Hand Arm Vibration Syndrome (HAVS) refers to injuries to the hands and arms caused by excessive exposure to vibrating tools. The most common condition is vibration-induced white finger, where fingers blanch and lose sensation when exposed to cold. Vibration can damage tendons, muscles, bones and joints, and affect the nervous system, collectively known as HAVS. Workers report attacks of finger whitening when cold, tingling, numbness, and pain between attacks. Undetected or advanced cases can permanently impair blood circulation, potentially leading to gangrene. Prevention strategies include limiting exposure time, using antivibration gloves, and maintaining tools.

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

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

3.  Vibration can cause changes:Vibration can cause changes:
 In tendons,In tendons,
 Muscles,Muscles,
Bones and joints, andBones and joints, and
 Can affect the nervous systemCan affect the nervous system

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

7.  Workers affected by HAVS commonly report:Workers affected by HAVS commonly report:
 Attacks of whitening (blanching) of one or moreAttacks of whitening (blanching) of one or more
fingers when exposed to coldfingers when exposed to cold
 Tingling and loss of sensation in the fingersTingling and loss of sensation in the fingers
 Loss of light touchLoss of light touch
 Pain and cold sensations between periodic whitePain and cold sensations between periodic white
finger attacksfinger attacks
 Loss of grip strengthLoss of grip strength
 Bone cysts in fingers and wristsBone cysts in fingers and wrists

9.  It is also known asIt is also known as SecondarySecondary Raynaud'sRaynaud's
SyndromeSyndrome,,
 If not detected in the early stages, it mayIf not detected in the early stages, it may
permanently impair blood circulation in thepermanently impair blood circulation in the
fingers and can lead to gangrene in thefingers and can lead to gangrene in the
more serious stages.more serious stages.

10. Raynaud's DiseaseRaynaud's Disease
 An idiopathic vascular disorderAn idiopathic vascular disorder
characterized by bilateral Raynaudcharacterized by bilateral Raynaud
phenomenon, the abrupt onset of digitalphenomenon, the abrupt onset of digital
paleness orpaleness or CYANOSISCYANOSIS in response to coldin response to cold
exposure or STRESS."exposure or STRESS."

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

12.  When Raynaud's symptoms appear alone,When Raynaud's symptoms appear alone,
without any other medical condition, it iswithout 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 toIn this condition, the blood vessels return to
normal afterward.normal afterward.
 Primary Raynaud's usually affects both thePrimary Raynaud's usually affects both the
hands and the feet.hands and the feet.

13. Raynaud's PhenomenonRaynaud's Phenomenon
 When Raynaud's symptoms have a specificWhen Raynaud's symptoms have a specific
cause or are accompanied by anothercause or are accompanied by another
disease, it is called Raynaud's phenomenondisease, it is called Raynaud's phenomenon
or secondary Raynaud's.or secondary Raynaud's.
 This condition, which more often affectsThis condition, which more often affects
either the hands or feet, is often moreeither the hands or feet, is often more
serious and may result in blood vesselserious and may result in blood vessel
scarring and long-term consequencesscarring and long-term consequences

14. Raynaud's phenomenonRaynaud's phenomenon
 Can be associated with diseases of theCan 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 lupusScleroderma and systemic lupus
erythematosus.erythematosus.
 It can also follow repeated trauma,It can also follow repeated trauma,
particularly vibrations such HAVS or thoseparticularly vibrations such HAVS or those
caused by typing or playing the piano.caused by typing or playing the piano.

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

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

17.  They then turn blue, which is a result of tinyThey then turn blue, which is a result of tiny
blood vessels dilating to allow more blood toblood vessels dilating to allow more blood to
remain in the tissues.remain in the tissues.
 When the flow of blood returns, the areaWhen the flow of blood returns, the area
becomes red and then later returns tobecomes 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 lastand painful throbbing. The attacks may last
from minutes to hoursfrom minutes to hours

18.  If the condition progresses, blood flow to theIf the condition progresses, blood flow to the
area could become permanently decreasedarea could become permanently decreased
causing the fingers to become thin andcausing the fingers to become thin and
tapered, with smooth, shiny skin and slowtapered, 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 maygangrene or ulceration of the skin may
occur.occur.

19.  The risk factors include associated diseasesThe risk factors include associated diseases
and smoking.and smoking.
 Women are 9 times more likely to beWomen are 9 times more likely to be
affected than men.affected than men.

20. DiagnosisDiagnosis
 Generally diagnosis of Raynaud's SyndromeGenerally diagnosis of Raynaud's Syndrome
requires no special tests, although tests such asrequires no special tests, although tests such as
nail fold capillaroscopy (examining the nail foldnail fold capillaroscopy (examining the nail fold
under magnification to see capillary changesunder magnification to see capillary changes
indicative of connective tissue disease);indicative of connective tissue disease);
 Cold stimulation this involves submerging theCold stimulation this involves submerging the
hands in ice and then timing their return to normalhands in ice and then timing their return to normal
colour.colour.
 Or a vascular laboratory assessment may be usedOr a vascular laboratory assessment may be used
to determine the severity of the disease.to determine the severity of the disease.

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

22.  The tip of the nose and the earlobes andThe 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 blueNumbness 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 sometimesor tingling sensation and sometimes
swelling.swelling.

