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Biomedical subjects

P L Pelmear

Publications and source records attributed to P L Pelmear.

At least 19 recordsLinked to original sources
PubMed1994

Carpal tunnel syndrome and hand-arm vibration syndrome. A diagnostic enigma.

OBJECTIVE: This article serves to draw attention to the risk to workers from repetitive strain and hand-arm vibration in the workplace and to the diagnostic difficulty in distinguishing carpal tunnel syndrome from the sensorineural component of hand-arm vibration syndrome. DATA SOURCES: Journal publications, textbooks on hand-arm vibration, guidelines of the International Standards Organisation, and European Economic Community directives. STUDY SELECTION: Recent reports and current standards. CONCLUSION: Carpal tunnel syndrome can be distinguished from hand-arm vibration syndrome if all factors--anatomical, associated physiological and medical conditions, work exposure history, and ulnar nerve involvement--are evaluated. In some circumstances, the conditions may be present together. A correct diagnosis is crucial because surgical intervention is not usually beneficial if hand-arm vibration exposure has been a contributing factor. The further reduction in grip strength may constitute a serious additional handicap for a worker.

Carpal Tunnel Syndrome↗
PubMed1994

Clinical assessment of hand-arm vibration syndrome.

The clinical assessment of patients thought to be suffering from hand-arm vibration syndrome (HAVS) requires the use of multiple vascular and sensory tests. In a family physician's office, Adson's, Allen's and cold water immersion of the hands are the only feasible vascular tests, while the sensory tests have to be limited to assessing impairment of skin sensitivity and manipulative dexterity. This paper reviews the laboratory tests deemed to be useful in a hospital or clinic facility, and reports on the investigation of 364 patients exposed to hand-arm vibration who were examined in Toronto, Canada during the period 1989-92. A statistical clustering algorithm was used to categorise 138 male subjects according to the results of their diagnostic tests. From the cluster analysis, four vascular and four sensorineural categories of impairment were recognised in patients suffering from HAVS. The Stockholm vascular classification stages and the four vascular clusters were found to correspond. The Stockholm sensorineural classification (Stages 1, 2, and 3) correlated with clusters formed from the sensory tests evaluating the sensitivity of the nerve endings and the distal digital branches of the median and ulnar nerves. When the myelinated nerve fibres were affected, as detected by abnormal Tinel's, Phalen's, and nerve conduction tests, an additional cluster group emerged. The subjects with abnormal nerve conduction test results constituted a distinct group with increased impairment, so there is a need for them to be categorised separately i.e. as a Stage 4. It is suggested that a Stage 4 be included in the Stockholm sensorineural classification.

Arm↗
PubMed1994

Hand-arm vibration syndrome.

The hand-arm vibration syndrome affects workers who perform tasks that generate vibration. Raynaud's phenomenon and sensory impairment of the fingers are the predominant effects. A history of hand-arm vibration (HAV) exposure in a patient with these symptoms should alert the physician to the diagnosis. Referral to a special clinic or hospital department for multiple clinical tests is required to confirm the diagnosis and, using the Stockholm classification, to grade the severity in each hand. The assessment permits the patient to be monitored either for progression of or recovery from the syndrome. Avoidance of further vibration exposure is recommended, together with the prescription of a slow-release calcium channel blocker to improve peripheral circulation. Hand-arm vibration syndrome should be distinguished from carpal tunnel syndrome (CTS), which may have similar symptomatology but requires different treatments. Surgery is contraindicated in the former and should be the last resort for carpal tunnel syndrome in a worker requiring good grip-strength in future employment.

Arm Injuries↗
PubMed1993

Hand-arm vibration syndrome: a guide to medical impairment assessment.

Hand-arm vibration syndrome is a complex condition with vascular, sensorineural, and musculoskeletal components. Workers who handle vibratory tools suffer from it, and the severity of this syndrome is now graded internationally using the Stockholm classification. For compensation purposes the severity must be translated into impairment and this paper proposes how this may be done using the AMA Guides to the Evaluation of Permanent Impairment. The case history of a typical claimant is presented to demonstrate how an impairment rating might be derived.

