Prognosis of vibration induced white finger: a follow up study

OBJECTIVES--To follow up 102 patients with vibration induced white finger (VWF). METHODS--102 subjects with VWF were reexamined one to 13 years after the condition had first been diagnosed. Information about symptoms, occupation, vibration exposure, smoking habits, age, and the prevalence of other diseases was present in the medical records from the first examination and was collected by a questionnaire and an interview at the second examination. The decrease in systolic blood pressure in a finger during cold provocation (FSP%) was measured in the same finger at both examinations. RESULTS--At the second examination, 22% stated that the frequency of attacks had decreased. The improvement was most frequent in subjects with little or no exposure to vibration during the previous two years, in non-smokers, and in subjects without other circulatory diseases than VWF. 32% stated that the frequency of attacks had increased. The aggravation was most notable in smokers and subjects who also had circulatory diseases other than VWF. The number of finger phalanges that blanched on cooling averaged 15.8 at the first examination and 14.4 at the second examination. Working with high vibration hand held tools during the previous two years was related to an aggravation, with more finger phalanges affected at the second examination. Presence of other circulatory diseases had the same effect. In non-smokers the number of affected finger phalanges had decreased at the second examination. The FSP% had increased (improvement) in 43%, decreased (aggravation) in 12%, and was unchanged in 45%. The increase in FSP% was more pronounced in the older than in the younger subjects. The decrease of FSP% was more frequent among the younger subjects and subjects with a short follow up. CONCLUSION--As the FSP% in nearly half of the subjects had improved, it is concluded that VWF has a good prognosis in patients with mainly moderate to severe VWF after one to 13 years of observation. The improvement in FSP%, however, was not reflected in the subjective experience of the development of attacks of VWF. Continued work with high vibration hand held tools, smoking, other circulatory diseases, and low age at the time of diagnosis had an unfavourable influence on the prognosis.