[The diagnosis of occupational hand-arm syndromes. 1. The state of the art].

Alterations of the microcirculation are, at our latitudes, the most common distal manifestations of the hand-arm syndrome, and of a number of other work-related diseases. Diagnostic investigations aimed at providing documentary evidence for microvascular damage or disfunction are, therefore, of particular importance. This paper discusses the currently available diagnostic approaches for professional acrosyndromes. The biohumoral alterations associated with cold-induced angiospasm are also described, but their diagnostic utilization is not recommended. The technical aspects of the "cold tests", as well as its advantages and drawbacks, are finally presented. On the basis of a personal experience with over 4.500 subjects, the authors conclude that, in the field of prevention, digital volumetric pulse plethysmography in association with the "cold test" should be adopted to evaluate the worker fitness for specific tasks.