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Objectives: The aim was to examine exposure-response relations between occupational hand exposures and carpal tunnel syndrome (CTS) and to compare the relation between surgery-treated and non-surgery-treated CTS. The secondary aim was to study sex-specific differences in exposure-response relations., Methods: We conducted a nationwide register-based cohort study of all persons born in Denmark (1945-1994). During follow-up (2010-2013), we identified first-time events of CTS. Occupational hand exposure estimates the year before each follow-up year were obtained by linking individual occupational codes with a job exposure matrix. We used multivariable logistic regression equivalent to discrete survival analysis based on sex and surgery. The excess fraction of cases was calculated., Results: For both sexes, exposure-response relations were found for all occupational hand exposures. Among men, we found OR adj of 3.6 (95% CI 3.2 to 3.8) for hand-related force, 2.9 (95% CI 2.5 to 3.2) for repetitive hand movements, 3.8 (95% CI 2.7 to 5.2) for non-neutral hand posture and 2.5 (95% CI 2.2 to 2.7) for hand-arm vibration in the highest exposure groups. For combined exposure (hand load), OR adj was 3.5 (95% CI 3.1 to 4.0). Slightly higher ORs adj were generally found for surgery-treated CTS compared with non-surgery-treated CTS for both sexes. When comparing sex, somewhat higher ORs adj were found among men. The excess fraction was 42%., Conclusions: Occupational hand exposures carried a 3-5-fold increased risk of CTS with slightly higher risks for surgery-treated compared with non-surgery-treated CTS. Even though CTS occurs more frequently among women, somewhat higher exposure-response relations were found for men compared with women. In the general working population, a substantial fraction of first-time CTS could be related to occupational hand exposures., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Sustained exposure to high-level hand-transmitted vibrations may result in angioneurotic disorders, which partly originate from vibration-altered hemodynamics in the finger arteries when repeating these disturbances throughout working life. Hence, the aim of this study is to assess the most relevant hemodynamic descriptors in the digital arteries, determine the relationship between the latter and vibration features, and gain better understanding of the physiological mechanisms involved., Methods: An experimental setup, mainly comprised of an ultra-high frequency ultrasound scanner and a vibration shaker, was used to image the digital proper volar arteries of the forefinger. Raw ultrasound data were post-processed by custom-made numerical routines to supply a pulsatile fluid mechanics model for computing the hemodynamic descriptors. Twenty-four healthy volunteers participated in the measurement campaign. Classical statistical methods were then applied to the dataset and also the wavelet transform for calculating the signal power in the frequency bands matching cardiac, respiratory, myogenic and neurogenic activities., Results: The artery diameter, the wall shear stress - WSS - and the WSS temporal gradient - WSSTG - were found to be the most relevant descriptors. Vibration-induced WSS was divided by three compared to its basal value whatever the vibration frequency and it was proportional to log 2 of the acceleration level. Marked increases in WSSTG when stopping vibration might also lead to adverse health effects. Vibration caused a drop in WSS power for the frequency band associated with the neurogenic activity of the sympathetic nervous system., Conclusion: This study may pave the way for a new framework to prevent vibration-induced vascular risk., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Muscle fatigue (MF) can lead to musculoskeletal disorders (MSDs) in the long term; however, it can be managed if the causes are well known. This study aimed to examine the grip force (GF) and grip fatigue (GFa) of employees with light, moderate and heavy manual tasks using a dynamometer and find their possible relationship with other factors. The nature of heavy manual tasks led to more experience of GFa and GF of the right hand. Moreover, the equal need for both hands in occupations with light and moderate manual tasks is the reason for more GFa in the left hand. In this primary study, the height, weight and age of subjects and their exposure to vibration had a decisive effect on GF. In order to determine the accurate effects of the aforementioned risk factors on MF, it is recommended for future studies to be performed on larger populations.

The magnitude of hand- (HTV) and wrist- (WTV) transmitted vibration can negatively impact upper limb responses even during short-term exposure. This study aimed to establish the effects of various handle-grip designs on the harmful impacts of vibration, sustained grip exertion, and unnatural posture. The primary focus was to investigate how using a handle grip and how three shapes with two surface profiles affect HTV, WTV, and forearm muscle activities during exposure. The secondary goal was to evaluate the immediate effects on fundamental hand functions, perceived discomfort/comfort, and perceived vibration level after exposure. The final objective was to assess which of the handle designs had the least harmful effects. Fourteen young male adults were recruited and asked to consistently grip a vibrating handle structure for 2 min while the primary parameters were recorded. Pre- and post-task measurements of secondary parameters were recorded on the six design conditions and one control condition (no handle grip). The study found that implementing a regular circular-smooth handle resulted in lower transmitted vibrations, leading to lower upper-limb discomfort, higher grip comfort, and lower perceived vibration. Additionally, shape significantly affected HTV, resulting in grip strength reduction, while surface profile did not influence transmitted vibrations but significantly impacted ring and small finger sensitivity, finger and hand discomfort, and grip comfort. Finally, forearm muscle activities were unaffected, and no significant interaction effects were observed. Circular handles also had the least negative impacts, and elliptic handles had the most negative impacts on the upper extremity because of the level of hand-handle contact stress and hand-grip effort. Meanwhile, the uneven distribution of vibration on the fingers and palm imposed by the rounded spikes on the patterned surface led to decreased finger sensitivity, higher discomfort, and lower grip comfort. Therefore, when machine operation involves moderate grip exertion, pronated forearm posture, and short-term handle vibration exposure, implementing a hard-solid handle with less hand-handle contact area, less grip effort, and even texture is recommended.

This study focuses on the integrated performance of anti-vibration (AV) gloves in terms of manual dexterity and distributed palm and fingers' vibration transmissibility. Experiments were designed to measure vibration transmission and manual dexterity performance of 10 different gloves using 15 subjects. The results showed all gloves impeded manual dexterity, while five gloves satisfied the AV glove screening criteria. Glove type yielded a significant effect on manual dexterity ( p  < 0.001) and vibration transmissibility ( p  ≤ 0.001). Manual dexterity decreased nearly linearly with an increase in glove thickness ( p  < 0.05), while palm and fingers' vibration transmissibility in high-frequency range was negatively correlated with glove thickness ( R 2 > 0.70). A strong correlation was evident between glove material stiffness and the H-frequency range palm vibration transmissibility ( R Anti-vibration gloves are used to isolate hand from power tools vibration, while these may adversely affect manual dexterity. Vibration isolation was correlated with material properties and thickness, while dexterity was correlated with thickness alone. Glove thickness is a vital parameter for realising a compromise between vibration isolation and manual dexterity. 2 HTV: hand-transmitted vibration; AV: anti-vibration; MANOVA: multivariate analysis of variance; TR: vibration transmissibility; ASTM: ASTM F2010 standard test; Minnesota: Two-Hand Turning and Placing Minnesota test; rANOVA: repeated-measures analysis of variance; rms: root mean square; CoV: coefficient of variations; S: score.Practitioner summary Anti-vibration gloves are used to isolate hand from power tools vibration, while these may adversely affect manual dexterity. Vibration isolation was correlated with material properties and thickness, while dexterity was correlated with thickness alone. Glove thickness is a vital parameter for realising a compromise between vibration isolation and manual dexterity. Abbreviations: HTV: hand-transmitted vibration; AV: anti-vibration; MANOVA: multivariate analysis of variance; TR: vibration transmissibility; ASTM: ASTM F2010 standard test; Minnesota: Two-Hand Turning and Placing Minnesota test; rANOVA: repeated-measures analysis of variance; rms: root mean square; CoV: coefficient of variations; S: score.

