[Hand-arm vibration syndrome: diagnostic aspects, dose-response relationship and exposure limits]

This paper reviews the clinical aspects and laboratory methods to diagnose the vascular, sensorial and neural components of the hand-arm vibration syndrome. The resolutions adopted by the experts of the Stockholm Workshop 94 are reported. The methods of measurement and assessment of both daily and cumulative vibration exposure are discussed with respect to the risk for vibration-induced disorders of the upper extremities. An update of the relationship between vibration exposure and the occurrence of vibration-induced white finger (VWF) is given, as well as the results of epidemiologic studies of the reversibility of VWF after cessation of vibration exposure or introduction of vibration isolation systems in forest work. Regarding occupational exposure to hand-transmitted vibrations, this review considers the guidelines and provisions contained in the European Communities (EC) Directive for machinery (89/393/EC) and the proposal for an EC Directive for physical agents (94/C 230/03).