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Background In Swedish working life, exposure to cold and exposure to hand-arm vibration (HAV) are two common health hazards. Health effects of HAV in the neurosensory, vascular and musculoskeletal systems are collectively denoted hand-arm vibration syndrome (HAVS), and have been thoroughly studied. Effects of cold exposure in terms of effects on the peripheral neurosensory and vascular system are on the contrary limited, especially in an occupational setting. Effects of cold exposure or cold injury have not previously been assessed with quantitative sensory testing (QST). Commonly reported symptoms after exposure to HAV and after cold injuries, includes cold sensitivity and sensation of cold. Cold sensitivity can also occur without previous exposure to vibration or cold and may have a major impact on quality of life. Other possible risk factors for cold sensitivity need to be assessed. Sensation of cold hands could theoretically imply an early manifestation of damage to the neurosensory or vascular system, and therefore be of importance to enable early detection of vascular and neurosensory HAVS. The purpose of this thesis was to increase the knowledge about health effects from cold and HAV on the peripheral neurosensory and vascular system, with an occupational perspective. The aims were: first, to identify and evaluate health effects and sequelae in the peripheral neurosensory and vascular system due to cold injury and cold exposure; second, to investigate if sensation of cold hands is a predictor for future onset of Raynaud's phenomenon or paresthesia; and third, to identify possible risk factors associated with cold sensitivity. Methods A case series on 15 military conscripts with local cold injuries in the hands or feet, involving QST and symptom descriptions, was conducted to investigate the hypothesis that cold injuries can result in similar neurosensory and vascular impairments as in HAVS. To assess health effects of cold exposure, a cohort study on 54 military conscripts in cold winter military training, with cold exposure assessments, was conducted. Possible health effects were assessed after 14 months of military training, containing considerable cold exposure, by means of QST, Finger systolic blood pressure after local cooling (FSBP) and a questionnaire. To investigate if sensation of cold hands is a predictor for vascular or neurosensory HAVS we investigated a cohort of 178 employees at a manufacturing company where HAV was a common exposure. The cohort was followed during 21 years and both vibration exposure and health outcomes were assessed regularly. Questionnaire items were used to assess sensations of cold hands as well as signs of Raynaud’s phenomenon and paresthesia. To identify risk factors for cold sensitivity a case-control study was conducted involving 997iiiparticipants from the general population in northern Sweden. The study was cross-sectional and explored possible risk factors for cold sensitivity. Results Cold injuries and cold exposure were associated with reduced sensibility in QST and increase severity and prevalence of neurosensory and vascular symptoms. Our results did not show any impairment in peripheral blood flow due to cold exposure, detectable by FSBP. The risk of developing Raynaud's phenomenon was increased for workers previously reporting sensation of cold hands (OR 6.3, 95% CI 2.3-17.0). No increased risk for paresthesia in relation to a sensation of cold hands was observed. The identified risk factors for cold sensitivity were frostbite in the hands, rheumatic disease, nerve injury in upper extremities or neck, migraine and vascular disease. When analysing women and men separately, women’s risk factors were frostbite in the hands, rheumatic disease, migraine and cold exposure. Men’s risk factors were frostbite in the hands, vibration exposure and nerve injury in upper extremities or neck. BMI > 25 was a protective factor for both men and women. Conclusion Cold injury and cold exposure are associated with impairments in the neurosensory system, detectable by QST. Symptoms such as sensation of cold hands and white fingers indicate vascular involvement, even though no vascular impairments due to cold exposure could be detected by objective measurements. A sensation of cold hands is a risk factor for development of Raynaud´s phenomenon, but not for paresthesia. At the individual level, reporting cold hands does not appear to be useful information when considering the possibility of a future development of Raynaud’s phenomenon. Frostbite in the hands is a risk factor for cold sensitivity among both women and men. For women rheumatic disease, migraine and cold exposure are also independent risk factors, and for men, exposure to HAV. Being overweight is a protective factor for both women and men.

