title: Hand-arm vibration syndrome with use of anti-vibration chain saws: 19-year follow-up study of forestry workers.
abstract: OBJECTIVE
  Hand-arm vibration syndrome (HAVS) consists of vascular and neurological component. Musculoskeletal component has not been delineated yet. In the present follow-up study, we evaluated the prevalence of HAVS and the cumulative exposure to vibration among a cohort of forestry workers. Special interest was given to numbness and musculoskeletal disorders of upper extremity and neck in forestry workers.
  
  
  METHODS
  A follow-up study starting from 1976 was conducted among forestry workers in Suomussalmi in Finland. Total exposure of hand-arm vibration was recorded during 11 cross-sectional surveys. The last study was carried out in 1995. The lifetime dose of vibration energy was calculated. A cohort of 52 forest workers participated to all 11 cross-sectional surveys 1976-1995. HAVS and musculoskeletal disorders were evaluated.
  
  
  RESULTS
  The prevalence of active vibration white finger (VWF) decreased from 13 to 4% in the cross-sectional study. In the cohort VWF decreased from 17 to 8% and numbness increased from 23 to 40%. Rotator cuff syndrome (P=0.034) and epicondylitis (P=0.004) associated with numbness. Regional neck pain was diagnosed in 38% of workers and associated with low back pain. In modeling VWF, the lifelong vibration energy (OR 1.03, CI 1.01-1.05), and smoking (OR 7.36, CI 1.07-50.76) were significant. Numbness was modeled by pain in upper extremities (OR 12.43, CI 2.42-63.80) and neck pain (5.97, CI 1.25-28.39), not by lifelong vibration energy. Right rotator cuff syndrome was modeled by age (OR 2.58, CI 1.04-6.41) and lifelong vibration energy (OR 1.04, CI 1.00-1.07).
  
  
  CONCLUSIONS
  The prevalence of VWF constantly decreased. Numbness did not follow the vibration exposure profile. Numbness also associated with upper extremity musculoskeletal disorders. Hand-arm vibration associated with the right rotator cuff syndrome in forestry workers.
authors.affiliation: Department Of Physical Medicine and Rehabilitation, North Karelia Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland. paivi.sutinen@fimnet.fi
authors.forename: Päivi
authors.initials: P
authors.lastname: Sutinen
authors.forename: Esko
authors.initials: E
authors.lastname: Toppila
authors.forename: Jukka
authors.initials: J
authors.lastname: Starck
authors.forename: Anthony
authors.initials: A
authors.lastname: Brammer
authors.forename: Jing
authors.initials: J
authors.lastname: Zou
authors.forename: Ilmari
authors.initials: I
authors.lastname: Pyykkö
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D016468:Forestry; D053421:Hand-Arm Vibration Syndrome / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000209:etiology; D019547:Neck Pain / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure; D010146:Pain / Q000453:epidemiology