HAND-ARM VIBRATION SYNDROME (HAV)

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HAND-ARM VIBRATION SYNDROME (HAV)
Results from exposure to vibration (4 to 5000
Hz) Time exposure one month to 30 years
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HAVSymptoms / Signs
Circulatory (vasospasm) with local finger
blanching) previously known as
vibration-induced white finger
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HAV
First noticed on cold, wet, and windy morning, in
the tips of the fingers most affected by
vibration. Intermittent numbness or tingling
often precedes actual blanching. Vasospasm
rarely symmetrical, and reflects the subjects
grip on the vibrating tool. With continued
exposure, vasospasm progresses proximally, and to
other fingers. In advanced cases cyanotic
tinge, progressing to trophic skin changes
(gangrene). Worse in smokers.
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HAVSymptoms / Signs - continued

• Sensory motor disturbances
• numbness, loss of finger co-ordination and
• dexterity
• inability to perform intricate tasks.
• Musculoskeletal disturbances

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TABLE 1 Some tools associated with HAVs
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TABLE 1 Some tools associated with HAVs-
continued
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Some occupations associated with HAVs and type
of tool
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Some occupations associated with HAVs and type
of tool - continued
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Some occupations associated with HAVs and type
of tool - continued
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Some occupations associated with HAVs and type
of tool - continued
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HAVDiagnosis

• Based on history, and on exclusion of other
  causes of Raynauds phenomenon
• primary Raynauds or constitutional white
  finger,
• local trauma to digital vessels,
• thoracic outlet syndrome,
• peripheral vascular disease,
• collagen diseases.

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HAVLaboratory tests

• Doppler studies (for patency of limb blood
  vessels and blood pressure ratios in peripheral
  vessels)

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HAVLaboratory tests

• Doppler studies
• Blood pressure of an affected digit pre- and
  post- cold stress), and cold air or water
  provocation tests (immersion of the digits in
  water or air for 2 to 10 minutes at 5 to 15 C
  with recording of skin temperature) to note any
  reactive hyperaemia while immersed, and delay in
  recovery afterwards.

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HAVLaboratory tests

• Doppler studies
• Blood pressure of an affected digit pre- and
  post- cold stress), and cold air or water
  provocation tests
• Nerve conductions studies.

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The Stockholm Workshop Scale for the
Classification of Sensorineural Affects of the
Hand-arm Vibration Syndrome
The sensorineural stage to be established for
each hand.
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The Stockholm Workshop Scale for the
classification of Cold-Induced Raynauds
Phenomenon in the Hand-arm Vibration Syndrome
The staging is made separately for each hand.
In the evaluation of the subject, the grade of
the disorder is indicated by the stages of both
hands and the number of affected fingers on each
hand example 2L(2) / 1R(1), - / 3R(4), etc.
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Management

• Smoking cessation
• Decrease or avoid exposure to vibration
• Hold tools as lightly as possible, to decrease
  vibration transmission
• Decrease vibration at source (anti vibration
  tools and proper servicing of tools
• Ergonomic design (minimize strain on user)
• high power to weight ratio
• low torque
• non-slip surface of handles to reduce the need
• to grip tightly.

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Pharmacotherapy
Calcium channel blockers. ________ 1. Pelmea
r PL Hand-Arm Vibration Syndrome.
Mastromatteo Oration 1998. Annual Scientific
Conference, OEMAC, October 6, 1998.