Vibration-induced white finger (VWF) is classified using the Stockholm Workshop Scale. A 52-year-old quarry driller reports intermittent blanching of the 2nd and 3rd fingers of both hands on cold exposure, with numbness and sensory loss even in warm weather. This presentation corresponds to which stage of VWF?

• A Stage 1: occasional attacks affecting only tips of one or more fingers
• B Stage 3 vascular + sensorineural component (Stage 3SN) with attacks of all phalanges and persistent sensory symptoms ✓
• C Stage 2: occasional attacks affecting distal and middle phalanges
• D Stage 3: frequent attacks affecting all phalanges of most fingers, with digital skin changes

Explanation

The Stockholm Workshop Scale for VWF has vascular (Stages 0–4) and sensorineural components. Stage 3 (vascular): frequent attacks affecting all phalanges of most fingers, with changes in skin. The sensorineural component (SN) is graded separately from Stage 0SN (no symptoms) to Stage 3SN (intermittent or persistent numbness/sensory loss affecting daily activities). In this patient, blanching of multiple finger phalanges (vascular Stage 3) combined with persistent sensory loss in warm weather indicates the combined Stage 3 vascular + Stage 3SN sensorineural presentation. Persistent symptoms in warm weather confirm the sensorineural involvement is beyond purely vasospastic.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.