Vibration is experienced when a body is subjected to either internal or external forces which cause oscillation, with most operators of industrial equipment often exposed to high dosage, higher than the stipulated values. In this research, Digital Real-Time Frequency Analyzer (RSA 5106A) was used, while the results obtained were evaluated and compared with the health guidelines of the ISO 2631-1 : 1997 and ISO 2631-5 : 2004 standards, as described in the Health Guidance Caution Zone for a daily exposure action value (EAV) of 0.47 m/s 2 and a daily exposure limit value (ELV) of 0.93 m/s. High acceleration was mostly seen on the z -axis in all the results obtained, whereas many were not within the HGCZ ( A rms <0.47, and >0.93 m/s 2 ). Comparing (VDV <8.5 m/s 1.75 and >17 m/s 1.75 ) with the ISO standard, the accelerations on all x- and y -axes were slightly within the HGCZ, with just a little below 0.47 m/s 2 limit. The results obtained clearly showed that urgent action is needed virtually on all the equipment in both the Secondary Manufacturing Department (SMD) and Primary Manufacturing Department (PMD) to minimize vibration exposure on the technical operators., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Oluseyi Adewale Orelaja et al.)

This study conducted two series of experiments to investigate the relationships between hand coupling force and biodynamic responses of the hand-arm system. In the first experiment, the vibration transmissibility on the system was measured as a continuous function of grip force while the hand was subjected to discrete sinusoidal excitations. In the second experiment, the biodynamic responses of the system subjected to a broadband random vibration were measured under five levels of grip forces and a combination of grip and push forces. This study found that the transmissibility at each given frequency increased with the increase in the grip force before reaching a maximum level. The transmissibility then tended to plateau or decrease when the grip force was further increased. This threshold force increased with an increase in the vibration frequency. These relationships remained the same for both types of vibrations. The implications of the experimental results are discussed. Practitioner Summary: Shocks and vibrations transmitted to the hand-arm system may cause injuries and disorders of the system. How to take hand coupling force into account in the risk assessment of vibration exposure remains an important issue for further studies. This study is designed and conducted to help resolve this issue.

Purpose: To investigate whether exposure to cold could influence the thermal perception thresholds in a working population., Methods: This cross-sectional study was comprised of 251 males and females and was carried out at two mines in the northern part of Norway and Sweden. The testing included a baseline questionnaire, a clinical examination and measurements of thermal perception thresholds, on both hands, the index (Digit 2) and little (Digit 5) fingers, for heat and cold., Results: The thermal perception thresholds were affected by age, gender and test site. The thresholds were impaired by experiences of frostbite in the fingers and the use of medication that potentially could affect neurosensory functions. No differences were found between the calculated normative values for these workers and those in other comparative investigations conducted in warmer climates., Conclusions: The study provided no support for the hypothesis that living and working in cold climate will lead to impaired thermal perception thresholds. Exposure to cold that had caused localized damage in the form of frostbite was shown to lead to impaired thermal perception.

Objective: To explore whether polymorphic variants of the HTR1B gene are associated with the susceptibility of Raynauds' Phenomenon (RP) coursed by vibration., Methods: 148 subjects exposed to vibration for more than 2 years were classified into either induced white finger (VWF) group (n = 72), or non-VWF group (n = 76). Vibration exposure levels were measured and assessed following ISO 5349-1:2001 protocol. All workers were genotyped by sequencing for the single nucleotide polymorphisms (SNPs) in the 5'-flanking and coding region of HTR1B. Genetic characteristics and linkage disequilibrium (LD) were analyzed with Haploview. Serum serotonin levels of each subject were detected using ELISA. The association between the susceptibility of vascular damage and genotype was analyzed via logistic regression., Results: 7 known SNPs were obtained and their allele frequencies were inserted into the Hardy-Weinberg equilibrium. rs6297 variant genotype had an increased risk of VWF compared with wild genotype (OR = 2.14, 95% CI = 1.04- 4.58, P < 0.05). rs6298 mutant type (AG+GG) was found to have a significant interaction on vibration exposure LN(CEI), accounting for VWF occurrence. LN(5-HT) level is significantly different between the VWF group (x¯±s= 1.99±1.09 ng/mL) and the non-VWF group (x¯±s= 2.72±1.47 ng/mL)., Conclusions: Serotonin levels may affect the progression of secondary RP. Polymorphic variants of the HTR1B gene are associated with the susceptibility of secondary RP in vibration-exposed occupational populations of Chinese Han people.

The diagnosis of vascular hand-arm vibration syndrome (HAVS) requires consistent symptoms, photographic evidence of digital blanching and sufficient exposure to hand-transmitted vibration (HTV; A(8) > 2.5 m/s2). There is no reliable quantitative investigation for distinguishing HAVS from other causes of Raynaud's phenomenon and from normal individuals. Hypothenar and thenar hammer syndromes produce similar symptoms to HAVS but are difficult to diagnose clinically and may be confused with HAVS. Magnetic resonance angiography (MRA) is a safe and minimally invasive method of visualizing blood vessels. Three cases of vascular HAVS are described in which MRA revealed occlusions of the ulnar, radial and superficial palmar arteries. It is proposed that HTV was the cause of these occlusions, rather than blows to the hand unrelated to vibration, the assumed mechanism for the hammer syndromes. All three cases were advised not to expose their hands to HTV despite one of them being at Stockholm vascular stage 2 (early). MRA should be the investigation of choice for stage 2 vascular HAVS or vascular HAVS with unusual features or for a suspected hammer syndrome. The technique is however technically challenging and best done in specialist centres in collaboration with an occupational physician familiar with the examination of HAVS cases. Staging for HAVS should be developed to include anatomical arterial abnormalities as well as symptoms and signs of blanching. Workers with only one artery supplying a hand, or with only one palmar arch, may be at increased risk of progression and therefore should not be exposed to HTV irrespective of their Stockholm stage., (© The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Hand is frequently the site of work accidents or occupational diseases. The musculoskeletal upper limb is the first recognized occupational disease and carpal tunnel syndrome is the most common of them. The most common location of occupational dermatoses is the hand. Their causes are often multifactorial, involving chemical irritants, physical, allergens and endogenous factors (mainly atopic dermatitis). Occupational exposure to microtrauma and iterative use of vibrating tools may also be the cause of hypothenar hammer syndrome and acrosyndromes. The frequent chronicity and functional impairment induced by these attacks can cause lasting disabilities, an inability to source workstation. Occupational physician is a focal point for helping to maintain the position and the prevention of socioprofessional disinsertion. Many pathologies of the hand related to professional activity may benefit from a statement in occupational disease and thus allow the patient to obtain compensation and employment protection. Prevention of occupational hand diseases should be made by all health actors, especially in occupations and industries at risk., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: We systematically reviewed etiological factors of Kienböck's disease (osteonecrosis of the lunate) discussed in the literature in order to examine the justification for including Kienböck's disease (KD) in the European Listing of Occupational Diseases., Methods: We searched the Ovid/Medline and the Cochrane Library for articles discussing the etiology of osteonecrosis of the lunate published since the first description of KD in 1910 and up until July 2012 in English, French or German. Literature was classified by the level of evidence presented, the etiopathological hypothesis discussed, and the author's conclusion about the role of the etiopathological hypothesis. The causal relationship between KD and hand-arm vibration was elucidated by the Bradford Hill criteria., Results: A total of 220 references was found. Of the included 152 articles, 140 (92%) reached the evidence level IV (case series). The four most frequently discussed factors were negative ulnar variance (n=72; 47%), primary arterial ischemia of the lunate (n=63; 41%), trauma (n=63; 41%) and hand-arm vibration (n=53; 35%). The quality of the cohort studies on hand-arm vibration did not permit a meta-analysis to evaluate the strength of an association to KD. Evidence for the lack of consistency, plausibility and coherence of the 4 most frequently discussed etiopathologies was found. No evidence was found to support any of the nine Bradford Hill criteria for a causal relationship between KD and hand-arm vibration., Conclusions: A systematic review of 220 articles on the etiopathology of KD and the application of the Bradford Hill criteria does not provide sufficient scientific evidence to confirm or refute a causal relationship between KD and hand-arm vibration. This currently suggests that, KD does not comply with the criteria of the International Labour Organization determining occupational diseases. However, research with a higher level of evidence is required to further determine if hand-arm vibration is a risk factor for KD.

