title: Thermal perception thresholds among young adults exposed to hand-transmitted vibration.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. tohr.nilsson@lvn.se
authors.forename: T
authors.initials: T
authors.lastname: Nilsson
authors.forename: L
authors.initials: L
authors.lastname: Burström
authors.forename: M
authors.initials: M
authors.lastname: Hagberg
authors.forename: R
authors.initials: R
authors.lastname: Lundström
mesh_terms: D003080:Cold Temperature; D003430:Cross-Sectional Studies; D005260:Female; D018737:Hand Strength; D053421:Hand-Arm Vibration Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006358:Hot Temperature; D006801:Humans; D008297:Male; D012684:Sensory Thresholds; D020886:Somatosensory Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013548:Sweden; D014732:Vibration / Q000009:adverse effects*; D055815:Young Adult