Arm↗
PubMed1992

Occupationally-induced scleroderma.

Systemic sclerosis or scleroderma is an uncommon multisystem disease with a reported incidence of 2 to 12 cases per million people per year. The clinical and pathological features can be grouped into three main categories: those related to fibrosis, to vascular abnormalities, and to immunological abnormalities. Cutaneous features dominate the patients' appearance, and Raynaud's phenomenon is an early symptom. A possible association between scleroderma and workers exposed to hand-arm vibration and/or silica has been suggested by reports in the literature since the turn of the century. A further four patients with collagen disease are reported here. Three were occupationally exposed to both hand-arm vibration and silica, the fourth to hand-arm vibration alone. In conjunction with previously reported cases, this supports the hypothesis that collagen disease may be work attributable in hypersusceptible persons.

Adult↗
PubMed1991

Hand-arm vibration syndrome: clinical evaluation and prevention.

Increasing recognition by workers that blanching of their fingers may be due to hand-arm vibration exposure from the tools they use at work and their consequent claims for compensation emphasize a need for better clinical evaluation and prevention. We describe the symptoms and signs, and enumerate the diagnostic procedures (both screening and laboratory) necessary to establish the diagnosis and severity grading of subjects with hand-arm vibration syndrome. Although effective treatment of the condition other than avoidance of further vibration exposure is still being researched, prevention is all important. The necessary steps are identified.

Hand↗
PubMed1990

Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel.

In a retrospective study (by questionnaire) of 8032 personnel exposed to anaesthetic gases in operating and recovery rooms in Ontario hospitals, and 2525 non-exposed hospital staff, the response was 78.8% for the exposed and 87.2% for the unexposed personnel during the period 1981-5. Logistic regression analysis, with age and smoking standardised, showed that women in the exposed group had significantly increased frequencies of spontaneous abortion and their children had significantly more congenital abnormalities (p less than 0.05). No chronic disease was significantly associated with the exposed group. These findings, together with similar ones from other studies, suggest that it is prudent to minimise exposure to waste anaesthetic gases.

Abortion, Habitual↗
PubMed1989

Measurement of vibration of hand-held tools: weighted or unweighted?

The standards for hand-arm vibration have evolved from research studies in the late 1960s and were based on discomfort and tolerance levels. The lower frequencies were more intolerant and were weighted accordingly. The vascular and neurologic components of the hand-arm vibration syndrome may develop independently, and recent epidemiologic studies have shown both underestimation and overestimation in the incidence of Raynaud's phenomenon from the International Standard Organization dose-response criteria with respect to different tools. The validity of the current International Standard Organization, British Standards Institute, American National Standards Institute, and The American Conference of Governmental Industrial Hygienists Threshold Limit Values is therefore questionable. The weighted and unweighted frequency spectra of various hand-held tools are presented in this paper. It is concluded that, until such time as more dose-effect data become available, unweighted measurements should be determined. Furthermore, the frequencies measured should be extended to 5 kHz.

Arm↗
PubMed1987

Cold provocation test results from a 1985 survey of hard-rock miners in Ontario.

A total of 143 miners, 6 ex-miners, and 42 referents from five mines in northern Ontario were examined with a cold provocation test. The skin temperatures, measured by thermocouples at the tips of the fingers and thumbs were recorded at 5-s intervals throughout the immersion in cold water (10 degrees C) for 10 min and during the recovery period. The finger skin temperature was followed until 99% recovery had occurred as compared to the starting temperature. For the referents and the vibration-exposed subjects, the results by separate stage of the Taylor-Pelmear scale for hand-arm vibration syndrome were compared. There were statistically significant differences in the mean finger temperature at the 50, 75, 90, and 95% recovery times between stages 0, 0T/0N, and stages 1 through 3 combined, as well as significant differences between stages 1, 2, and 3. The mean temperature at 10 min and the mean hyperemia temperature for eight fingers combined were compared between the miners and referents. There were significant differences in the mean temperature at 10 min and in the hyperemia temperature between the referents and miners in stage 0T/0N, as well as between the referents and the miners in stages 1 through 3 combined. For the worst finger (defined as that with the lowest temperature at 10 min) there was an increasing trend towards a lower hyperemia temperature and delay in recovery time from stage 0 to stages 2 and 3 combined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Clinical evaluation of vibration-exposed complainants in field surveys.

