Hand-Arm Vibration Syndrome
(Vibration White Finger)

What is hand-arm vibration syndrome?

Hand-arm vibration syndrome (HAVS) causes symptoms in fingers, hands and arms caused by 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.

What causes hand-arm vibration syndrome?

HAVS is caused by repeated and frequent use of hand held vibrating tools. For example, power drills, chainsaws, pneumatic drills, etc. 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. It has been estimated that up to 1 in 10 people who work regularly with vibrating tools may develop HAVS.

What are the symptoms of hand-arm vibration syndrome?

Symptoms may include Raynaud's phenomenon (this is the 'white finger' part), nerve symptoms, and muscular aches and pains.

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 bout of Raynaud's phenomenon is as follows.

• At first the fingers go white and cool. This is due to the small blood vessels narrowing (going into spasm).
• They then go a blue-ish colour. This is due to the oxygen being used up from the reduced blood supply of the narrowed blood vessels.
• They then go bright red. This is due to the blood vessels opening up again (dilating) and the return of a good blood flow. This may cause tingling, throbbing and pain.

Some people do not have the full classic colour changes, but still develop bouts of uncomfortable, pale, cold fingers. The duration of each bout of symptoms can last from minutes to hours. The amount of pain or discomfort varies between people. Symptoms usually go after each bout, but one or more blue-ish fingers may persist in the most severe cases.

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

Nerve symptoms
Numbness (loss of feeling) and/or tingling (pins and needles) in one or more fingers may develop. 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, 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.

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.

How do symptoms progress?

You may at first have bouts of Raynaud's phenomenon on cold, wet, and windy days affecting the ends of one or more fingers. You may have some numbness or tingling which 'comes and goes' around the same time. 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 other cold conditions that trigger Raynaud's phenomenon.

As the condition develops, the amount of cold needed to trigger symptoms is less. You may then have bouts of Raynaud's phenomenon in the summer, though usually only if your hands are wet. If the condition becomes more severe you may have bouts of Raynaud's phenomenon along the full length of affected fingers, and develop some permanent numbness.

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

Can hand-arm vibration syndrome be prevented?

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 excessive grip or to use a tool for longer than necessary.
• Use antivibration gloves.
• 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 the hands to keep the blood flow as good as possible.
• You should not smoke - the chemicals in tobacco can affect blood flow.

What should I do if symptoms develop?

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.

What is the treatment for hand-arm vibration syndrome?

Stop using vibrating tools if possible.
This may prevent symptoms from getting worse. Bouts of Raynaud's phenomenon may ease off if symptoms are mild and you stop working with vibrating tools. However, it is not clear whether nerve symptoms can improve once they have developed. If possible, you should consider a change of job.

General advice regarding Raynaud's phenomenon
In addition, general advice is similar to that given to people who have Raynaud's phenomenon, whatever the cause. This aims to prevent the blood vessels going into spasm and causing the symptoms of Raynaud's phenomenon. The following are usually advised.

• Smoking may make symptoms worse. The chemicals in tobacco can cause the small blood vessels to narrow. If you smoke, if you stop smoking it may ease the problem.
• Some medicines that are used to treat other conditions sometimes trigger symptoms, or make them worse. The medicine may cause the blood vessels to narrow. Such medicines include: beta-blockers, some anti-migraine medicines, decongestants, and, very occasionally, the contraceptive pill. Don't stop a prescribed medicine if you suspect it may be making symptoms worse. See your doctor to discuss possible alternatives.
• Other drugs. Caffeine (in tea, coffee, cola, and in some medicines) triggers symptoms in some people. Try cutting out caffeine for a few weeks to see if it helps. Amphetamines and cocaine may also be a trigger.
• Try to keep warm in cool weather or in cool environments
  • Keep your hands warm. Warm gloves are essential when you are out in cool weather.
  • Keep your whole body warm, not just your hands. Although your hands are the most important, symptoms are less likely to occur if you keep your entire body warm. So, wrap up warmly before going into cooler areas such as outside on cold days. For example, wear hats and scarves in addition to warm gloves.
  • It is best to put on the gloves when you are warm, before going into colder areas. Ideally, keep gloves in an airing cupboard or near a radiator so they will be warm when put on.
  • If you have severe symptoms, or symptoms that are easily triggered, then portable heat packs, and battery heated gloves are useful. The Raynaud's and Scleroderma Association have a list of suppliers - see below for their details. Your pharmacist or local medical supplier may also be able to advise.
• Try not to touch cold objects. For example, use a towel or gloves when removing food from the freezer or working with cold food.
• Regular exercise is recommended by many experts. Exercise your hands frequently to improve the circulation.
• When a bout or symptoms develops, warm the hands as soon as possible. Soaking the hands in warm running water is a good way to get warm (but take care that the water does not become too hot, or lose its heat and become cool).

Medication to help prevent Raynaud's phenomenon
A medicine called nifedipine may be advised if symptoms of Raynaud's phenomenon are severe. It works by 'opening up' (dilating) the small blood vessels. Some people take nifedipine regularly, each day, to prevent symptoms. Some people take nifedipine just during the winter, or just during cold weather spells. If you are prescribed nifedipine, read the leaflet that comes in the medicine packet for a full list of possible side-effects and cautions.

Various other medicines may be tried if nifedipine is not helpful, or causes side-effects.

Further help and advice

The Raynaud's and Scleroderma Association
112 Crewe Road, Alsager, Cheshire, ST7 2JA
Tel (helpline): 0800 917 2494    Tel (office): 01270 872776    Web: www.raynauds.org.uk
Can advise on coping with symptoms of Raynaud's phenomenon.

Useful websites include:
TUC information about Vibration White Finger - www.tuc.org.uk/h_and_s/tuc-8705-f0.cfm
Health and Safety Executive information on HAVS - www.hse.gov.uk/vibration/index.htm

© EMIS and PIP 2006   Updated: April 2006   PRODIGY Validated