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  • Concordance between the Stockholm Workshop Scale and the International Consensus Criteria for grading the severity of neurosensory manifestations in hand-arm vibration syndrome in a Swedish clinical setting

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Concordance between the Stockholm Workshop Scale and the International Consensus Criteria for grading the severity of neurosensory manifestations in hand-arm vibration syndrome in a Swedish clinical setting
  1. Eva Tekavec1,
  2. Tohr Nilsson2,
  3. Jakob Riddar1,
  4. Anna Axmon1,
  5. Catarina Nordander1
  1. 1Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
  2. 2Division of Sustainable Health and Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  1. Correspondence to Dr Eva Tekavec, Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00 Lund, Sweden; eva.tekavec{at}med.lu.se

Abstract

Objectives Occupational exposure to vibration using hand-held tools may cause hand-arm vibration syndrome (HAVS). Correct diagnosis and grading of severity are crucial in protecting the individual’s health and for workers’ compensation claims. The International Consensus Criteria (ICC) has been suggested to replace the widely used Stockholm Workshop Scale (SWS). The aims were to, in a clinical setting, assess the concordance between the SWS and the ICC neurosensory severity grading of vibration injury, and to present the clinical picture according to symptoms, type of affected nerve fibres and the relation between vascular and neurosensory manifestations.

Methods Data were collected from questionnaires, clinical examination and exposure assessment of 92 patients with HAVS. The severity of neurosensory manifestations was classified according to both scales. The prevalence of symptoms and findings was compared across groups of patients with increasing severity according to the SWS.

Results Classification with the ICC resulted in a shift towards lower grades of severity than with the SWS due to a systematic difference between the scales. Affected sensory units with small nerve fibres were far more prevalent than affected units with large nerve fibres. The most prevalent symptoms were numbness (91%) and cold intolerance (86%).

Conclusions Using the ICC resulted in lower grades of the severity of HAVS. This should be taken into consideration when giving medical advice and approving workers’ compensation. Clinical examinations should be performed to detect affected sensory units with both small and large nerve fibres and more attention should be paid to cold intolerance.

  • Occupational Health
  • Vibration

Data availability statement

Data are available on reasonable request. The datasets presented in this article are not readily available because public access to data is restricted to Swedish Authorities (Public Access to Information and Secrecy Act), but data can be available for researchers after a special review that includes approval of the research project by both an Ethics Committee and the Authorities’ Data Safety Committees.

http://dx.doi.org/10.1136/oemed-2023-108914

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    Data availability statement

    Data are available on reasonable request. The datasets presented in this article are not readily available because public access to data is restricted to Swedish Authorities (Public Access to Information and Secrecy Act), but data can be available for researchers after a special review that includes approval of the research project by both an Ethics Committee and the Authorities’ Data Safety Committees.

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    Footnotes

    • Contributors ET contributed to planning, data collection, statistical analyses and outlined the manuscript. TN contributed to planning, interpretation of data and the manuscript wordings. AA had the main responsibility for the statistical analyses, interpretation of data and discussions concerning the manuscript. JR contributed with exposure assessment and forming the manuscript. CN and ET contributed to planning, data collection, statistical analyses and supervised the composing of the manuscript. All authors approved the final version of the manuscript. CN is responsible for the overall content as the guarantor.

    • Funding The study was funded by AFA Insurance (grant number 170124).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.