Journal List > Ann Occup Environ Med > v.26(1) > 1124839

TOOLS
Lee, Sung, Park, Yoo, Sim, Oh, and Lee: Nailfold capillary microscopy for evaluating hand-arm vibration syndrome
Research Article

Ann Occup Environ Med 2014; 26(1): 27.

Published online: 4 January 2014

DOI: https://doi.org/10.1186/s40557-014-0027-y

Nailfold capillary microscopy for evaluating hand-arm vibration syndrome

Chan Boo Lee1, Joo Hyun Sung1, Jung Hun Park1, Cheol In Yoo1, Chang Sun Sim1, Ji Seon Oh2, Hun Lee1, *

1Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea

2Department of Internal Medicine, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea

*Correspondence: leeheun67@gmail.com 1Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea Full list of author information is available at the end of the article

Received 24 December 2013       Revised 27 June 2014       Accepted 10 October 2014

Copyright © 2014 Korean Society of Occupational & Environmental Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

We evaluated nailfold capillary abnormalities in patients with hand-arm vibration syndrome using nailfold capillary microscopy.

Methods

Fifty workers who underwent a special health examination because of exposure to hand-arm vibration at Ulsan University Hospital in 2012 (exposed group) and a control group of 50 white-collar employees were evaluated through a questionnaire survey regarding their present tasks, types of tools used, vibration exposure duration, use of protective wear, and medical history. Then, an occupational physician performed a physical examination for any hand deformities, skin problems, or motor and sensory dysfunctions of the upper extremities. The nailfold capillary morphologies (tortuous, crossing, bushy, meandering, branching, hemorrhage, avascular area, enlarged, and giant), capillary dimensions (afferent, top, venous, total width, and length), and specific counts (crossing and branching) on both fourth fingers were determined by a rheumatologist. Thereafter, the exposed subjects were assessed according to the Stockholm workshop classification scale. In total, 8 and 6 subjects in the exposed and control groups, respectively, were excluded from the study because of poor capillary microscopic image quality. In addition, 24 subjects in the exposed group with Stockholm vascular stage 0 were excluded. Finally, capillary morphology, dimensions, and specific counting were compared between the exposed (n=18) and control groups (n=44).

Results

The exposed group had significantly greater crossing capillaries and abnormal capillary numbers that included crossing capillaries (crossing, branching, bushy, and meandering) but smaller branching and abnormal capillary numbers that excluded crossing capillaries (branching, bushy, and meandering) than the control group did. No significant difference in capillary dimensions was observed between the two groups. Despite the adjustment for age, smoking status, and underlying diseases, the statistical significance was unchanged. In the specific counting of the type of capillaries, the exposed group had a significantly higher total crossing count but fewer total branching count than the control group did. However, no statistical significance resulted after adjustment for age, smoking status, and underlying diseases.

Conclusions

In this study, the exposed group had significantly more crossing capillaries and a higher crossing count than the control group did.

Keywords: Hand-arm vibration syndrome, Nailfold capillary microscopy, Crossing capillary number, Crossing count