Hand-held power tools used for fastening operations exert high dynamic forces on the operator's hand-arm, potentially causing injuries to the operator in the long run. This paper presents a study that analyzed the vibrations exerted by two hand-held power tools used for fastening operations with the operating exhibiting different postures. The two pneumatic tools, a right-angled nut-runner and an offset pistol-grip, are used to install shearing-type fasteners. A tri-axial accelerometer is used to measure the tool's vibration. The position and orientation of the transducer mounted on the tool follows the ISO-5349 Standard. The measured vibration data is used to compare the two power tools at different operating postures. The data analysis determines the number of years required to reach a 10% probability of developing finger blanching. The results indicate that the pistol-grip tool induces more vibration in the hand-arm than the right-angled nut-runner and that the vibrations exerted on the hand-arm vary for different postures., (Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Background: In recent years, temporary work (TW) has increased in European countries due to the greater uncertainty in the economy., Aims: To compare the prevalence of non-specific musculoskeletal symptoms of the upper extremities (UEMSDs) and their main risk factors in blue-collar workers employed through temporary agencies (TW) and in those in permanent employment (PE)., Methods: UEMSDs occurring during the preceding 7 days were assessed using a Nordic questionnaire completed by 1493 blue-collar workers randomly included in a surveillance programme for UEMSDs (171 in TW and 1322 in PE) in a large French region. Personal factors and work-related risk factors for UEMSDs were assessed by self-administered questionnaires., Results: The prevalence of UEMSDs during the preceding 7 days did not significantly differ between workers in TW or PE. However, after adjustment for age and gender, TW had a higher risk of symptoms of the wrist/hand region (OR = 1.6, 95% CI 1.04-2.6). TW was characterized by higher exposure to paced work (OR = 2.0, 95% CI 1.4-3.0), repetitive work (OR = 2.3, 95% CI 1.6-3.4), awkward postures of the wrist (OR = 1.6, 95% CI 1.2-2.4) and intensive use of vibrating hand tools (OR = 1.7, 95% CI 1.1-2.3). Workers in TW suffered from a lack of autonomy (OR = 2.5, 95% CI 1.7-3.6) and skill discretion at work (OR = 2.0, 95% CI 1.3-3.1) more frequently, but there was no difference in relation to psychological demands of the task or social support., Conclusions: Temporary workers were more frequently exposed to working time constraints, repetitive work and biomechanical constraints of the wrist/hand region when compared to permanent workers and may represent a subpopulation at particularly high risk of UEMSDs.

Hypothenar hammer syndrome is an uncommon cause of upper-extremity ischemia that is often overlooked in the absence of a thorough occupational and recreational history. Importantly, it is a reversible cause of hand ischemia that, if missed, can lead to significant morbidity and even amputation. The occupational ramifications and quality of life of those affected can be significant. Its relative rarity, set against the ubiquitous use of the hand as a 'hammer' is noteworthy. Several other causes of hand ischemia can present similarly; therefore, consideration of other etiologies must be thoroughly investigated. Key distinguishing clinical features, in addition to a detailed occupational and recreational history, may include characteristic sparing of the thumb, the absence of a hyperemic phase in 'Raynaud's phenomenon', and a positive Allen's sign. Both non-invasive and invasive diagnostic studies, including bilateral upper-limb segmental pulse volume recordings (PVR), arterial duplex examination, and upper-extremity angiography, are complementary to a thorough history and physical examination. Optimal management strategies are not well defined because of its rarity and resultant lack of quality, evidence-based data. Though most cases can be successfully managed non-operatively, micrographic arterial reconstruction may be limb saving in severe or recalcitrant cases. Newer, experimental strategies including selective sympathetic blockage using botulinum toxin A have been reported in a few recalcitrant cases. The brief case description illustrates the typical presentation and potential treatment strategies employed in a difficult case. A review of relevant literature is also presented.

This invited paper reviews experimental studies of the frequency-dependence of absolute thresholds for the perception of vibration, equivalent comfort contours, temporary changes in sensation caused by vibration, and reductions in finger blood flow caused by hand-transmitted vibration. Absolute thresholds depend on the contact conditions but for a typical hand grip the thresholds show greatest sensitivity to acceleration around 125 Hz. The frequency-dependence of discomfort caused by hand-transmitted vibration depends on vibration magnitude: similar to absolute thresholds at low magnitudes, but the discomfort at higher magnitudes is similar when the vibration velocity is similar (at frequencies between about 16 and 400 Hz). Hand-transmitted vibration induces temporary elevations in vibrotactile thresholds that reflect the sensory mechanisms excited by the vibration and are therefore highly dependent on the frequency of vibration. Hand-transmitted vibration reduces finger blood flow during and after exposure; when the vibration velocity is similar at all frequencies there is more vasoconstriction at frequencies greater than 63 Hz than at lower frequencies. A single frequency weighting cannot provide a good indication of how all effects of hand-transmitted vibration depend on vibration frequency. Furthermore, a single frequency weighting provides only an approximate indication of any single response, because many factors influence the frequency-dependence of responses to hand-transmitted vibration, including the magnitude of vibration, contact conditions, and individual differences. Although the frequency weighting in current standards extends from 8 to 1,000 Hz, frequencies greater than 400 Hz rarely increase the weighted value on tools and there is currently little psychophysical or physiological evidence of their effects.

