A Guide to HAVS/Hand Arm Vibration Syndrome

Hand Arm Vibration Syndrome (HAVS) is a prevalent occupational disease, affecting industrial workers who work with vibrating power tools.

To help understand this condition, we have collated a guide to HAVS. Here are the three main components of Hand Arm Vibration Syndrome:

• Vascular (in the form of secondary Raynaud phenomenon). Commonly referred to as ‘Vibration White Finger’. Colloquially termed ‘white finger’.
• Sensorineural
• Musculoskeletal

HAVS in its later stages can contribute to disability and a poor quality of life. The prevalence of this condition in workers exposed is around 50%.

When are symptoms likely to become apparent?

Symptoms usually become prevalent in middle age, but can be seen in younger people with high-intensity interaction with Vibratory tools. The latency period is around four years.

Pathophysiology

HAVS likely causes local endothelial damage through mechanical trauma and oxidative stress and leads to peripheral vasoconstriction by activating the sympathetic nervous system. Exposure may also damage nerve fibres.

Musculoskeletal symptoms might occur through direct vibration-induced damage to musculoskeletal tissues or secondary nerve damage.

What are the symptoms?

• Raynaud phenomenon presents as well-demarcated pallor or cyanosis of the fingers accompanied by numb or tingling sensations.
• This may be followed by rewarming pain or hyperaemia.
• Often starts on the dominant hand.
• Begins at the fingertips and moves down toward the base of the palm.
• Occasionally in late stages fingers may become permanently cyanotic and develop tissue necrosis or gangrene.
• Pain and cold sensations can become chronic.
• Tingling of the fingers may also result in reduced range of movement in colder conditions.

How is HAVS diagnosed?

Diagnosis usually consists of exclusion. Primary Raynaud phenomenon and other causes of Secondary Raynaud phenomenon should be ruled out before diagnosis is given.

Conditions like autoimmune rheumatic disease can give rise to similar symptoms as HAVS, so after other possible causes are dismissed a diagnosis can be given.

History and Physical Examination

At least 2 years of exposure to vibratory tools needs to exist immediately before the onset of vascular disease. Also, a history of previous work to show if there was any other chance for potential exposure.

The type of Vibration tool should also be obtained.  A precordial examination should be performed. The Allen Test assesses radial and ulnar circulation and the Adson test rules out the possibility of vascular thoracic outlet syndrome.

Management

Attention should be paid to Vibration White Finger as it is the most recognised manifestation of HAVS. A reduction in vibration exposure or ceasing of exposure entirely is the best way to treat HAVS and may increase the chances of work continuation.

If it cannot be avoided, protection equipment, engineering control and changes at work will help manage the condition. Further to this, it may help to introduce breaks into the period of exposure.

Avoidance of cold conditions and vibration exposure will help manage the onset of Raynaud Attacks. Also, stopping smoking may be of benefit.

What prognosis does the condition have?

HAVS may lead to poor quality of life. It is linked to psychological stress as well as a reduction in general wellbeing. Recognising the condition early has a greater chance of producing functional outcomes. The likelihood of recovery is higher for those with less exposure.

Further reading

We have a full illustrated guide to HAVS and Vibration White Finger (VWF), here, on our website.

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