Examination of Raynaud’s Phenomenon in Traumatic Vasopastic Disorders
D. Duprez, M.D., D.Sc., F.I.C.A.* M. De Buyzere, D.Sc.* P. Vandenbroeck, M.D.* M. De Meester, M.D.** M. C. Lamon, M.D.** and D.L. Clement, M.D., Ph.D., F.I.C.A.*
GENT, BELGIUM
Abstract Certain types of occupation-related vibrations can cause traumatic vasospastic disorders. Findings from clinical examination are often normal at the office consultation. Measurements of finger blood flow using plethysmography while the local ambient temperature is changed can give important information about the severity of traumatic vasospastic disorder and the concomitant disability. This technique can also be used for follow-up of the finger blood flow after withdrawal from vibrations.
Introduction The occurrence of Raynaud’s phenomenon during the performance of a certain work function can have a negative influence on work capacity. The relationship between certain types of work such as vibrations and the onset of Raynaud’s phenomenon was first described by Hamilton.’ Other reports2’3 emphasized the significance of the combination of vibrations and cold for the development of secondary Raynaud’s phenomenon. Changes in temperature play a role in the occurrence of vasospasm at the level of the or
4
digital arteries.4 From the *Department of Cardiovascular Diseases, University Hospital, Gent, and the **Department of Occupational Medicine, Belgian Railways Company, Brussels, Belgium
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143 It is often difficult during a clinical and occupational examination to determine the grade and severity of the Raynaud’s phenomenon. Most literature reports are limited to the clinical description of Raynaud’s phenomenon in certain occupational circumstances.5-’ It is not known whether patients with Raynaud’s phenomenon due to vibra-
tion (white finger syndrome) return to a condition with normal digital arterial blood flow if they are withdrawn from vibrations. The first aim of the present study was, therefore, to examine the digital arterial blood flow in patients with Raynaud’s phenomenon due to vibrations because of their occupation at the railways (pneumatic tools). The digital arterial blood flow was compared with that of age-matched control subjects. The other purpose of the study was to examine the digital arterial blood flow after withdrawal from vibrations for six months. Materials and Methods
Thirty male patients with a mean age of thirty-one years (range: twenty-seven to thirtyfour years) exposed to vibrations during their daily work at the railways and complaining of Raynaud’s phenomenon were referred by a physician of the department of occupational medicine of the Belgian Railways Company. Other causes of Raynaud’s phenomenon were excluded. A control group of 16 age-matched (mean age of thirty years) apparently healthy subjects (no smoking habits) were also enrolled in the study. Finger blood flow was measured simultaneously in two fingers in which the subjects had the most complaints of their Raynaud’s phenomenon. The blood flow measurements were done using an ECG-triggered venous occlusion, plethysmograph.8 A small cuff was put at the proximal part of the finger in which the blood flow was measured, while the mercury-in-silastic strain gauge was put at the distal phalanx of the finger. The hand was immersed in a water bath in which the temperature was constant. The finger blood flow was then measured when the temperature of the water bath was changed respectively to a temperature of 40 °, 30 °, 20 °, 10 °, 5 ° C, and again to 40 ° C. Each temperature level was stabilized after one minute and the finger blood flow was further measured for four minutes at a constant temperature. For each person the finger blood flow was averaged for each temperature level. The values of finger blood flow are expressed as their mean value ± SEM. An analysis of variance was used to compare the finger blood flow values at each temperature level. A Wilcoxon test was used for comparing the finger blood flow between the subjects with Raynaud’s phenomenon before and after the withdrawal of the vibrations and the control subjects. The level of statistical significance was reached for p less than 0.05. Results
Figure 1 and Table I illustrate the finger blood flow in the control subjects, in the patients with vasospastic trauma, and after six months of withdrawal from vibrations. At an ambient temperature of 40 °C there was a significant difference (p < 0.01) between the finger blood flow in the patients with traumatic vasospastic disorders and that in healthy control subjects. After the lowering of the ambient temperature around the
Downloaded from ang.sagepub.com at MCGILL UNIVERSITY LIBRARY on April 2, 2015
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FIG. 1. Finger blood flow in persons (n 30) with traumatic vasospastic disorder before and 6 months after withdrawal from vibrations and in a group of control subjects (n 16) *P
D. Duprez, M.D., D.Sc., F.I.C.A.* M. De Buyzere, D.Sc.* P. Vandenbroeck, M.D.* M. De Meester, M.D.** M. C. Lamon, M.D.** and D.L. Clement, M.D., Ph.D., F.I.C.A.*
GENT, BELGIUM
Abstract Certain types of occupation-related vibrations can cause traumatic vasospastic disorders. Findings from clinical examination are often normal at the office consultation. Measurements of finger blood flow using plethysmography while the local ambient temperature is changed can give important information about the severity of traumatic vasospastic disorder and the concomitant disability. This technique can also be used for follow-up of the finger blood flow after withdrawal from vibrations.