Jackhammer manufacturers have recently developed lightweight (45-60 lbs) jackhammers intended to reduce the required lifting and pushing forces during operation. However, the vibration characteristics of the lightweight jackhammers and their effect on muscle activity are currently unknown. The objective of this study was to compare the measured vibration and muscle activity between: (i) conventional (90 lb) and light weight (60 lb) jackhammers, (ii) different pavement type/thickness combinations, and (iii) pneumatic and hydraulic jackhammers. Five jackhammers were tested on 4 and 6 inch thick asphalt and concrete pavements by four experienced operators. Analysis of the results revealed that both weight classes averaged 9.7 m/s(2) at the 20 Hz weighted 1/3 octave band frequency, and the TLV of daily exposure for either weight class of jackhammer was less than 1.5 hours/per day. There was an approximately 33% difference in vibration measured on the hand of the operators due to pavement thickness, 30% due pavement type, and no difference due to power source. Conventional jackhammers overall produced higher muscle activity than lightweight jackhammers. Although selection of the correct jackhammer for the job involves many factors including pavement type and thickness, the results of this research can be used to assist in selecting the appropriate jackhammer.

Background: Previous studies have suggested that the presence of the vascular component of hand-arm vibration syndrome (HAVS) in the hands increases the risk of cold-induced vasospasm in the feet., Aims: To determine if objectively measured cold-induced vasospasm in the hands is a risk factor for objectively measured cold-induced vasospasm in the feet in workers being assessed for HAVS., Methods: The subjects were 191 male construction workers who had a standardized assessment for HAVS including cold provocation digital photocell plethysmography of the hands and feet to measure cold-induced vasospasm. Bivariate analysis and multinomial logistic regression were used to examine the association between plethysmographic findings in the feet and predictor variables including years worked in construction, occupation, current smoking, cold intolerance in the feet, the Stockholm vascular stage and plethysmographic findings in the hands., Results: Sixty-one (32%) subjects had non-severe vasospasm and 59 (31%) had severe vasospasm in the right foot with the corresponding values being 57(30%) and 62 (32%) in the left foot. Multinomial logistic regression indicated that the only statistically significant predictor of severe vasospasm in the feet was the presence of severe vasospasm in the hands (OR: 4.11, 95% CI: 1.60-10.6, P < 0.01 on the right side and OR: 4.97, 95% CI: 1.82-13.53, P < 0.01 on the left side). Multinomial logistic regression analysis did not indicate any statistically significant predictors of non-severe vasospasm in the feet., Conclusions: Workers assessed for HAVS frequently have cold-induced vasospasm of their feet. The main predictor of severe vasospastic foot abnormalities is severe cold-induced vasospasm in the hands.

Objectives: To quantify variance components of hand-arm vibration exposure from data collected in a laboratory study of four different angle grinders., Methods: Four different angle grinders were sent to seven laboratories for grinding tests by three operators at each laboratory. Vibration in both the throttle and support handles was measured. For one grinder, the experimental set-up was repeated and two measurements were collected for that specific grinder., Results: At least one-third of the estimated variability is attributable to the wheel and less than one-third to the operator. In repeated experiments, between-occasion, operator and wheel factors explained 4, 29 and 17% of the total variability, respectively., Conclusions: Since measured vibrations in the support and throttle handles are significantly differed, measurements should be taken at both locations. Factors influencing vibration variability include the presence/absence of an auto balance unit, wheel and operator, but other factors remain to be elucidated.

Background: A cold provocation test is used to assess the presence and extent of the peripheral vascular disorders in the upper extremities of workers exposed to hand-arm vibration. A quantitative evaluation of vascular response to cold provocation is determined by measuring the finger skin temperature. In the study two methods of cold exposure were used to assess the effect of water temperature and immersion duration on recovery time in subjects with the acropoikilothermic thermoregulation., Material and Methods: In the study two cold provocation tests were performed. One test consisted of a 10 min immersion of both hands in cold water at 14 degrees C (Polish requirements) and the second one adequately, of a 5 min immersion in cold water at 12 degrees C (ISO 14835-1:2004 standard). Twenty young (aged 22-24 years) and healthy subjects took part in each test. Finger skin temperature was measured on all fingers of both hands before and after immersion., Results: The mean recovery time of the cold provocation test was longer in the group examined by ISO 14835-1:2004 standard requirements than in the group examined by the method used in Poland., Conclusions: Immersion parameters used in the cold provocation test performed in acropoikilotherms have a significant effect on recovery time.

Stimulation and needle electromyography studies covered 102 patients with occupational hands disorders. 87% of the examinees showed tunnel syndromes signs: 44% of those had one tunnel syndrome, 36% - two synromes, and 7% - multiple ones. The results failed to demonstrate reliable difference in tunnel syndrome frequency for vibration exposure and functional hands overstrain. Sensitivity thresholds in vibration disease were increased in 86.7% of the examinees and in 61.5% of those with functional hands overstrain. Peripheral nerve disorders in residual defects with occupational hands diseases are persistent due to compression within physiologic tunnels.

Objectives: Segmental sensory nerve conduction velocity (SNCV) was measured from the wrists to the hands and digits in a population of 134 (126 men and 8 women) vibration-exposed shipyard workers following systemic warming using a bicycle ergometer. Results were compared to earlier nerve conduction tests, identical in execution, except that the warming process was segmental and cutaneous. The study was designed to investigate whether SNCVs, which were selectively slow in the fingers after segmental cutaneous (skin surface) warming, would be affected differently by systemic warming., Methods: Wrist-palm, palm-proximal digit, and digital sensory nerve segments were assessed antidromically by stimulating at the wrist with recording electrodes placed distally. The same subjects were cutaneously warmed in 2001 to >or=31 degrees C and were systemically warmed 28 months later in 2004 by ramped sustained exercise to 100 W for 12 min. Skin temperatures were measured by traditional thermistry and by infrared thermal images taken over the hand and wrist surfaces., Results: When systemic warming was compared to segmental cutaneous warming, SNCVs were increased by 15.1% in the third digit and 20.4% in the fifth digit of the dominant hand. Respective increases in the non-dominant hand were 11.0% and 19.4%. A strong association between increased surface skin temperature and faster SNCV, which had been observed after segmental cutaneous warming, was largely eliminated for both digit and palmar anatomic segments after systemic warming. Significant differences in SNCV between vibration-exposed and non-exposed workers, which had been observed after segmental cutaneous warming, were eliminated after systemic warming. Systemic warming had only a small effect on the wrist-palm (transcarpal) segmental SNCVs., Conclusions: Reduced SNCV in the digits was observed in vibration-exposed and non-exposed workers. Substituting exercise-induced systemic warming for segmental cutaneous warming significantly increased SNCV in the digits and appeared to reduce differences in SNCV between vibration-exposed and non-exposed workers. These findings persisted despite a substantial time interval between tests, during which the subjects continued to work. There may be more general implications for diagnosing clinical conditions in industrial workers, such as the carpal tunnel syndrome and the hand-arm vibration syndrome.

