Diagnostic aspects of vibration-induced white finger

Vibration-induced white finger (VWF) is a secondary type of Raynaud's phenomenon (RP) caused by exposure to hand-arm vibration. The present review concerns the cold-provoked attack of RP in vasospastic VWF. It concentrates on the most common clinical and laboratory methods used to diagnose RP in vibration-exposed subjects. Some physiological aspects of the attack of RP are mentioned to elucidate the diagnostic principles of the tests. Anamnestic diagnostics by medical interviews and questionnaires as well as cold-provocation tests with detection of finger colour, finger systolic blood pressure (FSP), recovery time of finger skin temperature and recovery time of normal nail colour after nail compression are mentioned. The discriminative capacity and the reproducibility of the tests are discussed. Cold-provocation tests with detection of finger colour or zero FSP during cooling are recommended to be used if an attack of RP has to be registered for diagnostic or medico-legal purposes in individual cases. An abnormal reduction in FSP during cooling makes a history of RP very probable and is a suitable laboratory test for groups of subjects. Both recovery tests may be useful screening tests in field studies of vibration-exposed subject groups.