1997) The ten test. Plast Reconstr Surg 99(4):1074–1078
Szabo RM, Gelberman RH, Dimick MP (1984) Sensibility testing in patients with carpal tunnel syndrome. J Bone Joint Surg (Am) 66:60–64
Travers PH (1988) Soft tissue disorders of the upper extremities. Occup Med State Art Rev 3:271–283
Werner RA, Franzblau A, Johnston E (1994) Quantitative vibrometry and electrophysiological assessment in screening for carpal tunnel syndrome among industrial workers: a comparison. Arch Phys Med Rehabil 75:1228–1232
Werner RA, Franzblau A, Johnston E (1995) Comparison of multiple frequency vibrometry testing and sensory nerve conduction measures in screening for carpal tunnel syndrome in an industrial setting. Am J Phys Med Rehabil 74:101–106
Woolf CJ (1983) Evidence for a central component of post-injury pain hypersensitivity. Nature 306:686–688
Acknowledgements
The authors wish to thank Bente Rona Jensen and Marianne Pilegaard (Department of Human Physiology, Institute for Exercise and Sport Sciences, August Krogh Institute, University of Copenhagen) for valuable advice during the study. Financial support has been received from Fabrikant Mads Clausens Fond, Nordborg and Fonden for Lægevidenskabelig Forskning Ringkjøbing, Ribe og Sønderjyllands Amter, Ringkøbing (J. no. 2-44-8-4-01).
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Laursen, L.H., Jepsen, J.R. & Sjøgaard, G. Vibrotactile sense in patients with different upper limb disorders compared with a control group. Int Arch Occup Environ Health 79, 593–601 (2006). https://doi.org/10.1007/s00420-006-0094-7
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DOI: https://doi.org/10.1007/s00420-006-0094-7