Journal
CLINICAL NEUROPHYSIOLOGY
Volume 124, Issue 8, Pages 1680-1688Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.clinph.2013.01.025
Keywords
Quantitative sensory testing; QST; Hand-arm vibration syndrome; HAVS; Vibration-induced white fingers; VWF; Neurography; Autonomous nervous system; Carpal tunnel syndrome; CTS
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Funding
- Eli Lilly and Company
- Pfizer Inc.
- Astellas Pharma
- DFG (German Research Foundation)
- BMBF (Bundesministerium fur Bildung und Forschung)
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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%). Conclusion: Findings are consistent with a mechanically-induced, distally pronounced motor and sensory neuropathy independent of CTS. Significance: HAVS involves a neuropathy predominantly affecting large fibers with a sensory damage related to resonance frequencies of vibrating tools. (C) 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
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