title: The relationship between clinical and standardized tests for hand-arm vibration syndrome.
abstract: BACKGROUND
  Standardized laboratory tests are undertaken to assist the diagnosis and staging of hand-arm vibration syndrome (HAVS), but the strength of the relationship between the tests and clinical stages of HAVS is unknown.
  
  
  OBJECTIVE
  To assess the relationship between the results of thermal aesthesiometry (TA), vibrotactile (VT) thresholds and cold provocation (CP) tests with the modified Stockholm scales for HAVS and to determine whether the relationship is affected by finger skin temperature.
  
  
  METHODS
  Consecutive records of workers referred to a Tier 5 HAVS assessment centre from 2006 to 2015 were identified. The diagnosis and staging of cases was undertaken from the clinical information contained in the records. Cases with alternative or mixed diagnoses were excluded and staging performed according to the modified Stockholm scale without knowledge of the results of the standardized laboratory tests.
  
  
  RESULTS
  A total of 279 cases of HAVS were analysed. Although there was a significant trend for sensorineural (SN) and vascular scores to increase with clinical stage (P < 0.01), there was no significant difference in scores between 2SN early and 2SN late or between 2SN late and 3SN. There was moderate correlation between the TA and VT scores and the clinical SN stages (r = 0.6). This correlation did not change when subjects were divided into those with a finger skin temperature <30 and >30°C. CP scores distributed bimodally and correlated poorly with clinical staging (r = 0.2).
  
  
  CONCLUSIONS
  Standardized SN tests distinguish between the lower Stockholm stages, but not above 2SN early. This has implications for health surveillance and UK policy.
authors.affiliation: Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK, jon.poole@hsl.gsi.gov.uk.
authors.forename: C J M
authors.initials: CJ
authors.lastname: Poole
authors.affiliation: Chemical and Biological Risk Unit, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK.
authors.forename: H
authors.initials: H
authors.lastname: Mason
authors.affiliation: Mathematical Science Unit, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK.
authors.forename: A-H
authors.initials: AH
authors.lastname: Harding
mesh_terms: D000328:Adult; D053421:Hand-Arm Vibration Syndrome / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D015203:Reproducibility of Results; D013697:Thermosensing; D055698:Touch Perception; D014732:Vibration / Q000009:adverse effects*
keywords: Finger skin temperature; HAVS; Stockholm scales.; hand–arm vibration syndrome; standardized tests