Hand-arm vibration syndrome: What family physicians should know.

OBJECTIVE: To provide family physicians with an understanding of the epidemiology, pathogenesis, symptoms, diagnosis, and management of hand-arm vibration syndrome (HAVS), an important and common occupational disease in Canada. SOURCES OF INFORMATION: A MEDLINE search was conducted for research and review articles on HAVS. A Google search was conducted to obtain gray literature relevant to the Canadian context. Additional references were obtained from the articles identified. MAIN MESSAGE: Hand-arm vibration syndrome is a prevalent occupational disease affecting workers in multiple industries in which vibrating tools are used. However, it is underdiagnosed in Canada. It has 3 components-vascular, in the form of secondary Raynaud phenomenon; sensorineural; and musculoskeletal. Hand-arm vibration syndrome in its more advanced stages contributes to substantial disability and poor quality of life. Its diagnosis requires careful history taking, in particular occupational history, physical examination, laboratory tests to rule out alternative diagnoses, and referral to an occupational medicine specialist for additional investigations. Management involves reduction of vibration exposure, avoidance of cold conditions, smoking cessation, and medication. CONCLUSION: To ensure timely diagnosis of HAVS and improve prognosis and quality of life, family physicians should be aware of this common occupational disease and be able to elicit the relevant occupational history, refer patients to occupational medicine clinics, and appropriately initiate compensation claims.

Hand-arm vibration syndrome: Workers' experience with functional impairment and disability.

STUDY DESIGN: Qualitative and descriptive study. INTRODUCTION: Hand-arm vibration syndrome (HAVS) is a prevalent disease in Canada. There is little work on the perspectives of HAVS patients. PURPOSE OF THE STUDY: Explore perceptions of disability and functional compromise in patients with HAVS. METHODS: Semi-structured telephone interviews were conducted with HAVS patients and analysed using content analysis. RESULTS: The 11 participants reported numbness, pain, and reduced dexterity, strength, and sensation. Participants noted that HAVS was an inevitable aspect of their work. They indicated frustration with their condition and viewed it as a disability. To overcome impairments risky strategies are often used. Participants reported lack of support to manage symptoms and overcome work disability. DISCUSSION: HAVS related impairment is disabling. Workers require improved resources and support to address symptom management and safe strategies to minimize work disability. CONCLUSION: HAVS patients experience functional, social, emotional, and psychological disability. LEVEL OF EVIDENCE: Not applicable.

[Vibration disease: hygienic and medical aspects].

The hygienic assessment of working conditions of employees exposed to local vibration established that working conditions for employees ofvibration dangerous occupations at the aircraft plant according to the degree from a health standpoint and hazard are referred to the fourth (dangerous) class of the degree of danger that stipulates stable high levels of the morbidity rate. The leading factor is a local vibration that results in the consistently high levels of occupational morbidity rate. There was shown the efficiency of the use of the pulsed magnetic stimulation in the treatment ofpatients with vibration disease associated with the exposure to local vibration. For the evaluation of the effectiveness of treatment in patients the condition of the central nervous system was determined with the use of computer electroencephalography with the registration of visual and auditory evoked potentials and somatosensory evoked potentials; there was studied the state of the peripheral nerves in arms and legs relying upom electromyographic data; there was performed psychological study. After the performance of pulse magnetic stimulation in patients diagnosed to have the vibration diseases there were observed the improvement in the interaction of cortical-subcortical structures and associative areas of the frontal and temporal lobes of the brain. After treatment there was noted the shortening of the time of the conduction of the afferent wave of the excitation at the level of the cervical spinal cord, subcortical structures and the central conduction time. There was restored previously reduced the speed of the conduction of the impulse via the distal parts of the tibial and median nerve, through the ulnar nerve in the area of the elbow joint. There was noted the rise in the average temperature on the hands; the decline of thresholds of vibration and pain sensitivity; the improvement of indices characterizing of the state of mnestic- attentional and psycho-emotional scope of activity.

[Improving diagnosis and treatment of tunnel upper limb neuropathies in miners with vibration disease].

The article presents results of research aimed to diagnosis and treatment of tunnel upper limb neuropathies in mining industry workers subjected to vibration factor. The authors specified diagnostic criteria for early diagnosis of tunnel neuropathies affecting median, ulnar and radial nerves, with the severity evaluation for further adequate treatment.

[Life quality as an additional criterion to evaluate efficacy of treating vibration disease patients].

Studies covered as an additional criterion to evaluate efficiency of treating vibration disease patients. Studies covered life quality in 40 males having vibration disease during the treatment course. Before the treatment, all the examinees demonstrated decrease in all life quality parameters especially of "role physical functioning" (16.89 points), general health (38.39 points), role emotional functioning (39.64 points). After the treatment most the parameters reliably improved, besides physical and social functioning. The authors recommend SF-36 life quality questionnaire to evaluate treatment efficiency for occupational diseases.

[Pulsed low-frequency electrotherapy of vibration disease associated with osteoarthrosis].

The study involving 185 patients with vibration disease and concomitant osteoarthrosis has demonstrated the positive influence of pulsed low-frequency currents in combination with hydrogen sulphide baths on the clinical course of the disease. This combined therapy produced good immediate and late post-treatment results. The data obtained suggest high efficiency of differential application of complex-modulated pulsed and fluctuating currents in patients with vibration disease. It is concluded that amplipulse therapy is the method of choice for the management of this pathology in the absence of apparatuses emitting pulsed currents in the running way regime.