Introduction The occurrence of Raynaud’s phenomenon during the performance of a certain work function can have a negative influence on work capacity. The relationship between certain types of work such as vibrations and the onset of Raynaud’s phenomenon was first described by Hamilton.’ Other reports2’3 emphasized the significance of the combination of vibrations and cold for the development of secondary Raynaud’s phenomenon. Changes in temperature play a role in the occurrence of vasospasm at the level of the or
4
digital arteries.4 From the *Department of Cardiovascular Diseases, University Hospital, Gent, and the **Department of Occupational Medicine, Belgian Railways Company, Brussels, Belgium
142
Downloaded from ang.sagepub.com at MCGILL UNIVERSITY LIBRARY on April 2, 2015
143 It is often difficult during a clinical and occupational examination to determine the grade and severity of the Raynaud’s phenomenon. Most literature reports are limited to the clinical description of Raynaud’s phenomenon in certain occupational circumstances.5-’ It is not known whether patients with Raynaud’s phenomenon due to vibra-
tion (white finger syndrome) return to a condition with normal digital arterial blood flow if they are withdrawn from vibrations. The first aim of the present study was, therefore, to examine the digital arterial blood flow in patients with Raynaud’s phenomenon due to vibrations because of their occupation at the railways (pneumatic tools). The digital arterial blood flow was compared with that of age-matched control subjects. The other purpose of the study was to examine the digital arterial blood flow after withdrawal from vibrations for six months. Materials and Methods
Thirty male patients with a mean age of thirty-one years (range: twenty-seven to thirtyfour years) exposed to vibrations during their daily work at the railways and complaining of Raynaud’s phenomenon were referred by a physician of the department of occupational medicine of the Belgian Railways Company. Other causes of Raynaud’s phenomenon were excluded. A control group of 16 age-matched (mean age of thirty years) apparently healthy subjects (no smoking habits) were also enrolled in the study. Finger blood flow was measured simultaneously in two fingers in which the subjects had the most complaints of their Raynaud’s phenomenon. The blood flow measurements were done using an ECG-triggered venous occlusion, plethysmograph.8 A small cuff was put at the proximal part of the finger in which the blood flow was measured, while the mercury-in-silastic strain gauge was put at the distal phalanx of the finger. The hand was immersed in a water bath in which the temperature was constant. The finger blood flow was then measured when the temperature of the water bath was changed respectively to a temperature of 40 °, 30 °, 20 °, 10 °, 5 ° C, and again to 40 ° C. Each temperature level was stabilized after one minute and the finger blood flow was further measured for four minutes at a constant temperature. For each person the finger blood flow was averaged for each temperature level. The values of finger blood flow are expressed as their mean value ± SEM. An analysis of variance was used to compare the finger blood flow values at each temperature level. A Wilcoxon test was used for comparing the finger blood flow between the subjects with Raynaud’s phenomenon before and after the withdrawal of the vibrations and the control subjects. The level of statistical significance was reached for p less than 0.05. Results
Figure 1 and Table I illustrate the finger blood flow in the control subjects, in the patients with vasospastic trauma, and after six months of withdrawal from vibrations. At an ambient temperature of 40 °C there was a significant difference (p < 0.01) between the finger blood flow in the patients with traumatic vasospastic disorders and that in healthy control subjects. After the lowering of the ambient temperature around the
Downloaded from ang.sagepub.com at MCGILL UNIVERSITY LIBRARY on April 2, 2015
144
FIG. 1. Finger blood flow in persons (n 30) with traumatic vasospastic disorder before and 6 months after withdrawal from vibrations and in a group of control subjects (n 16) *P
