White finger vibration - hand arm vibration syndrome

What is white finger vibration?

White finger vibration, also known as hand-arm vibration syndrome, is one of the causes of Raynaud's phenomenon. The syndrome affects blood vessels, nerves, muscles, joints and connective tissue of the hand, wrist and arm. This is not uncommon as many developed countries publish regulatory documentation on frequency (Hz) exposure limits, effects and control.

Who is affected by white finger vibration?

Workers who use hand-held or hand-guided power tools for more than a few hours a day are at risk of white finger vibration. The period of time between exposure to vibration and the development of symptoms varies, from months to years. The risk of developing hand-arm vibration syndrome increases with the intensity and duration of exposure to vibration, and continued exposure results in a worsening of symptoms. It is recommended that people suffering from certain vascular or neurological disorders affecting the hand or arm, eg. Raynaud's disease or carpal tunnel syndrome are not exposed to vibrations at work.

What Causes White Finger Vibration?

White finger vibration can occur in those who use vibrating hand tools, such as sanding tools, hammer drills, jackhammers, and chain saws. It can also be caused by holding or working with vibrating machinery. The vibration promotes vasoconstriction through arterial smooth muscle hypertrophyand damage to endothelial cell walls; There is an increase in the release of vasoconstrictor chemicals such as serotonin and thromboxane. Nerve damage also occurs.

Clinical features of white finger vibration

There are some specific characteristics and symptoms of white finger vibration:

• Symptoms of nerve damage include pain, tingling, numbness, and shrinking skill. Initially, symptoms are intermittent, but can become continuous if exposure to vibration continues.
• Vascular manifestations include cold-induced vasoconstriction (vasospasm) that causes the fingertip or finger to turn white due to lack of blood supply. One or more fingers may be affected.
• Fingers can turn blue in more advanced cases when all available oxygen in the blood is depleted.
• When reheating, the fingers turn bright red.
• Seizures can occur after using vibrating tools, especially if the hands are exposed to the cold.
• Musculoskeletal Complications include reduced grip strength, osteoporosis of the wrist or elbow, and bone cysts.

What can be done to improve white finger vibration?

General advice:

• Keep your hands as warm as possible to stop spasms in the finger arteries and improve circulation.
• Smokers should cut down or quit, as tobacco causes blood vessels to constrict, decreasing blood flow to the fingertips.
• Exercise regularly to improve circulation.
• Avoid tight clothing that can restrict blood flow.
• Try to avoid sitting for long periods of time - regular exercise, such as walking around a room, moving your arms and legs to maintain circulation, will help make sure your fingers and toes don't get cold.
• Try to stay warm. If clothes get wet, change them immediately. Drink hot beverages.
• Avoid touching cold objects.

Workplace Tip:

• Limit the use of vibrating tools. If practical, avoid them altogether.
• See if it is possible to replace the vibrating tool with an alternative method to get the job done efficiently.
• Hold the vibrating tools as freely as possible and in different positions.
• Ensuring tools are well maintained; make sure cutting blades are kept sharp to maintain efficiency and replace worn parts.
• Use tools correctly and use the right tool for the job (to get the job done faster and reduce exposure time).
• Store tools so that they do not have very cold handles the next time they are used.
• Wear anti-vibration gloves.
• Take regular breaks of at least 10 minutes every hour away from the tool.
• Choose brands / models of low-vibration equipment.

Standard tests used to diagnose white finger vibration include:

• Vibrotactile threshold test: to measure the sensitivity of the mechanoreceptors in the nerves of each hand to stretching, texture and vibration.
• Thermal stiometry test: to measure thermal receptors (for cold / heat).
• Purdue Pegboard Test - To measure dexterity and any loss of movement in either hand.
• Cold Challenge Test - Provides visual evidence of pallor.

It is appropriate to rule out Raynaud's disease or secondary Raynaud's phenomenon due to other causes.

White finger vibration treatment

If a worker has developed a vibrating white finger, management may include:

• Reduction or cessation of exposure to vibrating tools. However, in more advanced cases, symptoms may be persistent after cessation of exposition.
• Encouragement to quit smoking
• Referral to a dermatologist, rheumatologist or neurologist for evaluation and treatment, including calcium channel antagonists and pain management.