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.