Hand Arm Vibration Syndrome (HAVS) is Hand Arm Vibration Syndrome (HAVS) is the generic terms used to describe a variety the generic terms used to describe a variety of injuries incurred to the hands and arms of injuries incurred to the hands and arms caused through excessive exposure to caused through excessive exposure to vibrating tools. vibrating tools.

Vibration-induced white finger Vibration-induced white finger (VWF) is the most common (VWF) is the most common condition among the operators of condition among the operators of hand-held vibrating tools. hand-held vibrating tools.

Vibration can cause changes:Vibration can cause changes: In tendons, In tendons, Muscles, Muscles,

Bones and joints, and Bones and joints, and Can affect the nervous systemCan affect the nervous system

Collectively, these effects are known as Collectively, these effects are known as Hand-Arm Vibration Syndrome (HAVS). Hand-Arm Vibration Syndrome (HAVS).

Workers affected by HAVS commonly report: Workers affected by HAVS commonly report: Attacks of whitening (blanching) of one or more Attacks of whitening (blanching) of one or more

fingers when exposed to cold fingers when exposed to cold Tingling and loss of sensation in the fingers Tingling and loss of sensation in the fingers Loss of light touch Loss of light touch Pain and cold sensations between periodic white Pain and cold sensations between periodic white

finger attacks finger attacks Loss of grip strength Loss of grip strength Bone cysts in fingers and wrists Bone cysts in fingers and wrists

It is also known as It is also known as Secondary Secondary Raynaud'sRaynaud's Syndrome Syndrome,,

If not detected in the early stages, it may If not detected in the early stages, it may permanently impair blood circulation in the permanently impair blood circulation in the fingers and can lead to gangrene in the fingers and can lead to gangrene in the more serious stages. more serious stages.

Raynaud's DiseaseRaynaud's Disease

An idiopathic vascular disorder An idiopathic vascular disorder characterized by bilateral Raynaud characterized by bilateral Raynaud phenomenon, the abrupt onset of digital phenomenon, the abrupt onset of digital paleness or paleness or CYANOSISCYANOSIS in response to cold in response to cold exposure or STRESS." exposure or STRESS."

In 1862, Dr. Maurice Raynaud, a Paris In 1862, Dr. Maurice Raynaud, a Paris physician, first descried the paraesthesia physician, first descried the paraesthesia followed by finger blanching attacks in followed by finger blanching attacks in females who were exposed to cold females who were exposed to cold temperatures, but not vibration; this temperatures, but not vibration; this condition became known as Primary condition became known as Primary Raynaud's Disease. Raynaud's Disease.

When Raynaud's symptoms appear alone, When Raynaud's symptoms appear alone, without any other medical condition, it is without any other medical condition, it is called Raynaud's disease. called Raynaud's disease.

It is also termed primary Raynaud's. It is also termed primary Raynaud's. In this condition, the blood vessels return to In this condition, the blood vessels return to

normal afterward. normal afterward. Primary Raynaud's usually affects both the Primary Raynaud's usually affects both the

hands and the feet.hands and the feet.

Raynaud's Phenomenon Raynaud's Phenomenon

When Raynaud's symptoms have a specific When Raynaud's symptoms have a specific cause or are accompanied by another cause or are accompanied by another disease, it is called Raynaud's phenomenon disease, it is called Raynaud's phenomenon or secondary Raynaud's.or secondary Raynaud's.

This condition, which more often affects This condition, which more often affects either the hands or feet, is often more either the hands or feet, is often more serious and may result in blood vessel serious and may result in blood vessel scarring and long-term consequences scarring and long-term consequences

Raynaud's phenomenonRaynaud's phenomenon

Can be associated with diseases of the Can be associated with diseases of the arteries such as:arteries such as:

Buerger's disease and atherosclerosis,Buerger's disease and atherosclerosis, Rheumatoid arthritis, Rheumatoid arthritis, Scleroderma and systemic lupus Scleroderma and systemic lupus

erythematosus. erythematosus. It can also follow repeated trauma, It can also follow repeated trauma,

particularly vibrations such HAVS or those particularly vibrations such HAVS or those caused by typing or playing the piano. caused by typing or playing the piano.

An overdose of ergot compounds or An overdose of ergot compounds or methysergide may also be a cause of methysergide may also be a cause of Raynaud's phenomenon. Raynaud's phenomenon.

Strong emotion or exposure to the cold Strong emotion or exposure to the cold causes the fingers, toes, ears or nose to causes the fingers, toes, ears or nose to become white, due to a lack of blood flow in become white, due to a lack of blood flow in the area. the area.

They then turn blue, which is a result of tiny They then turn blue, which is a result of tiny blood vessels dilating to allow more blood to blood vessels dilating to allow more blood to remain in the tissues. remain in the tissues.

