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Yoon, Sim, Oh, Sung, Lee, Lee, Kim, Yoo, and Lee: The General Characteristics and Results of the Cold Provocation Test in the Risk Group of HAVS
Original Article
Korean Journal of Occupational and Environmental Medicine

Korean Journal of Occupational and Environmental Medicine 2012; 24(3): 207-216.

Published online: 30 September 2012

DOI: https://doi.org/10.0000/kjoem.2012.24.3.207

The General Characteristics and Results of the Cold Provocation Test in the Risk Group of HAVS

Jae-Kook Yoon, Chang-Sun Sim1, Myoung-Soon Oh1, Joo-Hyun Sung1, Ji-Ho Lee1, Choong-Ryeol Lee1, Yangho Kim1, Cheol-In Yoo1, Hun Lee1

Department of Occupational and Environmental Medicine, Anjung-Baik Hospital, Korea.

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

Corresponding author (leeheun67@gmail.com)

Received 20 October 2011       Revised 6 July 2012       Accepted 6 July 2012

Copyright © 2012 The Korean Society of Occupational and Environmental Medicine

Abstract

Objectives

The cold provocation test for diagnosing the vascular component in hand-arm vibration syndrome (HAVS) is likely to be accepted as an objective test, and a few studies have been performed. However, controversy has continued regarding the diagnostic performance of this method. Although objective methods such as plethysmography and laser doppler flowmetry have been studied, they have not received as much attention as other diagnostic methods. Therefore, our study aim was to spread the awareness of HAVS by reporting the results of the cold provocation test in a hand-transmitted vibration exposure group.

Methods

The study subjects were 549 workers who had been exposed to hand-transmitted vibrations and reported symptoms in their hands. While the subject immersed both their hands in 10℃ water for 10 minutes, the skin temperature of 10 fingers was recorded from pre-immersion time to 20 minute postimmersion including 10 minutes immersion time. The recovery rates were calculated from the recorded skin temperatures. The 'decreased recovery rate' criteria were less than 30% at 5 minutes post-immersion and 60% at 10 minute post-immersion.

Results

Of the subjects, 69.1% and 30.9% had more severe symptoms in the right and left hands, respectively. The mean finger skin temperature of the right hand after cold-water immersion for 10 minutes was approximately 10℃, which increased gradually with time, but they did not reach the baseline temperature at 20 minutes post-immersion. The deviations of the skin temperature in the subjects were higher in the recovery phase than in the baseline and cold immersion phase. The 3rd finger of both hands showed the lowest 5-minute recovery rate among the fingers examined, and the left 4th finger and right 3rd finger showed the lowest 10-minute recovery rate. Of the subjects, 37.6% and 10.4% of subjects showed a lower recovery rate at 5 and 10 minutes in at least one finger, respectively, while 10.2% showed a lower recovery rate at both 5 and 10 minutes simultaneously in at least one finger.

Conclusions

The larger deviations in the recovery phase than in the other phases indicated that interindividual differences are more prominent in the recovery phase. There might be no benefit in observing the finger skin temperature for an additional 10 minutes after 10 minutes post-immersion. Overall, approximately 10% of the subjects in the HAVS risk group had HAVS.

Keywords: Hand-Arm Vibration Syndrome, Skin temperature, Immersion

Figures and Tables

Fig. 1
Finger skin temperatures and their dispersion at each time in each finger. (unit: ℃)
kjoem-24-207-g001
Fig. 2
The recovery rates of temperature and their dispersionin each finger. (unit: %)
kjoem-24-207-g002
Table 1
The general characteristics of subjects
kjoem-24-207-i001

*upper limb or cervical spine.

Table 2
The number of subjects according to vascular stage of Stockholm Workshop scale
kjoem-24-207-i002
Table 3
The number of subjects according to number of finger in vascular stage
kjoem-24-207-i003
Table 4
The number of subjects according to neurological stage of Stockholm Workshop scale
kjoem-24-207-i004
Table 5
The number of subject who had finger that decreased recovery rate
kjoem-24-207-i005

*standard of recovery rate: (i) 5 min: 30%, (ii) 10 min : 60%.

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