Hand Arm Vibration Syndrome (HAVS) is a collective term for the symptoms arising from the prolonged use of vibrating hand tools. An investigation into the literature on available screening tools for HAVS was conducted. A screening tool is used for the quick identification of certain symptoms without a full medical check up, and is for use by mine medical personnel for the determination of workers with HAVS symptoms and those without. Twenty-two non-exposed volunteers were tested with the screening tools and forty-two rock drill operators. Only the rock drill operators had a medical examination and standardised tests for HAVS diagnoses, to determine their HAVS diagnosis and severity. This diagnosis was used as the standard for the evaluation, of existing screening tools and for developed screening tool, sensitivity for the detection of HAVS symptoms. The screening tools chosen were a traditional tuning fork, a similar tuning fork but mounted into a box with a set excitation unit and a two-point discriminator set a 3mm, 6mm, and 10mm apart. The results showed that a screening questionnaire that specifically focuses on the symptoms of HAVS has better sensitivity and specificity to identify cases. A two-point discriminator with variable distance points, where patients have to distinguish between one pin prick and two, was able to identify HAVS cases when the distance was set at 3mm. However, the sensitivity of the two-point discriminator was lower than the sensitivity of the questionnaire. / Dissertation (MSc)--University of Pretoria, 2007. / Industrial and Systems Engineering / Unrestricted

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Syftet med att mäta vibrationer och rekyler i ett padelrack i detta arbete är att utveckla en prototyp som kan användas som träningsredskap för att minska risken för skador. En vanlig skada som drabbar padelspelare är tennisarmbåge, som enligt studier tros uppkomma genom upprepad exponering av mikrotrauman som vibrationer och rekyler. Genom att utföra en litteraturstudie i ämnet har systemkrav för ett sensorbaserat system definierats. Systemet som mäter vibrationer och rekyler har monterats i handtaget på padelracket. Två olika testmiljöer har utvecklats för att möjliggöra kontrollerade tester. För att identifiera och analysera slag använder systemet frekvensanalyser, korrelationstester och positionsförändring. Vid utveckling av metoden för identifiering av träffpunkt delades racket upp i fem olika zoner. Resultatet indikerar att träffar i två av zonerna ger upphov till mindre mängd vibrationer jämfört med de övriga zonerna. Resultatet för identifiering av träffzon varierar mellan testmiljöerna och enbart identifiering av en zon kan anses vara fungerande i båda fallen. Systemet identifierade träffzonen korrekt i 18 av 25 slag i den ena testmiljön och 9 av 25 i den andra. För att förbättra identifieringen av träffzon behövs flera analyser och korrelationtester utformas. En slutsats för det här examensarbetet är att det här arbetet kan användas som grund för vidare utveckling av ett sensorbaserat system för att identifiera träffzonen och kvantifiera vibrationer i ett padelrack. / The purpose of measuring vibrations and recoils in a padel racket in this thesis is to develop a prototype that can be used as a training equipment to reduce the risk of injury. A common injury for padel players is tennis elbow, studies show that the cause of this injury are microtraumas from vibrations and recoils. Through a literature study in the subject, system demands for a sensor-based system have been defined. The system that has been used to measure vibrations and recoils have been attached to the bottom of the handle on the padel racket. To achieve controlled tests two different test environments have been developed. To identify and analyze impacts the system utilizes frequency analysis, correlation tests and displacement tracking. For identification of the impact area the racket was divided into five zones. The result indicates, that two of the impact zones generate less vibrations than the others. The result also shows that identification of impact zone varies between the test environments and that only the sweet spot can be identified in both cases. The system identified the impact zone correctly in 18 out of 25 strokes in one test environment and 9 out of 25 in the other. To further improve the methods for identification of the impact zone more analyses and correlations tests are required. One conclusion for this thesis is that it can be used as a platform for further development of a sensor-based system that can correctly identify impacts in all zones and quantify the resulting vibrations.