Objectives: The purpose of this paper is to assess the overlap and stability of two different case definitions of carpal tunnel syndrome CTS. The analysis considers the association between different case definitions and objective tests (sensory nerve conduction velocities, SNCVs and vibrotactile perception thresholds, TTS), and the natural history of CTS, in the context of two vibration-exposed cohorts., Methods: Clinical CTS cases were defined in two ways: (1) by the study physician using fixed criteria, and; (2) by questionnaire and hand diagram. SNCV in median and ulnar nerves was measured for digital, transpalmar, and transcarpal segments, and conventionally as from wrist-digit. Skin temperature was assessed as a point measurement by thermistor and regionally by thermal imaging. VTTs were determined at the bilateral fingertips of the third and fifth digits using a tactometer meeting the requirements of ISO 13091-1 (ISO 2001). The subjects were cohorts of shipyard workers in 2001 and 2004, and dental hygienists in 2002 and 2004., Results: Results are reported for 214 shipyard workers in 2001 and 135 in 2004, and for 94 dental hygienists in 2002 and 66 in 2004. In 2001, 50% of shipyard workers were diagnosed as CTS cases by at least one of the diagnostic schemes, but only 20% were positive by both criteria. Among study physician diagnosed cases, 64% were CTS negative in 2001, 76% were negative in 2004, 13% were positive in both years, 22% became negative after being positive, and 11% became positive after being negative. For only study physician diagnosed CTS did VTTs differ between cases differ and non-cases in digit 3; there was no such distinction in digit 5. The dental hygienists had little CTS., Conclusion: Clinical case definitions of CTS based on diagrams and self-assessment, and clinical evaluation have limited overlap. Combining clinical criteria to create a more narrow or specific case definition of CTS does not appear to predict SNCV. The natural history of CTS suggests a protean disorder with considerable flux in case status over time.

In the interest of providing more effective evaluations of impact wrench vibration exposures and the development of improved methods for measuring vibration emissions produced by these tools, this study focused on three variables: acceleration measured at the tool surface, vibration exposure duration per test trial, and the amount of torque required to unseat the nuts following a test trial. For this evaluation, six experienced male impact wrench operators used three samples each of five impact wrench models (four pneumatic models and one battery-powered model) in a simulated work task. The test setup and procedures were based on those provided by an International Organization for Standardization (ISO) Technical Committee overseeing the revision of ISO 8662-7. The work task involved the seating of 10 nuts onto 10 bolts mounted on steel plates. The results indicate that acceleration magnitudes vary not only by tool type but also by individual tools within a type. Thus, evaluators are cautioned against drawing conclusions based on small numbers of tools and/or tool operators. Appropriate sample sizes are suggested. It was further noted that evaluators could draw different conclusions if tool assessments are based on ISO-weighted acceleration as opposed to unweighted acceleration. As expected, vibration exposure durations varied by tool type and by test subject; duration means varied more for study participants than they did for tool types. For the 12 pneumatic tools evaluated in this study, torque varied directly with tool handle acceleration. Therefore, in order to reduce vibration exposure, tools should be selected and adjusted so that they produce no more than the needed torque for the task at hand.

Two tools for assessing tactile sensory disturbances in the hands have been constructed from mechanoreceptor-specific vibrotactile threshold shifts, and thresholds changes with time, and employed in a prospective study of forest workers (N=18). Statistically significant positive threshold shifts (i.e., reductions in sensitivity compared to the hands of healthy persons) were found in five hands at study inception (13.9%), and 15 hands at follow-up (41.7%). Four patterns of threshold shift could be identified, involving selectively the median and/or ulnar nerve pathways and/or end organs. Statistically significant positive threshold changes (i.e., reductions in sensitivity with time) were recorded in 69.4% of the hands over a five-year period, even though a majority of the workers remained symptom free. If the thresholds recorded from subjects not working with power tools are used to control for aging, lifestyle, and environmental factors during the five year period, then 40% of the remaining subjects are found to be experiencing work-related threshold changes in their hands. The ability of the threshold shift metric to predict the numbness reported by these subjects shows that it is closely associated with the tactile sensory changes occurring in their hands.

Algorithms used to determine the vibrations to which hand-tool operators are exposed take into account only vibrations measured on a tool. Thus, the significant influence of constraints joining the elements of the tool-operator system is neglected. This paper attempts to determine the influence of grip on vibrations recorded both on the tool and on the limb. The estimation was based on the use of the wavelet transfer function, in which the analysis was done by filtration with wavelet functions. Signals recorded with the specially designed system were utilised in investigations.

Background: Hand-arm vibration syndrome (HAVS) refers to the vascular, neurological and musculoskeletal effects that may occur in workers with prolonged exposure to vibrating tools. Hypothenar hammer syndrome (HHS) is a lesion of the ulnar artery at the level of the hamate bone secondary to single or repeated episodes of trauma to the hypothenar eminence. The literature suggests that digital arterial thrombosis and HHS may be associated with the use of vibrating tools., Aim: This study will familiarize investigators with the range of vascular abnormalities seen in workers using vibrating tools, and highlight the importance of screening for arterial thrombosis in the hand when assessing hand-arm vibration-exposed patients., Methods: In the patients referred to our clinic for HAVS assessment, three were identified during the period 2001 to 2004 who had vascular occlusions in the hands in addition to HAVS. In addition to standardized HAVS vascular investigations, all three patients had arteriograms based on a significantly positive Allen's test., Results: All three cases had documented HAVS based on vascular testing. Arteriograms revealed a spectrum of severity of arterial thromboses from severe HHS, to occlusion limited to the digital arteries., Conclusion: Our study reports three cases of HAVS with concomitant HHS and/or digital artery thrombosis. These findings support previous reports of an association between HAVS and vascular thrombosis in the hands. Screening for arterial occlusive problems in the hands should be included in the HAVS work up.

Objectives: This study examined onset time for reported vascular and neurological symptoms in relation to the vibration load in a group of workers exposed to vibration., Methods: Information on the self-stated year for the first occurrence of symptoms was collected by means of questionnaires. During interviews data were obtained on self-stated estimations of daily exposure time, type of tool, and number of months or years with different exposures. The estimations of the vibration magnitudes of exposure were based on conducted measurements. From these data, the individual vibration exposure at the time of onset of symptoms was calculated., Results: The incidence was 25.6 and 32.9 per 1000 exposure years for vascular and neurological symptoms, respectively, in the group of workers. The first onset of symptoms appeared after an average of 12 years of exposure. For the workers, the symptoms of vascular or neurological disorders started after about the same number of exposure years. The calculated accumulated acceleration correlated best with the onset time of symptoms., Conclusions: It was concluded that, since the workers' exposure to vibration was below the action level established in the European vibration directive, the results suggest that the action level is not a safe level for avoiding vascular and neurological symptoms.