When the flow of blood returns, the area When the flow of blood returns, the area becomes red and then later returns to becomes red and then later returns to normal colour. normal colour.

There may be associated tingling, swelling, There may be associated tingling, swelling, and painful throbbing. The attacks may last and painful throbbing. The attacks may last from minutes to hours from minutes to hours

If the condition progresses, blood flow to the If the condition progresses, blood flow to the area could become permanently decreased area could become permanently decreased causing the fingers to become thin and causing the fingers to become thin and tapered, with smooth, shiny skin and slow tapered, with smooth, shiny skin and slow growing nails.growing nails.

If an artery becomes blocked completely, If an artery becomes blocked completely, gangrene or ulceration of the skin may gangrene or ulceration of the skin may occur. occur.

The risk factors include associated diseases The risk factors include associated diseases and smoking. and smoking.

Women are 9 times more likely to be Women are 9 times more likely to be affected than men. affected than men.

DiagnosisDiagnosis

Generally diagnosis of Raynaud's Syndrome Generally diagnosis of Raynaud's Syndrome requires no special tests, although tests such as requires no special tests, although tests such as nail fold capillaroscopy (examining the nail fold nail fold capillaroscopy (examining the nail fold under magnification to see capillary changes under magnification to see capillary changes indicative of connective tissue disease); indicative of connective tissue disease);

Cold stimulation this involves submerging the Cold stimulation this involves submerging the hands in ice and then timing their return to normal hands in ice and then timing their return to normal colour. colour.

Or a vascular laboratory assessment may be used Or a vascular laboratory assessment may be used to determine the severity of the disease.to determine the severity of the disease.

Severity, duration, and frequency of attacks Severity, duration, and frequency of attacks may vary between individuals and over time, may vary between individuals and over time, the primary symptoms of Raynaud's the primary symptoms of Raynaud's Syndrome are changes in skin colour.: Syndrome are changes in skin colour.: fingers and sometimes toes turn white, then fingers and sometimes toes turn white, then blue, then red. blue, then red.

The tip of the nose and the earlobes and The tip of the nose and the earlobes and (rarely) the cheeks or chin can also be (rarely) the cheeks or chin can also be affected. affected.

Sometimes the fingers perspire. Sometimes the fingers perspire. Numbness accompanies the white and blue Numbness accompanies the white and blue

phases. phases. The red phase brings a burning, throbbing, The red phase brings a burning, throbbing,

or tingling sensation and sometimes or tingling sensation and sometimes swelling. swelling.

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A higher prevalence of vascular symptoms are A higher prevalence of vascular symptoms are found in cold countries, reflecting the role of found in cold countries, reflecting the role of external temperature. external temperature.

Control studies have found that vascular Control studies have found that vascular symptoms may be absent or milder in warm symptoms may be absent or milder in warm climates or where workers in cold climates work climates or where workers in cold climates work indoors in warm temperatures, making HAVS indoors in warm temperatures, making HAVS mimic mimic CTSCTS Cold temperature work is also Cold temperature work is also associated with a greater risk of developing work associated with a greater risk of developing work related related CTSCTS. .

Carpal comes from carpus, the Latin word Carpal comes from carpus, the Latin word for wrist. for wrist.

The carpal tunnel is a small passage inside The carpal tunnel is a small passage inside the wrist. the wrist.

Several fine bones of the wrist form the floor Several fine bones of the wrist form the floor and sides of the tunnel. and sides of the tunnel.

A ligament called the transverse carpal A ligament called the transverse carpal ligament, which arches over the bones, ligament, which arches over the bones, forms the roof of the tunnel. forms the roof of the tunnel.

Passing through this tunnel are:Passing through this tunnel are: The median nerve, which conducts The median nerve, which conducts

impulses, sent by the brain, down the arm impulses, sent by the brain, down the arm and to the fingers The tendons of the finger and to the fingers The tendons of the finger flexor muscles, which allow the fingers to flexor muscles, which allow the fingers to bend Arteries and veinsbend Arteries and veins

The median nerve supplies most of the The median nerve supplies most of the feeling in the hand, particularly to the feeling in the hand, particularly to the thumb, index and middle fingers, the thumb thumb, index and middle fingers, the thumb half of the palm and the outer side of the half of the palm and the outer side of the hand. hand.

It also controls the movement of many of It also controls the movement of many of the tendons that bend the fingers, allowing the tendons that bend the fingers, allowing the hand to grasp objects as well as pinch.the hand to grasp objects as well as pinch.

Workers handling vibrating tools may Workers handling vibrating tools may experience tingling and numbness in their experience tingling and numbness in their fingers and hands.fingers and hands.

If vibration exposure continues, these If vibration exposure continues, these symptoms tend to worsen and can interfere symptoms tend to worsen and can interfere with work capacity and life activities. with work capacity and life activities. Vibration-exposed workers may exhibit Vibration-exposed workers may exhibit increased vibratory, thermal and tactile increased vibratory, thermal and tactile thresholds in clinical examinations.thresholds in clinical examinations.

