The Stockholm Workshop scale for cold-induced Raynaud's phenomenon in the hand-arm vibration syndrome is a modification of the Taylor-Pelmear scale which separates the vascular from the neurological and musculoskeletal components.
Clinical Features:
(1) Vasospasm may be precipitated by exposure to cold, dampness or vibration.
(2) Vasospasm results in blanching of the skin, and may be associated with numbness, tingling or paresthesias. As the vasospasm remits and circulation improves, there may be tingling and pain in the fingers.
(3) Involvement usually starts with the finger tip, but may progress to involve the entire finger.
(4) Thumbs tend to be the last digits involved.
(5) In severe disease, the vasospasm may be sufficient to result in ischemia of the distal finger, with gangrene.
Patient Evaluation: Staging is performed separately for each hand.
Description
Grade
Stage
no attacks
0
occasional attacks affecting only the tips of one or more fingers
mild
1
occasional attacks affecting distal and middle (rarely also proximal) phalanges of one or more fingers
moderate
2
frequent attacks affecting all phalanges of most fingers
severe
3
frequent attacks affecting all phalanges of most fingers, with trophic skin changes in the finger tips
very severe
4
where:
• Trophic skin changes include gangrene.
Recording - designate:
(1) stage (0 to 4)
(2) hand (L or R) and
(3) number of fingers (1 to 5).
Example: 3L(4) / 2R(2)
Differential Diagnosis:
(1) Vibration associated Raynaud's phenomenon needs to be distinguished from primary Raynaud's phenomenon, Buerger's disease and vasculitis.
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