Background: Concerns about provider competence and quality of hand-arm vibrations (HAVs) health surveillance programmes were identified by Health & Safety Executive (HSE) inspectors., Aims: To evaluate health surveillance programmes and compare them with published HSE guidance. To identify deficiencies and areas for improvement in the health surveillance programmes., Methods: A proforma was developed for the study and used on a sample of 10 local occupational health providers., Results: All 10 organizations were aware of current HSE guidance for health surveillance for HAVs but only a minority (30%) were following it. Occupational health provider training, written procedures and health surveillance delivery were all identified as areas requiring improvement., Conclusions: The majority of organizations were not following HSE guidance. Occupational health providers undertaking health surveillance for HAV require specific training.

Measurements of changes in finger skin blood flow with laser Doppler perfusion imaging (LDPI) in response to cold provocation test (10 degrees C, 10 min) were performed in 12 men suffering from vibration induced white finger (VWF) and 13 exposed controls. The mean perfusion values in both groups reduced markedly as a result of immersion of the hand in cold water. In the controls, however, the mean value increased gradually until the end of the cold provocation, while that in the VWF subjects remained at the lowest level. After removal of the hand from the cold water, the skin blood perfusion in the controls recovered rapidly and nearly reached the baseline value. In the VWF subjects, it had a slight increase immediately following the cold immersion but no tendency to rise as the time span increased. Analysis of covariance controlling for possible confounders revealed that the VWF subjects had significantly lower perfusion values compared to the controls in the last several minutes of the cold provocation and the following recovery. These findings suggest that the LDPI technique enables visualizing and quantifying the peripheral vascular effects of cold water immersion on the finger skin blood perfusion and thus has the potential of providing more detailed and a&curate information that may help detect the peripheral circulatory impairment in the fingers of vibration-exposed workers.

The biodynamic responses of the hand-arm system under x(h)-axis vibration are investigated in terms of the driving point mechanical impedance (DPMI) and absorbed power in a laboratory study. For this purpose, seven healthy male subjects are exposed to two levels of random vibration in the 8-1,000 Hz frequency range, using three instrumented cylindrical handles of different diameters (30, 40 and 50 mm), and different combinations of grip (10, 30 and 50 N) and push (0, 25 and 50 N) forces. The experiments involve grasping the handle while adopting two different postures, involving elbow flexion of 90 degrees and 180 degrees, with wrist in the neutral position for both postures. The analyses of the results revealed peak DPMI magnitude and absorbed power responses near 25 Hz and 150 Hz, for majority of the test conditions considered. The frequency corresponding to the peak response increased with increasing hand forces. Unlike the absorbed power, the DPMI response was mostly observed to be insensitive to variations in the excitation magnitude. The handle diameter revealed obvious effects on the DPMI magnitude, specifically at frequencies above 250 Hz, which was not evident in the absorbed power due to relatively low velocity at higher frequencies. The influence of hand forces was also evident on the DPMI magnitude response particularly at frequencies. above 100 Hz, while the effect of hand-arm posture on the DPMI magnitude was nearly negligible. The magnitude of power absorbed within the hand and arm was observed to be strongly dependent upon the excitation level over the entire frequency range, while the influence of hand-arm posture on the total absorbed power was observed to be important. The effect of variations in the hand forces on the absorbed power was relatively small for the bent elbow posture, while an increase in either the grip or the push force coupled with the extended arm posture resulted in considerably higher energy absorption. The results suggested that the handle size, hand-arm posture and hand forces, produce coupled effect on the biodynamic response of the hand-arm system.

Manual dexterity and hand functional difficulties in daily life in hand-arm vibration syndrome (HAVS) were investigated in 29 male patients with HAVS and 30 male controls without occupational exposure to hand-arm vibration. Manual dexterity was assessed by measuring the performance time of picking up and transferring 30 red beans, one by one, from one plate to another. Vibrotactile perception thresholds at 125 Hz and grip strength were also examined. Hand functional difficulties in daily life were surveyed with a questionnaire. The HAVS patients had an increased vibrotactile threshold, decreased grip strength, and low performance in transferring beans. Low performances with transfer times over 53 s (2SD from the mean in the controls) were found in 66% of the HAVS patients and 3% of the controls. Bean transfer times in the patients were correlated with an increasing vibrotactile threshold and decreasing grip strength. The transfer times of the patients were also associated with hand functional difficulties such as picking up coins, turning the pages of a newspaper, buttoning clothes, and pouring from a teapot. The patients with a prolonged transfer time over 60 s (3SD from the mean in the controls) were most likely to have hand functional difficulties. The present findings suggest that measurement of the bean transfer time will serve to assess manual dexterity among HAVS patients, and that impaired manual dexterity in patients may be associated with impaired sensory feedback and muscular dysfunction in the fingers and hands.

The frequency weighting for assessing hand-transmitted vibration exposure is critical to obtaining a true dose-response relationship. Any valid weighting must have a solid theoretical foundation. The objectives of this study are to examine the biodynamic foundation for assessing the vibration exposure and to develop a set of biodynamic methods to formulate the frequency weightings for different anatomical locations of the fingers-hand-arm system. The vibration transmissibility measured on the fingers, hand, wrist, elbow, shoulder, and head was used to define the transmitted acceleration-based (TAB) frequency weighting. The apparent masses measured at the fingers and the palm of the hand were used to construct the biodynamic force-based (BFB) weightings. These weightings were compared with the ISO weighting specified in ISO 5349-1 (2001). The results of this study suggest that the frequency weightings for the vibration-induced problems at different anatomical locations of the hand-arm system can be basically divided into three groups: (a) the weighting for the fingers and hand, (b) the weighting for the wrist, elbow, and shoulder, and (c) the weighting for the head. The ISO weighting is highly correlated with the weighting for the second group but not with the first and third groups. The TAB and BFB finger weightings are quite different at frequencies lower than 100 Hz, but they show similar trends at higher frequencies. Both TAB and BFB finger weightings at frequencies higher than 20 Hz are greater than the ISO weighting.

The hand-tool coupling force in the operation of a vibrating tool is generally composed of applied force (AF) and biodynamic force (BF). There is wide interest in quantifying the coupling force. The objectives of this study are to develop an effective method for estimating the BF and to investigate its fundamental characteristics. Using the biodynamic response of the hand-arm system, such as apparent mass or mechanical impedance, and the acceleration that can be measured on vibrating tools, this study proposed an indirect method for the BF estimation. The BFs distributed on the fingers and the palm of the hand along the forearm direction (z(h)-axis) in the operations of eighteen types of tool were estimated and used to identify the distributed BF characteristics. The results indicate that the BFs depend on both the tool vibration spectrum and the biodynamic properties of the hand-arm system. The dominant BF frequency component is usually at the same frequency as the dominant vibration frequency of each tool. The BF distributed on the palm (2-98 N) is much higher than that distributed on the fingers (1-30 N) at frequencies less than 100 Hz, but these biodynamic forces (2-22 N) are comparable at higher frequencies. The palm BF on several tools with relatively low dominant frequencies (< or = 40 Hz), especially in the resonant frequency range (16-40 Hz), is comparable with the applied palm force (50-100 N). Since the resonant frequency of the palm BF is also in the range of the dominant vibration frequencies of many percussive tools, the palm BF may be related to the disorders in the wrist-arm system. The BF on the fingers is likely to be closely related to the dynamic stresses and deformations in the fingers and it may thus be used to quantify the finger vibration exposure.

