Where is the research frontier for hand-arm vibration?

A central question for current hand-arm vibration research is how to combine diagnostics with exposure evaluation so that reliable risk assessments can be made for different tools and work processes. The scientific foundation of the model, in annex of A of ISO 5349, for white finger (WF) risk prediction has been shown to be insufficient. Prospective epidemiologic studies are needed to establish exposure-response relationships addressing the specific etiologic factors. Another important research field concerns WF pathogenesis, which is likely to be a vessel wall lesion causing vasodilatory deficiency. Epidemiologic research, in combination with human and animal experimentation, on endothelium-dependent mechanisms is desirable, among other things, because a therapy may be within reach. A model is presented for the manifestation of cold-triggered WF in persons with exposure to vibration and other environmental stressors as a result of lowered symptom threshold and a raised level of sympathetic activity.