References

1. Harada N, Mahbub M. Diagnosis of vascular injuries caused by hand-transmitted vibration. Int Arch Occup Environ Health. 2008; 81:507–518.
2. Heaver C, Goonetilleke K, Ferguson H, Shiralkar S. Hand-arm vibration syndrome: a common occupational hazard in industrialized countries. J Hand Surg (European Volume). 2011; 36:354–363.
3. Harada N, Takahashi S, Shirono S, Fujimura H, Morita H, Inagaki J. Occupational exposure limit for hand-arm vibration of the Japan Society for Occupational Health. Proceedings of the Ninth International Conference on Hand-Arm Vibration INRS. 2001. 90–95.
4. Mahbub M, Harada N. Review of different quantification methods for the diagnosis of digital vascular abnormalities in hand-arm vibration syndrome. J Occup Health. 2011; 53:241–249.
5. Jung P, Trautinger F. Capillary microscopy of toes. J Dtsch Dermatol Ges. 2013; 11:855–866.
6. Cutolo M, Sulli A, Smith V. How to perform and interpret capillary microscopy. Best Pract Res Clin Rheumatol. 2013; 27:237–248.
7. Koenig M, Joyal F, Fritzler MJ, Roussin A, Abrahamowicz M, Boire G, Goulet JR, Rich E, Grodzicky T, Raymond Y, Senecal JL. Autoantibodies and microvascular damage are independent predictive factors for the progression of Raynaud's phenomenon to systemic sclerosis: a twenty-year prospective study of 586 patients, with validation of proposed criteria for early systemic sclerosis. Arthritis Rheum. 2008; 58:3902–3912.
8. Kaji H, Bossnev W, Honma H, Saito K, Tsutsui T, Matsuoka M. Capillary microscopy of finger nailfold as a tool for studying peripheral circulation disorders in hand-arm vibration syndrome. Occupations. 2004; 19:17. 13.
9. Littleford R, Khan F, Hindley M, Ho M, Belch J. Microvascular abnormalities in patients with vibration white finger. QJM. 1997; 90:525–529.
10. Harada N, Iwamoto M, Laskar MS, Hirosawa I, Nakamoto M, Shirono S, Wakui T. Effects of room temperature, seasonal condition and food intake on finger skin temperature during cold exposure test for diagnosing hand-arm vibration syndrome. Ind Health. 1998; 36:166.
11. Kim Y. Evaluation of finger skin temperature by cold provocation test for diagnosis of hand-arm vibration syndrome. Ann Occup Environ Med. 2002; 14:124–133.
12. Kabasakal Y, Elvins DM, Ring EF, McHugh NJ. Quantitative nailfold capillary microscopy findings in a population with connective tissue disease and in normal healthy controls. Ann Rheum Dis. 1996; 55:507–512.
13. Andrade LEC, Gabriel A Jr, Assad RL, Ferrari AJL, Atra E. Panoramic nailfold capillaroscopy: a new reading method and normal range. Semin Arthritis Rheum. 1990; 20:21–31.
14. Ingegnoli F, Gualtierotti R, Lubatti C, Zahalkova L, Meani L, Boracchi P, Zeni S, Fantini F. Feasibility of different capillaroscopic measures for identifying nailfold microvascular alterations. Semin Arthritis Rheum. 2009; 38:289–295.
15. Wasik JS, Simon RW, Meier T, Steinmann B, Amann-Vesti BR. Nailfold capillary microscopy: Specific features in Fabry disease. Clin Hemorheol Microcirc. 2009; 42:99–106.
16. Sakaguchi S, Miyai N, Takemura S, Fukumoto J, Tomura T, Shiozaki M, Kurasawa S, Yokoi K, Terada K, Yoshimasu K, Miyashita K. Morphologic classification of nailfold capillary microscopy in workers exposed to hand-arm vibration. Ind Health. 2011; 49:614–618.
17. Varga J, Denton CP, Wigley FM. Scleroderma: From Pathogenesis to Comprehensive Management. Springer;2011.
18. Jimenez SA, Derk CT. Following the molecular pathways toward an understanding of the pathogenesis of systemic sclerosis. Ann Intern Med. 2004; 140:37–50.
19. Svegliati Baroni S, Santillo M, Bevilacqua F, Luchetti M, Spadoni T, Mancini M, Fraticelli P, Sambo P, Funaro A, Kazlauskas A. Stimulatory autoantibodies to the PDGF receptor in systemic sclerosis. New Engl J Med. 2006; 354:2667–2676.
20. Korn J, Mayes M, Matucci Cerinic M, Rainisio M, Pope J, Hachulla E, Rich E, Carpentier P, Molitor J, Seibold J. Digital ulcers in systemic sclerosis: prevention by treatment with bosentan, an oral endothelin receptor antagonist. Arthritis Rheum. 2004; 50:3985–3993.
21. Monfrecola G, Riccio G, Savarese C, Posteraro G, Procaccini E. The acute effect of smoking on cutaneous microcirculation blood flow in habitual smokers and nonsmokers. Dermatology. 1998; 197:115–118.
22. Kao DS, Yan J-G, Zhang L-L, Kaplan RE, Riley DA, Matloub HS. Serological tests for diagnosis and staging of hand-arm vibration syndrome (HAVS). Hand. 2008; 3:129–134.
23. Kennedy G, Khan F, McLaren M, Belch J. Endothelial activation and response in patients with hand arm vibration syndrome. Eur J Clin Invest. 1999; 29:577–581.

Table 1
Characteristics of the exposed subjects
  VWF (n= 18) Non-VW (n=44) WF p value
Age (years)* 57.1±4.9 44.5± 11 1.0 0.001
Vibration exposure (years) 25.6±6.7 –  
Smoking† (%)      
Non-smoker 33.3 29.5 0.751
Ex-smoker 22.2 31.8  
Current smoker 44.4 38.6  
Alcohol consumption (%)      
Non-drinker 42.9 –  
Drinker 57.1 –  
Past medical history† (%)      
No past disease 72.2 93.8 0.098
Hypertension 11.1 6.3  
Finger injury 5.6 –  
Other diseases 11.1 –  
Source of vibration (%)      
Grinder 61.1 –  
Rock drill 38.9 –  
Antivibration gloves (%)      
Nothing 11.1 –  
Only cotton gloves 66.7 –  
Always 22.2 –  
Tasks (%)      
Painting 27.8 –  
Fitting 22.2 –  
Welding 11.1 –  
Mining 33.3 –  
Digging 5.6 –  
Mode of transportation to work (%)      
Walking 6.7 –  
Motorcycle 46.7 –  
Bus 46.7 –  

Mean ± SD.

* t test.

† Chi-square test.

