The specific question addressed was whether objectively measured cold-induced vasospasm in the hands is a risk factor for objectively measured cold-induced vasospasm in the feet in workers exposed to hand–arm vibration. This is a cross-sectional study of workers who were clinically assessed for HAVS, some of whom had objective evidence of cold-induced vasospasm in the hands. We also examine various potential predictors of vasospasm in the feet, in particular if the vascular changes due to HAVS in the hands are associated with cold-induced vasospasm in the feet. In this paper, we describe the prevalence of vascular abnormalities in the feet of workers assessed for HAVS at our clinic. Consequently, we began to do cold provocation digital plethysmography tests for vasospasm on the feet as well as the hands of all workers being assessed for HAVS. Over time, we noticed that workers often reported increased cold intolerance of their feet as well as their hands. Initially, the assessment of the vascular component of HAVS considered only vascular abnormalities in the hands. Michael’s Hospital, Toronto, Canada has been assessing workers with HAVS for many years. Demonstrating if an association exists between the presence and severity of vasospasm in the hands in workers with HAVS and the occurrence and severity of vasospasm in the feet would add to the existing body of knowledge about the nature and etiology of vibration-induced vascular dysfunction. In a systematic review of published papers on this topic, Schweigert concluded that hand–arm vibration was associated with cold-induced vasospasm in the feet but that the vascular component of HAVS needed to be present in the hands before cold-induced vasospasm occurred in the feet. There is epidemiologic evidence that chronic vibration exposure resulting in HAVS is associated with chronic vascular abnormalities in the feet. A central sympathetic vasoconstrictor reflex is involved in vibration-induced vasospasm and this reflex appears to be increased in workers with vascular HAVS. Acute vibration exposure to one hand is associated with decreased blood flow in not just the exposed hand but also the contralateral hand and the toes. Hand–arm vibration exposure results in both local and central sympathetic nervous system stimulation. The main vascular effect is a form of secondary Raynaud’s phenomenon. Hand–arm vibration syndrome (HAVS) is a common occupational health problem that consists of vascular, sensorineural and musculoskeletal components, which may all contribute to upper extremity disability. The main predictor of severe vasospastic foot abnormalities is severe cold-induced vasospasm in the hands.įeet, hand–arm vibration, occupational, vasospasm Introduction Multinomial logistic regression analysis did not indicate any statistically significant predictors of non-severe vasospasm in the feet.Ĭonclusions Workers assessed for HAVS frequently have cold-induced vasospasm of their feet.
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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). 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. 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. 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.
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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.Īims 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.