In the United Kingdom the diagnosis of Hand-arm Vibration Syndrome varies depending on the purpose of that diagnosis. The criteria differ in three situations. More than 100,000 miners and ex-miners with claims for HAVS have been examined using a Medical Assessment Process which included the use of standardised tests. This contract is unique but it has had significant effects on the two other processes. The Industrial Injuries Disablement Benefit Scheme provides a benefit that can be paid to an employed earner because of an accident or Prescribed Disease. New recommendations have been published to remove the anomalies in the present format for assessing HAVS. If implemented the new scheme will recognise the Stockholm Workshop Scales and workers with neurological problems will also be compensated. The Health and Safety Executive will issue new guidance in the near future on the hazards of hand-arm vibration. Health surveillance in the workplace will be fundamental and the HSE propose a tiered approach with levels 1 to 5. Specialist occupational nurses and doctors with training in the diagnosis and assessment of HAVS will be needed for levels 3 and 4. Only at this level may a diagnosis of HAVS be made. The Medical Assessment Process has demonstrated that it is possible to examine a large number of claimants in a standardised manner. The IIAC and HSE recommendations contain very important improvements on the existing positions in the UK and it must be hoped that they will be implemented in the near future.

A new frequency weighting method to assess hand-arm vibration exposure is proposed in this paper. The influence of frequency components was first estimated using the method of multivariate analysis, then a simple form of the weighting curve was introduced. Compared with the frequency weighting in the current ISO 5349-1 (2001), the proposed weighting can better explain the relationship between rates of symptoms and vibration exposure among vibrating tool users. Although this new weighting is derived from limited data, it suggests that the current weighting in ISO 5349-1 should be changed to give more weight to the high frequency range and less weight to the low frequency range.

Objectives: It is suspected that there is a large number of patients suffering from hand-arm vibration syndrome (HAVS) in Korea. However, no cases have been reported since 1992. This study was conducted to identify HAVS cases and determine the characteristics of the syndrome., Methods: In April 2001, the Busan, Ulsan, and Gyeong-Nam Province Occupational Disease Surveillance System (BUGODSS) was established to identify work-related HAVS and other occupational diseases. In the 2 years of this project, occupational physicians from five hospitals in these provinces collected information by way of interviews and questionnaires during mandatory occupational medical examinations. Among the initial 189 suspected HAVS cases, 58 volunteers were given cold-water provocation tests in order to diagnose the vascular component of the disorder., Results: One hundred fifty-four approximately occupational HAVS cases were identified from ca. 21,000 workers. One hundred fifty about of these cases were male. The cases were most often found in workers from the shipbuilding industry, and the grinder was the most common source of vibration exposure. Cases of sensorineural disorder (SD) were more common than cases of vascular disorder (VD). The mean values of the finger skin temperature and its recovery rate at 5 min and 10 min after cold-water provocation were significantly lower in the group with the VD than in the group with the SD., Conclusions: We identified 154 occupational HAVS cases, although no cases have been reported during the occupational medical examinations mandated by the state. The majority of the cases were in workers that used grinders in the shipbuilding industry. We determined that peripheral VD and peripheral SD can progress independently of each other. We conclude that exposure to hand-transmitted vibration (HTV) and HAVS cases are common in shipbuilding industry in Korea. The recovery rate of finger skin temperature after cold-water provocation is one of the useful methods for diagnosing the vascular component of HAVS.

Objectives: To compare effects of waterproof covering on finger skin temperature (FST) and subjective hand pain during immersion tests using cold water at 10 degrees C, 12 degrees C and 15 degrees C. In the (Draft International Standard) of the International Organization for Standardization (ISO/DIS 14835-1), a water temperature of 12 degrees C and use of water covering are proposed., Methods: Six healthy male subjects took part in the immersion tests and immersed both hands into water at 10 degrees C, 12 degrees C and 15 degrees C for 5 min, repeatedly, with waterproof covering (polyethylene gloves) or without (bare hands). The FST data from middle fingers and subjective pain scores for hand pain were analyzed. Furthermore, the test with water at 12 degrees C was repeated to assess the repeatability of the test., Results: The glove and water temperature factors for FST were significant at every minute from 1 min during immersion up to 2 min after recovery, showing higher values for waterproof covering than for bare hands and showing lowest values for water temperature of 10 degrees C and highest for 15 degrees C. The glove and water temperature factors for subjective pain score were significant at the 1-min and 2-min points during immersion, showing lower scores for waterproof covering than for bare hands and showing highest scores for water temperature of 10 degrees C and lowest for 15 degrees C. The results of the first and second tests using water of 12 degrees C showed no systematic difference in FST and hand pain between the tests, with a few exceptions., Conclusions: Subjective pain during the cold immersion test with polyethylene gloves and water at 12 degrees C can be reduced, while the differences in FST between water temperatures of 10 degrees C and 12 degrees C were small or not apparent at some points during immersion and recovery. The test also seems to be suitable for repeatability. Further investigation on hand-arm vibration syndrome (HAVS) patients to validate the use of the immersion test with gloves to obtain sufficient data for diagnostic value is required.

Few studies have focused on the health effects of vibrating tools on workers in the tropical area. Work conditions and health effects related to rock drill operation were studied in 102 quarry workers, including 73 rock drill operators in Vietnam. We aimed to clarify (1) risk of vibration exposure, (2) occurrence of vibration-induced white finger (VWF), and (3) characteristics of hand-arm vibration syndrome (HAVS). Total weighted r.m.s. acceleration of the Chinese -or Russian-made rock drills, was 45-55 m/s(2). According to work observation studies, daily exposure time to vibration was 160-210 min. ISO5349 predicted that this exposure level would be associated with a high risk of HAVS in workers. We found no clear evidence of VWF. There may be several reasons why no worker exhibited VWF: (1) warmer work conditions, (2) younger and less experienced workers, (3) seasonal changes in work operations, and (4) healthy worker effect. On the other hand, 5-10% of rock drill operators might be suffering from moderate HAVS which was sensori-neural type dominant. There may be some characteristic features of HAVS among quarry workers in the tropical area.

This study investigated the biodynamic response (BR) distributed at the palm of the hand subjected to a random vibration. Twelve male subjects were used in the experiment. Each subject applied three coupling actions (grip-only, push-only, and combined grip and push) on a simulated tool handle at three different levels (50, 75, and 100 N) of palm force. This study found that the hand-arm system resonated mostly in the frequency range of 20 to 50 Hz, depending on the specific test treatment and individual characteristics. The maximum vibration power transmission through the palm occurred at the resonant frequency. Increasing the effective palm force generally increased the BR magnitude and resonant frequency. The apparent stiffness measured at the middle frequencies (80-100 Hz) is correlated to the BR in almost the entire frequency range (20-1,000 Hz). Under the same palm force, the push-only action corresponded to the highest BR values while the grip-only action generally produced the lowest values. Since the resonant frequency range matches the dominant vibration frequency range of many percussive tools, it is anticipated that the palm BR and vibration power transmission may have an association with vibration-induced injuries or disorders in the wrist-arm system among the workers using these tools.