It has been suggested that continuous It has been suggested that continuous vibration exposure can not only depress the vibration exposure can not only depress the excitability of skin receptors but also induce excitability of skin receptors but also induce pathological changes in the digital nerves pathological changes in the digital nerves such as perineural oedema, followed by such as perineural oedema, followed by fibrosis and nerve fibre loss.fibrosis and nerve fibre loss.

Epidemiological surveys of vibration-Epidemiological surveys of vibration-exposed workers show that the prevalence exposed workers show that the prevalence of peripheral neurological disorders varies of peripheral neurological disorders varies from a few per cent to more than 80 per from a few per cent to more than 80 per cent, and that sensory loss affects users of cent, and that sensory loss affects users of a wide range of tool types. a wide range of tool types.

It seems that vibration neuropathy develops It seems that vibration neuropathy develops independently of other vibration-induced independently of other vibration-induced disorders.disorders.

The Stockholm Workshop scale for the The Stockholm Workshop scale for the classification of cold-induced Raynaud's classification of cold-induced Raynaud's phenomenon in the hand-arm vibration phenomenon in the hand-arm vibration syndrome is now used. (revision of the syndrome is now used. (revision of the Taylor-Pelmear scale). Taylor-Pelmear scale).

Stage Assessment for Hand-arm Vibration Syndrome-Tayler-Stage Assessment for Hand-arm Vibration Syndrome-Tayler-Pelmear Classification SystemPelmear Classification System

Sensorineural stages of the Stockholm Workshop Sensorineural stages of the Stockholm Workshop scale for hand-arm vibration syndrome StageSigns scale for hand-arm vibration syndrome StageSigns

and symptomsand symptoms

0SN- Exposed to vibration but no symptoms0SN- Exposed to vibration but no symptoms 1SN - Intermittent numbness, with or without 1SN - Intermittent numbness, with or without

tingling,tingling, 2SN - Intermittent or persistent numbness, 2SN - Intermittent or persistent numbness,

reduced sensory perceptionreduced sensory perception 3SN - Intermittent or persistent numbness, 3SN - Intermittent or persistent numbness,

reduced tactile discrimination and/or reduced tactile discrimination and/or manipulative dexteritymanipulative dexterity

Vibration White FingerVibration White Finger

British miners were the among the first to be British miners were the among the first to be awarded compensation after they awarded compensation after they developed Vibration White Finger, a developed Vibration White Finger, a condition caused by working with vibrating condition caused by working with vibrating machinery such as jack hammers, chain machinery such as jack hammers, chain saws, grinders and drillssaws, grinders and drills

WBVSWBVS

Whole Body Vibration Syndrome. Whole Body Vibration Syndrome. Our bodies are exposed to vibration at work Our bodies are exposed to vibration at work

from many machines, such as construction from many machines, such as construction machinery (bulldozers, tow motors, forklifts machinery (bulldozers, tow motors, forklifts and cranes), heavy equipment (grinders, and cranes), heavy equipment (grinders, jack hammers), and power hand tools. jack hammers), and power hand tools.

Vibration has been proven to result in Vibration has been proven to result in musculoskeletal disorders of both the hand musculoskeletal disorders of both the hand and arm, the neck, and the back.and arm, the neck, and the back.

Quest HAVPro Basic Vibration MonitorQuest HAVPro Basic Vibration Monitor

The HAVPro is a compact, lightweight; fully The HAVPro is a compact, lightweight; fully integrated 3 channel Vibration Monitor for integrated 3 channel Vibration Monitor for obtaining tri-axial vibration measurements. obtaining tri-axial vibration measurements.

This basic monitor is the ideal screening This basic monitor is the ideal screening tool for quickly and simply determining the tool for quickly and simply determining the presence and magnitude of hazardous presence and magnitude of hazardous hand-arm or whole-body vibration levels. hand-arm or whole-body vibration levels.

ANTI-VIBRATION- Full and Half Finger ANTI-VIBRATION- Full and Half Finger

GlovesGloves

PreventionPrevention

Workers may be advised to hold tools as Workers may be advised to hold tools as loosely as possible and in varying positions, loosely as possible and in varying positions,

Ensure that tools are well maintained, andEnsure that tools are well maintained, and Consider the use of antivibration gloves Consider the use of antivibration gloves

Taking regular breaks of at least 10 minutes Taking regular breaks of at least 10 minutes from exposure to vibration,from exposure to vibration,

Keeping warm while at work, and not Keeping warm while at work, and not smoking. smoking.

In addition, heavy, old tools usually In addition, heavy, old tools usually generate more vibration than their newer, generate more vibration than their newer, lighter, and better designed equivalents lighter, and better designed equivalents