Hand-arm Vibration Syndrome

Authored by , Reviewed by Dr John Cox on | Certified by The Information Standard

The hand-arm vibration syndrome (sometimes abbreviated to HAVS) causes changes in the sensation of the fingers which can lead to permanent numbness of fingers, muscle weakness and, in some cases, bouts of white finger. It is caused by working with vibrating tools. It would be unusual for you to develop hand-arm vibration syndrome unless you had used vibrating tools for at least ten years. If you stop working with vibrating tools it may prevent mild symptoms from becoming worse.

Hand-arm vibration syndrome (HAVS) causes symptoms in fingers, hands and arms, as a result of using vibrating tools. It used to be called vibration white finger. The name was changed to HAVS, as other symptoms may occur in addition to white fingers.

HAVS is caused by repeated and frequent use of hand-held vibrating tools - for example, power drills, chainsaws and pneumatic drills. It may also be caused by holding or working with machinery that vibrates. It is not clear how vibration causes the condition. It is probably due to slight but repeated injury to the small nerves and blood vessels in the fingers. Over time these may gradually lose some of their function and cause symptoms. Possibly, up to 1 in 10 people who work regularly with vibrating tools may develop HAVS.

Nerves are affected initially, leading to changes in sensation. This can then be followed by Raynaud's phenomenon resulting from changes in the blood vessels and resulting in a white finger. These changes also lead to muscular aches and pains.

Nerve symptoms

Loss of feeling (numbness) and/or having pins and needles (tingling) in one or more fingers are usually the early features. It may be mild and just affect the tips of the finger(s) and come and go. In severe cases a permanent numbness may extend along affected fingers. This may cause clumsiness and difficulty in doing fine tasks. For example, it may become difficult to fasten buttons or to handle coins, screws, nails, threads, etc. In many people the severity of nerve symptoms is somewhere in between these two extremes. Sometimes one finger is badly affected with other fingers only mildly affected.

Raynaud's phenomenon - white finger symptoms

Raynaud's phenomenon comes in bouts or attacks that are triggered by cold weather or touching a cold object. A typical appearance in Raynaud's syndrome is seen when the fingers go white, then blue, then red.

Vibrating tools are just one cause of Raynaud's phenomenon. There are other causes too. See the separate leaflet called Raynaud's Phenomenon.

Aches and pains

Minor damage to the muscles, joints and bones may cause aches and pains in the hands and lower arm. The strength of your grip may be weakened.

You may have some loss of feeling (numbness) or tingling (pins and needles) which comes and goes. This may be followed by bouts of Raynaud's phenomenon on cold, wet and windy days, affecting the ends of one or more fingers. Symptoms may remain mild but can progress if you continue to work with vibrating tools. Vibration itself rarely triggers a bout of Raynaud's phenomenon. It is cold weather or cold conditions that trigger Raynaud's phenomenon.

As the condition develops, numbness becomes permanent. This leads to muscle weakness and wasting. Bouts of Raynaud's phenomenon will become more frequent (and also in the summer) although usually only if your hands are wet.

In some cases the symptoms develop months or years after finishing working with vibrating tools.

Your description of your symptoms and the fact that you have worked for a long time with vibrating tools may be enough to clinch the diagnosis of HAVS. However, tests are sometimes needed, especially if you are involved in a compensation claim. The tests may include checking your grip strength, your ability to perform fine hand movements and the response of your fingers to cold.

The Health and Safety Executive has a calculator that can help to gauge how much exposure you might have had to equipment that can cause hand-arm vibration syndrome (see 'Further reading' section below).

The following steps are thought to help prevent HAVS in workers who use vibrating tools:

  • Hold tools as loosely as possible and in varying positions.
  • Ensure that tools are well maintained.
  • Use tools correctly and use the right tool for the job. The aim is not to need to use excessive grip, nor to use a tool for longer than necessary.
  • Take regular breaks of at least 10 minutes away from the tool. Short bursts of work are better than long periods of work without a break.
  • Keep warm while at work - especially your hands.
  • You should not smoke - the chemicals in tobacco can affect blood flow.

If you suspect that you have symptoms of HAVS then see your doctor. Also, report your concerns to your employer, works nurse, or work doctor (if there is one) and, where relevant, to your union representative. It is your employer's responsibility to make sure that you work in a safe and acceptable working environment.

Stop using vibrating tools if possible

This may prevent symptoms from getting worse. However, it is not clear whether nerve symptoms can improve once they have developed. If possible, you should consider a change of job or reach an agreement with your employer to restrict the hours that you spend using vibrating machines.

Avoid medications that can make the circulation to the fingers worse

  • Examples include beta-blockers, which are used for high blood pressure or heart problems.
  • Decongestants that can be bought for cold and flu symptoms: these often contain adrenalin which can be bad for the circulation in your hands.
  • Certain migraine pills like propranolol, or those that are prescribed by specialists that contain medicines called ergot-derivates.
  • In woman, sometimes the oral contraceptive pill can make hand-arm vibration syndrome worse.

Stop smoking

  • Smoking will furr up the arteries that pump blood to your fingers so stopping smoking is one of the key things you can do to treatment hand-arm vibration syndrome.

Medications

  • Sometimes medications that relax the blood vessels can be tried.  They do not always work however.  An example is nifedipine.  Your doctor will explain the advantages and disadvantages of this to you.

HAVS does sometimes get better if you stop using vibrating tools early enough. However, if you have severe symptoms and carry on working you may find they persist, even when you do eventually stop.

Employers are aware of the risks of HAVS and this is usually disclosed to employees prior to starting work. To read more, see the separate leaflet called Industrial Injuries Disablement Benefit. Also listed below are other organisations which might be helpful:

  • Your trade union.
  • The local Citizens Advice Bureau.
  • The local Health and Safety Executive (HSE) area office.
  • The Environmental Health Department of your local council.
  • Department for Work and Pensions.

Further reading and references

  • ; Department for Work and Pensions, 2004

  • ; Health and Safety Executive

  • ; Health and Safety Executive

  • ; Hand-arm vibration syndrome. Canadian Medical Association Journal 2005 Apr 12172(8):1001-2.

  • ; The clinical assessment of hand-arm vibration syndrome. Occup Med (Lond). 2003 Aug53(5):337-41.

  • ; Health and Safety Executive

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