Abbreviations: VWF vibration-induced white finger, Non-VWF non-vibration-induced white finger.

Table 2
Morphological findings of the nailfold capillary microscopy test (non-VWF vs. VWF)
Microscopic findings Non-VWF (n=44) VWF (n=18) p value* Adjusted p value†
  Tortuous 2.11±2.13 1.94±2.34 0.783 0.464
  Crossing 3.61±3.03 5.89±3.79 0.015 0.915
  Bushy 0.14±0.90 0.00±0.00 0.527 –
  Meandering 0.27±1.09 0.11±0.32 0.539 0.953
Morphology Branching 1.02±1.49 0.28±0.75 0.012 0.142
  Hemorrhage 0.00±0.00 0.00±0.00 – –
  Avascular area 0.66±0.96 0.72±0.89 0.812 0.562
  Enlarged 1.64±2.24 1.89±2.05 0.682 0.714
  Giant 0.00±0.00 0.00±0.00 – –
Combined count Abnormal capillary (including crossing) 3.80±2.96 6.00±3.66 0.016 0.933
  Abnormal capillary (excluding crossing) 1.11±1.62 0.33±0.77 0.013 0.184
Average density (capillary number/mm)   6.70±0.92 6.69±1.06 0.970 0.764

Unit: capillary number.

* t test.

† Adjusted for age, smoking status, and diseases using analysis of covariance.

Abbreviations: Non-VWF non-vibration-induced white finger, VWF vibration-induced white finger.

Table 3
Descriptive factors of the observed capillaries (non-VWF vs. VWF)
Microscopic findings Non-VWF (n= 44) VWF (n= 18) p value* Adjusted p value†
Afferent Afferent 1 15.14± 3.70 15.61±4.02 0.663 0.591
Afferent 2 14.59± 3.59 14.39±4.01 0.847 0.819
Afferent 3 13.65± 3.99 13.67±2.75 0.990 0.625
Afferent mean 14.46± 3.09 14.55±3.00 0.915 0.952
Afferent maximum 16.77± 3.80 16.80±4.12 0.977 0.973
Top Top 1 17.41± 4.86 19.60±5.14 0.119 0.891
Top 2 17.42± 4.28 17.58±3.31 0.888 0.992
Top 3 16.25± 4.76 16.36±4.71 0.934 0.909
Top mean 17.03± 3.75 17.85±3.32 0.424 0.982
Top maximum 19.71± 5.07 21.00±4.84 0.363 0.875
Venous Venous 1 20.43± 6.73 19.63±4.94 0.650 0.478
Venous 2 18.14± 3.95 17.40±5.21 0.545 0.505
Venous 3 17.65± 5.67 17.51±4.16 0.924 0.383
Venous mean 18.74± 4.60 18.18±4.29 0.659 0.379
Venous maximum 21.81± 6.42 20.59±4.85 0.471 0.293
Total width Total width 1 52.48± 13.26 50.41±12.02 0.569 0.623
Total width 2 48.11± 9.64 49.89±13.67 0.621 0.308
Total width 3 47.65± 13.42 45.39±8.09 0.419 0.356
Total width mean 49.41± 10.37 48.56±9.46 0.764 0.345
Total width maximum 56.28± 13.21 55.69±12.36 0.872 0.355
Length Length 1 341.32±122.35 392.45±149.93 0.167 0.996
Length 2 321.50±129.00 384.07±176.19 0.126 0.256
Length 3 334.75±129.55 343.87±173.84 0.821 0.116
Length mean 332.52±112.75 373.46±152.51 0.248 0.848
Length maximum 389.61±138.84 445.69±151.15 0.164 0.587

Unit: μ m.

* t test.

† Adjusted for age, smoking status, and diseases using analysis of covariance.

Abbreviations: Non-VWF non-vibration-induced white finger, VWF vibration-induced white finger.

Table 4
Specific counts of morphological findings (non-VWF vs. VWF)
Microscopic findings Non-VWF (n=44) VWF (n= 18) p value* Adjusted p value†
Crossing count Crossing 1 1.66±0.94 2.33±0.69 0.008 0.058
Crossing 2 1.14±0.88 2.00±0.84 0.001 0.376
Crossing 3 0.77±0.80 1.44±0.78 0.004 0.378
Total crossing 3.57±2.35 5.78±2.02 0.001 0.169
Branching count Branching 1 0.59±0.69 0.22±0.55 0.032 0.280
Branching 2 0.23±0.42 0.06±0.24 0.048 0.187
Branching 3 0.16±0.37 0.00±0.00 0.007 0.168
Total branching 0.98±1.34 0.28±0.75 0.012 0.162

Unit: number.

* t test.

† Adjusted for age, smoking status, and diseases using analysis of covariance.

Abbreviations: Non-VWF non-vibration-induced white finger, VWF vibration-induced white finger.

TOOLS
Similar articles