The morphology of the abductor pollicis brevis muscle was studied in 20 patients suffering from hand-arm vibration syndrome. The main morphological changes observed were centrally located myonuclei and fibre type grouping (found in all 20 muscle biopsies), angulated muscle fibres (found in 19 biopsies), ring fibres and regenerating fibres (found in 18 biopsies) and fibrosis (found in 17 biopsies). The observed abnormalities are believed to reflect damage to both the muscle fibres and the motor nerve. The changes were related to different vibration exposure parameters. The number of fibres demonstrating centrally located nuclei correlated significantly with the cumulative vibration exposure, while the number of angulated fibres correlated significantly with the total vibration exposure time. This indicates that the vibrating tools may cause direct damage to muscle fibres as well as nerves.

Background: Occupational exposure to hand-transmitted vibration in forestry workers is associated with an increased risk for vascular, neurological and musculo-skeletal disorders of the upper limbs., Objectives: To carry out a cross-sectional study of the hand-arm vibration syndrome and soft-tissue disorders of the upper limb in a group of forestry workers employed in the Forestry Service of the Province of Trento (Italy). In the forestry worker group, usage of anti-vibration chain-saws was intermittent over a typical work year (16 weeks/yr, on average)., Methods: To investigate vascular, neurological and musculo-skeletal disorders of the upper limbs, the forestry workers (n=159) and a control group of manual workers, unexposed to hand-transmitted vibration, employed in the same Forestry Service (n=146) underwent a structured medical interview and a complete physical examination. The clinical diagnoses of vibration-induced white finger (VWF) and carpal tunnel syndrome were made according to internationally recognised consensus criteria. Occupational exposure to hand-transmitted vibration was assessed according to the recommendations of the International Standard ISO 5349-1 (2001)., Results: The forestry workers showed an increased prevalence of peripheral sensory-neural disturbances (33.3%), musculo-skeletal disorders of the upper limbs (37.7%), and carpal tunnel syndrome (21.4%) compared to those observed in the control group. There was no significant difference in the prevalence ofRaynaud' sphenomenon between the forestry workers (6.3%) and the controls (4.1%). After adjustment for confounding factors (age, body mass index, tobacco and alcohol consumption), a significant association was observed between peripheral neuropathies (peripheral sensory-neural disorders, carpal tunnel syndrome) and several indices of vibration exposure such as 8-hr energy-equivalent frequency-weighted acceleration [A(8) in m/s2 r.m.s.], duration of exposure (years), and lifetime vibration dose (m2/s4 hr). An excess, although not significant, risk for VWF was observed only in the forestry workers with A(8) > or = 4 m/s2 r.m.s.. In the forestry workers, there was no significant association between VWF and sensory-neural disorders, and between VWF and carpal tunnel syndrome. This finding seems to support the hypothesis that the vascular and neurological components of the hand-arm vibration syndrome develop independently of each other. Within the forestry worker group, the variable "years of tool usage" showed the strongest association with peripheral sensory-neural symptoms, carpal tunnel syndrome, and soft-tissue disorders of the upper limbs. It is likely that in the forestry workers the variable "years of tool usage" represents an overall index of duration of exposure to several adverse ergonomic and mechanical risk factors., Conclusions: The results of this study suggest a tendency for a decrease in the occurrence of VWF among forestry workers, and this finding seems to be associated with the use of anti-vibration chain saws, the reduction of exposure duration, and the improvement of work organization. On the other hand, the forestry workers showed an increase in the occurrence of peripheral sensory neuropathies, carpal tunnel syndrome, and upper-extremity musculo-skeletal disorders. This finding seems to support the view that there is epidemiological evidence for a positive association between exposure to a combination of risk factors (segmental vibration, forcefulness, awkward posture) and the occurrence of soft-tissue disorders of the upper limb in working populations.

When subjects repetitively lift an object, the grip force they select is influenced by the mechanical object properties of the preceding lift. Similar effects on grip force scaling are observed whether the subsequent lift is performed with the same hand or the hand contralateral to the preceding lift. Here we demonstrate that passive vibration of the hand muscles involved in the generation of grip force in the interval between two blocks of lifting trials interferes with predictive grip force scaling. Following ten trials in which subjects lifted an object with constant mechanical properties with the dominant hand, muscle vibration was given to the first interosseus and adductor pollicis muscles of the dominant hand during a 10-min rest period. Compared with the last lift preceding vibration, peak rates of grip force increase and peak grip forces were scaled too high during the first lift following vibration whether the lift was made with the dominant or non-dominant hand. Subjects scaled grip force accurately to the object properties within three lifts following vibration. If subjects rested for 10 min after the first ten trials and received no vibration, then there was no significant difference in the peak grip force or its rate of increase between the last lift preceding rest and the first lift following it. We suggest that vibration impairs the memory processes responsible for predictive grip force scaling. Our data are consistent with the recent suggestion that these memory processes are neither specific for a certain motor action nor do they reflect internal representations of mechanical object properties.

Objectives: Prolonged exposure to severe chipping hammer vibration may cause hand-arm vibration syndrome. A reliable test method is required to select appropriate tools and assist in the development of better chipping hammers. In the present study, the ISO standardized test method (ISO 8662-2, 1992) was examined through an investigation of the vibration characteristics of chipping hammers operating on the energy absorber specified in the standard., Methods: The energy absorber and test setup were designed and constructed based on those specified in the standard. The experiment employed six subjects and used two pneumatic chipping hammers and three different feed forces (50, 100 and 200 N). The subject posture was the same as that specified in the standard., Results: The vibration emission at the tool dominant frequency (or air blow rate) generally declined with an increase in feed force, thus decreasing the frequency-weighted accelerations. The increase in feed force, however, resulted in an increase in the unweighted vibration emission at high frequencies. The chipping hammer vibration emission operating on the energy absorber at the high feed force (200 N) was inconsistent., Conclusions: The measurement method has a good repeatability except at a high feed force. The feed force has a significant effect on the vibration emission. The single feed force specified in the standard may not be sufficient to test the tool behaviors. Multiple levels of feed force should be used for the chipping hammer test. Doing so may provide a more appropriate basis for tool screening.

Objectives: The aim of the study was to determine whether there are gender differences as regards the quantity of absorbed power, i.e., vibration absorption per unit of time, during exposure to vibration from a specially constructed handle., Methods: The study was conducted on 24 subjects (12 female and 12 male). The experiments were performed with exposure in two vibration directions, X(h), and Z(h), and with two vibration levels, 3 and 6 m/s(2)., Results: The male subjects had significantly higher power absorption during exposure to vibrations in the Z(h) direction at the vibration level of 6 m/s(2) than did the female subjects. When adjusted for anthropometrical measurements the difference did not remain significant. Higher vibration levels resulted in significantly higher absorption of power for both X(h) and Z(h) directions. The absorption was significantly higher in the Z(h) direction than in the X(h) direction., Conclusions: No gender difference in power absorption was shown.