Raynaud's phenomenon associated with the use of pneumatically powered surgical instruments

Five patients developed symptoms of Raynaud's phenomenon and upper extremity paresthesias after 7-32 months of exposure to air-powered surgical instruments used for the harvest of bone for bone banks. Results of cold challenge plethysmography, nerve conduction studies, vibrotactile thresholds, and quantitative sensory testing were as follows: all patients had significant reproducible vasospasm with nondetectable finger systolic blood pressure (FSBP = 0) after local digital cooling; nerve conduction abnormalities included delayed median nerve sensory conduction (< 48 m/s) across 5 of 10 wrists; and no ulnar nerve abnormalities were detected. Vibrotactile thresholds were only modestly elevated, an unexpected outcome given the frequently recognized association between vibrotactile tests and nerve conduction studies. These abnormalities occurred with exposures to frequencies previously thought to be too high to be harmful to medical personnel.