24.  A higher prevalence of vascular symptoms areA higher prevalence of vascular symptoms are
found in cold countries, reflecting the role offound in cold countries, reflecting the role of
external temperature.external temperature.
 Control studies have found that vascularControl studies have found that vascular
symptoms may be absent or milder in warmsymptoms may be absent or milder in warm
climates or where workers in cold climates workclimates or where workers in cold climates work
indoors in warm temperatures, making HAVSindoors in warm temperatures, making HAVS
mimicmimic CTSCTS Cold temperature work is alsoCold temperature work is also
associated with a greater risk of developing workassociated with a greater risk of developing work
relatedrelated CTSCTS..

25.  Carpal comes from carpus, the Latin wordCarpal comes from carpus, the Latin word
for wrist.for wrist.
 The carpal tunnel is a small passage insideThe carpal tunnel is a small passage inside
the wrist.the wrist.
 Several fine bones of the wrist form the floorSeveral fine bones of the wrist form the floor
and sides of the tunnel.and sides of the tunnel.
 A ligament called the transverse carpalA 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.

30.  Passing through this tunnel are:Passing through this tunnel are:
 The median nerve, which conductsThe median nerve, which conducts
impulses, sent by the brain, down the armimpulses, sent by the brain, down the arm
and to the fingers The tendons of the fingerand to the fingers The tendons of the finger
flexor muscles, which allow the fingers toflexor muscles, which allow the fingers to
bend Arteries and veinsbend Arteries and veins

31.  The median nerve supplies most of theThe median nerve supplies most of the
feeling in the hand, particularly to thefeeling in the hand, particularly to the
thumb, index and middle fingers, the thumbthumb, index and middle fingers, the thumb
half of the palm and the outer side of thehalf of the palm and the outer side of the
hand.hand.
 It also controls the movement of many ofIt also controls the movement of many of
the tendons that bend the fingers, allowingthe tendons that bend the fingers, allowing
the hand to grasp objects as well as pinch.the hand to grasp objects as well as pinch.

32.  Workers handling vibrating tools mayWorkers handling vibrating tools may
experience tingling and numbness in theirexperience tingling and numbness in their
fingers and hands.fingers and hands.
 If vibration exposure continues, theseIf vibration exposure continues, these
symptoms tend to worsen and can interferesymptoms tend to worsen and can interfere
with work capacity and life activities.with work capacity and life activities.
Vibration-exposed workers may exhibitVibration-exposed workers may exhibit
increased vibratory, thermal and tactileincreased vibratory, thermal and tactile
thresholds in clinical examinations.thresholds in clinical examinations.

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

36.  Epidemiological surveys of vibration-Epidemiological surveys of vibration-
exposed workers show that the prevalenceexposed workers show that the prevalence
of peripheral neurological disorders variesof peripheral neurological disorders varies
from a few per cent to more than 80 perfrom a few per cent to more than 80 per
cent, and that sensory loss affects users ofcent, and that sensory loss affects users of
a wide range of tool types.a wide range of tool types.
 It seems that vibration neuropathy developsIt seems that vibration neuropathy develops
independently of other vibration-inducedindependently of other vibration-induced
disorders.disorders.

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

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

40. Sensorineural stages of the Stockholm WorkshopSensorineural stages of the Stockholm Workshop
scale for hand-arm vibration syndrome StageSignsscale 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 without1SN - 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/orreduced tactile discrimination and/or
manipulative dexteritymanipulative dexterity

41. Vibration White FingerVibration White Finger
 British miners were the among the first to beBritish miners were the among the first to be
awarded compensation after theyawarded compensation after they
developed Vibration White Finger, adeveloped Vibration White Finger, a
condition caused by working with vibratingcondition caused by working with vibrating
machinery such as jack hammers, chainmachinery such as jack hammers, chain
saws, grinders and drillssaws, grinders and drills

42. WBVSWBVS
Whole Body Vibration Syndrome.Whole Body Vibration Syndrome.
 Our bodies are exposed to vibration at workOur bodies are exposed to vibration at work
from many machines, such as constructionfrom many machines, such as construction
machinery (bulldozers, tow motors, forkliftsmachinery (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 inVibration has been proven to result in
musculoskeletal disorders of both the handmusculoskeletal disorders of both the hand
and arm, the neck, and the back.and arm, the neck, and the back.

45. Quest HAVPro Basic Vibration MonitorQuest HAVPro Basic Vibration Monitor
 The HAVPro is a compact, lightweight; fullyThe HAVPro is a compact, lightweight; fully
integrated 3 channel Vibration Monitor forintegrated 3 channel Vibration Monitor for
obtaining tri-axial vibration measurements.obtaining tri-axial vibration measurements.
 This basic monitor is the ideal screeningThis basic monitor is the ideal screening
tool for quickly and simply determining thetool for quickly and simply determining the
presence and magnitude of hazardouspresence and magnitude of hazardous
hand-arm or whole-body vibration levels.hand-arm or whole-body vibration levels.

46. ANTI-VIBRATION- Full and Half FingerANTI-VIBRATION- Full and Half Finger
GlovesGloves

47. PreventionPrevention
 Workers may be advised to hold tools asWorkers 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 glovesConsider the use of antivibration gloves

48.  Taking regular breaks of at least 10 minutesTaking regular breaks of at least 10 minutes
from exposure to vibration,from exposure to vibration,
 Keeping warm while at work, and notKeeping warm while at work, and not
smoking.smoking.
 In addition, heavy, old tools usuallyIn addition, heavy, old tools usually
generate more vibration than their newer,generate more vibration than their newer,
lighter, and better designed equivalentslighter, and better designed equivalents