Objective testing for vasospasm in the hand-arm vibration syndrome.
Since vibration white finger (VWF) became a prescribed industrial disease in 1985, objective testing for the diagnosis and grading of the severity of the condition has become desirable. Measurements have been made of finger blood flow and finger systolic pressure before and after cold challenge in 22 healthy control subjects and 34 men presenting for medical examination in connection with compensation claims for VWF. This type of testing has previously produced one false negative result in 35 patients with an established clinical diagnosis of Raynaud's syndrome and no false positives in 40 control subjects. Finger blood flow was not significantly different in the claimants and controls in either warm or cool environments at local finger temperatures from 32 degrees C down to 20 degrees C. Finger systolic pressure in the claimants was not significantly different from that in the controls when the fingers were warm at 32 degrees C. After five minutes middle phalangeal cooling to 15 or 10 degrees C, finger systolic pressure was 0 mm Hg in 22 of the claimants indicating that vasospasm had occurred. No vasospasm occurred in the remaining 12 claimants or in any of the 22 control subjects. By clinical assessment alone, 26 of the 34 claimants had been thought to have VWF and 21 (81%) of these exhibited vasospasm in the laboratory. Of the eight considered not to have VWF, only one exhibited vasospasm in the laboratory.