In many occupations, exposure to hand-transmitted vibration (HTV) over a prolonged period causes various disorders involving the vascular, neural and musculoskeletal systems, collectively known as the hand-arm vibration syndrome (HAVS). It is a complex and potentially disabling chronic disorder of the upper extremities, especially of the hands. Numbness, tingling, reduced tactile discrimination, and impaired manipulative dexterity are often reported by workers exposed to HTV. The precise pathophysiological mechanism responsible for vascular injuries in HAVS has not yet been fully clarified; it seems to be multifactorial and highly complex. Interaction of neural signals, hormones, mediators and changes in the blood vessel itself appear to contribute to the development of such vascular injuries. This study aims to assess the risk of the hand-transmitted vibration exposure during pneumatic impact wrench operation in a rock drill repair and maintenance workshop at a South African platinum mine. A total of 8 workers working on a day to day basis with impact wrenches were available for this study. For each of the workers a control (not exposed to vibration) was selected on the basis of gender, ethnic group, smoking habits, age and body mass index (BMI). Grip force, dexterity and hand-eye co-ordination were tested on the workers and control group before and after work. Finger systolic blood pressure (FSBP) was also measured after cold provocation of the worker and control groups. Results have shown astatistically significant difference between the two groups with respect coordination, dexterity and FSBP after cold provocation. Vibration measurements shows three workers had values above the suggested ELV of 5 m/s² for an eight hour A (8) workday. With regards to dexterity, workers were capable to manipulate small objects better with their dominant right (vibration exposed) hand after work than before work. In contrast, it seems that the number of pegs correctly inserted by the controls is not uniformly affected by their 8 hour workday. The worker group showed a greater grip force than that of the control group, both before and after work.There was a statistically significant difference between the control and worker group with respect to the number of mistakes during the mirror trace and the time to complete this test only for the right hand. The difference in FSBP after cold provocation between the control and worker group observed is of medium importance when compared with effect sizes, however, there was no statistical significant difference. In this study, it was very difficult to make valid conclusions due to the limitations of a small sample size. A longitudinal study should be conducted preferably using newly appointed workers with no prior exposure to vibration and a sufficient control group to eliminate the effect other confounding variables such as general working conditions. / Thesis (MSc (Occupational Hygiene))--North-West University, Potchefstroom Campus, 2013.

In many occupations, exposure to hand-transmitted vibration (HTV) over a prolonged period causes various disorders involving the vascular, neural and musculoskeletal systems, collectively known as the hand-arm vibration syndrome (HAVS). It is a complex and potentially disabling chronic disorder of the upper extremities, especially of the hands. Numbness, tingling, reduced tactile discrimination, and impaired manipulative dexterity are often reported by workers exposed to HTV. The precise pathophysiological mechanism responsible for vascular injuries in HAVS has not yet been fully clarified; it seems to be multifactorial and highly complex. Interaction of neural signals, hormones, mediators and changes in the blood vessel itself appear to contribute to the development of such vascular injuries. This study aims to assess the risk of the hand-transmitted vibration exposure during pneumatic impact wrench operation in a rock drill repair and maintenance workshop at a South African platinum mine. A total of 8 workers working on a day to day basis with impact wrenches were available for this study. For each of the workers a control (not exposed to vibration) was selected on the basis of gender, ethnic group, smoking habits, age and body mass index (BMI). Grip force, dexterity and hand-eye co-ordination were tested on the workers and control group before and after work. Finger systolic blood pressure (FSBP) was also measured after cold provocation of the worker and control groups. Results have shown astatistically significant difference between the two groups with respect coordination, dexterity and FSBP after cold provocation. Vibration measurements shows three workers had values above the suggested ELV of 5 m/s² for an eight hour A (8) workday. With regards to dexterity, workers were capable to manipulate small objects better with their dominant right (vibration exposed) hand after work than before work. In contrast, it seems that the number of pegs correctly inserted by the controls is not uniformly affected by their 8 hour workday. The worker group showed a greater grip force than that of the control group, both before and after work.There was a statistically significant difference between the control and worker group with respect to the number of mistakes during the mirror trace and the time to complete this test only for the right hand. The difference in FSBP after cold provocation between the control and worker group observed is of medium importance when compared with effect sizes, however, there was no statistical significant difference. In this study, it was very difficult to make valid conclusions due to the limitations of a small sample size. A longitudinal study should be conducted preferably using newly appointed workers with no prior exposure to vibration and a sufficient control group to eliminate the effect other confounding variables such as general working conditions. / Thesis (MSc (Occupational Hygiene))--North-West University, Potchefstroom Campus, 2013.