The time constraints on research workers in the field inevitably limit the depth and quality of evaluations, which have two essential components, a questionnaire on the medical and work history and simple clinical tests conducted within a reasonable time frame. The questionnaire should include subject identification and age, personal and family history, past and present occupational history, and past and present hand-arm symptoms. The clinical tests, following a physical examination of the neck and upper limbs, should seek to evaluate the cardiovascular and neurological systems in the hands and arms. Tests to demonstrate the patency of the major vessels, and the response of the digital vessels following immersion in cold water, are feasible and practical, as are neurological tests to determine skin sensitivity to touch and vibration. Grip strength should be evaluated, as well as hearing loss by audiometry. Some errors in diagnosis occur with the use of such screening tests, but subsequent hospital investigations have usually confirmed their overall reliability. It is concluded that with improved instrumentation the evaluation of vibration-exposed workers at initial and follow-up examinations can only improve, as will the validity of the counseling of workers and machine manufacturers to reduce the risk.

Carpal Tunnel Syndrome↗
PubMed1987

The Stockholm Workshop scale for the classification of cold-induced Raynaud's phenomenon in the hand-arm vibration syndrome (revision of the Taylor-Pelmear scale).

On the basis of experience accumulated over the past few years, a revision has been made in the currently used Taylor-Pelmear scale for the staging of Raynaud's phenomenon in persons exposed to vibration from hand-held tools, while retaining as much as possible of the well-established advantages of the scale for research and its proved usefulness for clinical and medicolegal purposes. The 0T and 0N stages of symptoms have been omitted, together with the parallel disability scale. A separate staging for neurological disorders connected with the syndrome was proposed and accepted at the workshop "Symptomatology and Diagnostic Methods in the Hand-Arm Vibration Syndrome," held in Stockholm in 1986. The criteria descriptions have been changed so as to minimize their reliance on seasonal factors. The new staging system--a stage 0 and four stages (1-4) with attacks of cold-induced Raynaud's phenomenon--clearly defines the differences in the descriptions of the stage criteria in order to improve their clinical usefulness. A numerical scoring based on the extent and distribution of finger blanching was not, however, introduced, whereas a score based on the number of affected fingers on each hand was proposed, considered, and accepted.

Arm↗
PubMed1983

Effect of dust exposure in Ontario cotton textile mills.

The acute effect of cotton dust on respiratory function was assessed. Respiratory questionnaires, preshift and postshift pulmonary function testing and air sampling were completed for 176 cotton textile workers and 33 controls. The results showed a dose-response relationship between vertical elutriator dust measurements and change in forced expiratory volume at 1 s (FEV1) over the work shift. Dust levels of 0.2 mg/m3 or less were not associated with significant acute falls in FEV1.

Adult↗
PubMed1983

Effect of dust exposure in the cotton felt industry.

Respiratory histories and preshift and postshift spirometry were recorded for 90 cotton felt workers and 54 brick workers. Environmental monitoring included area sampling by vertical elutriator and cyclone and personal sampling for respirable dust by cyclone. The prevalence of mill fever and byssinosis was 31% and 5%, respectively, in the cotton workers. Significant dose-response effects were detected for both elutriator and cyclone dust measurements and change in forced expiratory volume at 1 s over the shift. A dose-response relationship was also found for the brick workers.

Adult↗