Department of Palliative Medicine, Rheinische Friedrich Wilhelms-University, Bonn, Germany.
Clin Neurophysiol. 2013 Aug;124(8):1680-8. doi: 10.1016/j.clinph.2013.01.025. Epub 2013 Mar 16.
Workers exposed to vibrating tools may develop hand-arm vibration syndrome (HAVS). We assessed the somatosensory phenotype using quantitative sensory testing (QST) in comparison to electrophysiology to characterize (1) the most sensitive QST parameter for detecting sensory loss, (2) the correlation of QST and electrophysiology, and (3) the frequency of a carpal tunnel syndrome (CTS) in HAVS.
QST, cold provocation tests, fine motor skills, and median nerve neurography were used. QST included thermal and mechanical detection and pain thresholds.
Thirty-two patients were examined (54 ± 11 years, 91% men) at the more affected hand compared to 16 matched controls. Vibration detection threshold was the most sensitive parameter to detect sensory loss that was more pronounced in the sensitivity range of Pacinian (150 Hz, x12) than Meissner's corpuscles (20 Hz, x3). QST (84% abnormal) was more sensitive to detect neural dysfunction than conventional electrophysiology (37% abnormal). Motor (34%) and sensory neurography (25%) were abnormal in HAVS. CTS frequency was not increased (9.4%).
Findings are consistent with a mechanically-induced, distally pronounced motor and sensory neuropathy independent of CTS.
HAVS involves a neuropathy predominantly affecting large fibers with a sensory damage related to resonance frequencies of vibrating tools.
接触振动工具的工人可能会患上手部-手臂振动综合征（HAVS）。我们使用定量感觉测试（QST）评估感觉表型，与电生理学进行比较，以表征（1）检测感觉丧失的最敏感 QST 参数，（2）QST 和电生理学的相关性，以及（3）HAVS 中腕管综合征（CTS）的频率。
使用 QST、冷激发试验、精细运动技能和正中神经神经图。QST 包括热觉和触觉检测以及痛觉阈值。
在受影响更大的手上检查了 32 名患者（54±11 岁，91%为男性），与 16 名匹配的对照相比。振动检测阈值是检测感觉丧失的最敏感参数，在 Pacinian（150 Hz，x12）的敏感性范围内比 Meissner 小体（20 Hz，x3）更为明显。QST（84%异常）比常规电生理学（37%异常）更能敏感地检测神经功能障碍。HAVS 中运动（34%）和感觉神经图（25%）异常。CTS 频率没有增加（9.4%）。
这些发现与机械诱导的、远端明显的运动和感觉神经病变一致，与 CTS 无关。
HAVS 涉及一种主要影响大纤维的神经病，其感觉损伤与振动工具的共振频率有关。
