title: Hand-arm vibration syndrome: clinical characteristics, conventional electrophysiology and quantitative sensory testing.
abstract: OBJECTIVE
  Workers exposed to vibrating tools may develop hand-arm vibration syndrome (HAVS). We assessed the somatosensory phenotype using quantitative sensory testing (QST) in comparison to electrophysiology to characterize (1) the most sensitive QST parameter for detecting sensory loss, (2) the correlation of QST and electrophysiology, and (3) the frequency of a carpal tunnel syndrome (CTS) in HAVS.
  
  
  METHODS
  QST, cold provocation tests, fine motor skills, and median nerve neurography were used. QST included thermal and mechanical detection and pain thresholds.
  
  
  RESULTS
  Thirty-two patients were examined (54 ± 11 years, 91% men) at the more affected hand compared to 16 matched controls. Vibration detection threshold was the most sensitive parameter to detect sensory loss that was more pronounced in the sensitivity range of Pacinian (150 Hz, x12) than Meissner's corpuscles (20 Hz, x3). QST (84% abnormal) was more sensitive to detect neural dysfunction than conventional electrophysiology (37% abnormal). Motor (34%) and sensory neurography (25%) were abnormal in HAVS. CTS frequency was not increased (9.4%).
  
  
  CONCLUSIONS
  Findings are consistent with a mechanically-induced, distally pronounced motor and sensory neuropathy independent of CTS.
  
  
  CONCLUSIONS
  HAVS involves a neuropathy predominantly affecting large fibers with a sensory damage related to resonance frequencies of vibrating tools.
authors.affiliation: Department of Palliative Medicine, Rheinische Friedrich Wilhelms-University, Bonn, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Rolke
authors.forename: Silke
authors.initials: S
authors.lastname: Rolke
authors.forename: Thomas
authors.initials: T
authors.lastname: Vogt
authors.forename: Frank
authors.initials: F
authors.lastname: Birklein
authors.forename: Christian
authors.initials: C
authors.lastname: Geber
authors.forename: Rolf-Detlef
authors.initials: RD
authors.lastname: Treede
authors.forename: Stephan
authors.initials: S
authors.lastname: Letzel
authors.forename: Susanne
authors.initials: S
authors.lastname: Voelter-Mahlknecht
mesh_terms: D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006225:Hand / Q000294:innervation / Q000503:physiopathology; D053421:Hand-Arm Vibration Syndrome / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D008875:Middle Aged; D017288:Pain Threshold / Q000502:physiology; D012678:Sensation Disorders / Q000175:diagnosis / Q000503:physiopathology; D014732:Vibration / Q000009:adverse effects
keywords: Autonomous nervous system; CDT; CMAP; CPT; CTS; Carpal tunnel syndrome; DFNS; DMA; DML; Deutscher Forschungsverbund Neuropathischer Schmerz=German Research Network on Neuropathic Pain; HAVS; HPT; HRV; Hand-arm vibration syndrome; MDT; MPS; MPT; Neurography; PHS; PPT; QST; Quantitative sensory testing; SNAP; SSR; TSL; VDT; VWF; Vibration-induced white fingers; WDT; WUR; cold detection threshold; cold pain threshold; compound muscle action potential; distal motor latency; dynamic mechanical allodynia; hand-arm vibration syndrome; heart rate variability; heat pain threshold; mNCV; mechanical detection threshold; mechanical pain sensitivity; mechanical pain threshold; motor nerve conduction velocity; paradoxical heat sensation; pressure pain threshold; quantitative sensory testing; sNCV; sensory nerve action potential; sensory nerve conduction velocity; sympathetic skin response; thermal sensory limen; vibration detection threshold; vibration-induced white finger disease; warm detection threshold; wind-up ratio