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MedTech Outlook | Wednesday, August 10, 2022
HAVS (Hand-arm vibration syndrome) is a general occupational disease affecting workers in numerous industries using vibrating tools.
FREMONT, CA: Hand-arm vibration syndrome (HAVS) is mainly because by occupational exposure to vibrating hand tools.
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It consists primarily of 'occupational' Raynaud disease and digital polyneuropathy. Carpal tunnel syndrome (CTS) is associated with hand-transmitted vibration exposure and can coexist with HAVS.
HAVS has three main components:
1. Peripheral neuropathy of the hands produces numbness, tingling, or both in a glove distribution. As a result, loss of talent may occur.
2. Vibration of the white finger (VWF), or Secondary Raynaud's phenomenon of the hands, is the most dramatic manifestation, distinctively producing intermittent well-demarcated blanching of the fingers starting at the distal tip of one or more digits. As the disease advance, the pallor extends more proximately to involve the length of the fingers, sometimes extending into the palm. The thumbs are usually the least affected. During these episodes, parallel paresthesia of the involved digits is typical.
3. Musculoskeletal problems. These are the most difficult manifestations and may incorporate complaints of weakness, discomfort, and pain of the hands, wrists, forearms, and elbows.
Peripheral neuropathy & Raynaud's phenomenon may occur independently but generally occur together. Symptoms are likely to be bilateral, and it is uncommon for more advanced symptoms to affect a single digit only. In this case, other diagnoses such as thenar or hypothenar hammer syndrome, as well as the more confined vascular injury of the palmar arches or digital arteries, should be reviewed.
Conditions like carpal tunnel syndrome, bone cysts, tendinopathies, and osteoarthritic changes of the hand, wrist, and elbows have been ascribed to exposure to hand-arm vibration. Still, it is hard to separate the contribution of vibration to these conditions from the ergonomic risk factors commonly encountered with handheld power tool usages, such as prolonged awkward postures, forceful static postures, repetitive movements, and impact or percussive trauma.
In BC, fallers, buckers, miners, auto mechanics, and glaziers are the occupational groups most generally diagnosed with HAVS. The important risk factor for HAVS is a cumulative exposure of thousands of hours to intense vibration from tools like chainsaws, impact tools, grinders, and jackhammers. In addition, risk factors include age, smoking, and pre-existing medical conditions that reason neurovascular pathology.
Physicians should think of the diagnosis of HAVS for patients who complain of new-onset peripheral neuropathy or Raynaud's phenomenon of the hands and who employ power tools regularly at work. The clinical assessment should exclude other conditions such as arthropathies, vasculopathy, tendinopathies, impingement neuropathies, or systemic illnesses that produce similar presentations. If you suspect your patient has occupational HAVS, submit a medical report to WorkSafeBC and encourage your patient to file a claim.
An occupational medicine specialist assesses all HAVS claims. Once the diagnosis is affirmed, workers are typically evaluated for a permanent functional impairment according to the intensity of signs and symptoms of their disease. Those with extra advanced diseases are always advised to stop using handheld power tools. Those with an excessive risk of impairment may be eligible for vocational rehabilitation.
Workers with mild disease and those who continue working with handheld power tools should decrease exposure to hand-arm vibration as much as possible. This may incorporate using low-vibration tools, wearing vibration-reducing gloves, and modifying work schedules to reduce the exposure duration. In addition, these workers should be monitored regularly for the progression of their disease.
In the beginning stages of the disease, removal from exposure may reduce Raynaud's phenomenon symptoms. However, neurologic symptoms are the least possible to reverse.
Medical treatment involves the application of antihypertensive medications like calcium channel blockers. Although this treatment is not often effective in a significant proportion of cases, a reasonable trial of therapy should be attempted before concluding a treatment failure. Other risk factors like smoking or working in cold environments should also be mitigated.
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