Raising awareness of hand-arm vibration syndrome (HAVS) using posters.

BACKGROUND: Hand-arm vibration syndrome (HAVS) is caused by prolonged occupational exposure to hand-transmitted vibration. Although HAVS is preventable, disease awareness and prevention knowledge are lacking in high-risk workplaces; this may contribute to under-diagnosis, delays in seeking care, and poor health outcomes. Posters may be used to increase awareness in the workplace. OBJECTIVE: To conduct a pilot survey in workers with HAVS about poster use in their workplaces, their recommendations for poster campaigns and training programs, and their evaluation of HAVS awareness and prevention posters. METHODS: All eligible HAVS patients in the Occupational Health Clinic at St. Michael's Hospital, in Toronto, Canada, were asked to complete a questionnaire on workplace poster use and to evaluate a set of HAVS posters. RESULTS: Fifty workers participated; almost all were males, aged 50 and older, working in construction. Most indicated having non-HAVS specific awareness posters in their workplaces. There was a positive evaluation of the design, content, and potential usefulness of the posters. The poster depicting finger blanching stood out most. The poster depicting anti-vibration gloves rated highest for relatability and effectiveness at conveying disease importance. CONCLUSIONS: Participants supported the proposed use of industry-specific HAVS awareness posters in their workplaces. Future research should evaluate the effectiveness of these posters in the workplace.

Human response to vibration stress in Japanese workers: lessons from our 35-year studies A narrative review.

The occupational uses with vibratory tools or vehicles provoked health disorders of users. We reviewed narratively our articles of 35 yr studies and their related literatures, and considered the pathophysiology of the hand-arm vibration disorders. Concerning the risk factors of health impairments in workers with vibratory tools, there are two conflicting schools of the researchers: The peripheral school emphasizes that vibration only makes predominant impairments on hands and arms, showing typically Raynaud's phenomenon in the fingers. In the systemic school, the health disorders are produced by combination with vibration, noise and working environment, namely vibratory work itself, leading to diversified symptoms and signs in relation to systemic impairments. Our 35 yr studies have evidently supported the systemic school, including disorders of the central and autonomic nervous systems. The genesis is vibratory work itself, including vibration, noise, cold working environment, ergonomic and biodynamic conditions, and emotional stress in work. Because the health disorders yield in the whole body, the following measures would contribute to the prevention of health impairments: the attenuation of vibration and noise generated form vibratory machines and the regulations on operating tool hours. In conclusion, this occupational disease results from systemic impairments due to long-term occupational work with vibratory tools.

Effects of partially ionised medical oxygen, especially with O2•-, in vibration white finger patients.

A major symptom of hand-arm vibration syndrome is a secondary Raynaud's phenomenon-vibration white finger (VWF)-which results from a vasospasm of the digital arteries caused by work with vibration devices leading to occupational disease. Pharmacotherapy of VWF is often ineffective or has adverse effects. The aim of this work was to verify the influence of inhalation of partially ionized oxygen (O2•-) on peripheral blood vessels in the hands of patients with VWF. Ninety one (91)patients with VWF underwent four-finger adsorption plethysmography, and the pulse wave amplitude was recorded expressed in numeric parameters-called the native record. Next, a cold water test was conducted following with second plethysmography. The patients were divided in to the three groups. First and second inhaled 20-min of ionized oxygen O2•- or oxygen O2 respectively. Thirth group was control without treatment. All three groups a follow-up third plethysmography-the post-therapy record. Changes in the pulse wave amplitudes were evaluated. Inpatients group inhaling O2•- a modest increase of pulse wave amplitude was observed compared to the native record; patients inhaling medical oxygen O2 and the control showed a undesirable decline of pulse wave amplitude in VWF fingers. Strong vasodilatation were more frequent in the group inhaling O2•- compare to O2 (p < 0.05). Peripheral vasodilatation achieved by inhalation of O2•- could be used for VWF treatment without undesirable side effect in hospital as well as at home environment.

[Hammer hypothenar syndrome: review of the literature and case report]. / Le syndrome du marteau hypothénarien: analyse de la littérature et cas clinique.

Hypothenar hammer syndrome is a rare disease first described by Conn et al. in 1970. It groups together symptoms of chronic microtraumatism to the ulnar artery or its superficial palmar branch against the hamate. Manual workers using vibrating tools are the most affected by this. Diagnosis is made by echodoppler, while arteriography is the gold standard for establishing the treatment plan. Hypothenar hammer syndrome may lead to severe complications secondary to ischemia and to embolic events resulting from delayed diagnosis or maltreatment. There is no real consensus as to the place of medical or surgical treatments. Medical treatment consists of eliminating favorizing factors and long-term antiplatelet aggregation treatment. Surgical treatment depends on the vascular lesions: simple arterial ligation, resection of the thrombosed arterial segment and end-to-end anastomosis, or revascularization using a pontage venous or arterial graft. Some authors suggested an associated thoracic sympathectomy. The diagnosis must be made early; the choice of treatment must be targeted at preventing serious embolic complications.