•Lucy Kenyon•OH Manager

Hand-arm Vibration Syndrome (HAVS) is an all-encompassing term to describe the signs and symptoms of disorder caused by vibration

HAVS consists of three components Vascular Neurological Musculo-skeletal

Each component may occur independently

VWF (PD A11) in April 1985 1992 minimum of 14% disability

introduced for entitlement Currently, neurological and musculo-

skeletal components cannot be compensated despite objections in 1995 from the IIAC

Number of claims larger than for noise-induced hearing loss

“I don’t go out much in the cold now” “I can only hold things in the kitchen

for short periods” “When I left mining, I wanted to take

up bowls, but couldn’t roll the ball very far”

“My wife has to cut up my food” “I can’t shave very quickly anymore” “I can still just manage to turn the

pages of a newspaper”

Very rare & severe cases

Consider other preexisting conditions such as scleroderma

Latency neurosensory symptoms vascular symptoms

Individual susceptibility? Pre-existing primary or secondary RP Pre-existing peripheral

neuropathies/entrapments Smoking (unproven) Age/Gender (unproven)

After cessation or reduction in vibration exposure, the vascular symptoms of HAVS and staging show some reversibility

May be less reversible at higher stages Smoking may hinder reversibility of

vascular symptoms Neurological symptoms are less

reversible

4,800,000 exposed to HAV at work >1.2m exposed above current HSE action

level of 2.8 m/s2 A(8) nearly 500,000 in construction industry highest exposures in heavy fabrication, foundry

fettlers, stone masons about 1.7 million exposed above new EAV nearly 1 million exposed above new ELV

Minimise the number of new cases of HAVS

Ensure existing cases do not progress to disabling stage (late stage 2)

Concentrate on the highest exposures first

When? risk assessment shows the need exposure action value exceeded

Employer’s control/management system

Feedback on effectiveness of controls particularly important for HAV because

absence of effective PPE means continued exposure and risk

Agreed policy Competent health professionals Well informed employees

Need for detailed worker information HSE/BOHRF leaflet

Vibration is measured in three axes The three axes of measurement are:

Who exposed and to what processes Description of tools, work pieces, methods etc. Vibration control methods adopted Estimations of daily exposures (w.r.t EAV, ELV) Sources of data Details of actions Any other data, assessors name and date Date of repeat assessment

Exposure log Current medication or prescriptions

Responsible person Qualified person FOM accredited practitioner

Level 3 F2F Assessment (P/E, 3 yearly and presentation of symptoms)

Level 2 Annual HQ - Routine Screening by OHA

Level 4 Diagnosis by FOM accredited practitioner

Level 5 Standardised Tests

Level 1 – NOT USED PEHQ reviewed by resonsible person

Handshake Is the person’s hand clammy and/or cold? Note the strength of the grip…

Upper limb movements Do they appear unrestricted? Are they freely moving their neck and

shoulders?

Some neurological symptoms (tingling/numbness) occur very often in most people following acute exposure E.g. Strimming the lawn

Important to ensure no exposure to vibration for at least 2 hours before assessment (temporary shift)

Dexterity Purdue Pegboard

Sensorineural Tests Semmes Weinstein monofilaments Vibrotactile perception thresholds (VTT,

vibrotactile temperature thresholds) Thermal perception thresholds (TA, thermal

aesthesiometry)

LeftRight

• Useful to mark reported symptom areas

• Overlay with test/physical examination outcomes

• May help in clarifying ‘classical’ HAVS from other problems which may or not be associated with vibrationPalmar hand map marked with sensory

deficit in ulnar nerve distribution, similar pattern on dorsal surface may indicate ulnar nerve entrapment in Guyon’s canal.

STAGE CRITERIA

   

0 v No attacks

1 v Attacks affecting only the tips of the distal phalanges of one or more fingers – usually a blanching score of 1 - 4

2 v(early)

Occasional attacks of whiteness affecting the distal and middle (rarely also the proximal) phalanges of one or more fingers – usually a blanching score of 5 - 9

2 v(late)

Frequent attacks of whiteness affecting the distal and middle (rarely also proximal) phalanges of one or more fingers - usually a blanching score of 10 -16

3 v Frequent attacks of whiteness affecting all of the phalanges of most of the fingers all year – usually a blanching score of 18 or more

4 v As 3v and trophic changes 

STAGE CRITERIA

   

0 sn Vibration exposure but no symptoms

1 sn Intermittent numbness and/or tingling (with a sensorineural,sn score of > 3 and < 6)

2 sn (early)

Intermittent numbness, and/or tingling, reduced sensory perception (usually an sn score of > 6 < 9)

2 sn(late)

Persistent numbness, and/or tingling, reduced sensory perception (usually an sn score of > 9 < 16)

3 sn Constant numbness and/or tingling, reduced sensory perception and manipulative dexterity in warmth (and an sn score > 19)

Intermittent- not persistent; persistent-lasting> 2hoursOccasional attacks= 3 or less per weekFrequent attacks=more than 3 per week

Review exposure and risk assessment Reduce exposure Advise the individual Advise the employer about fitness, (and

diagnosis, if consent given) Set a review date for health surveillance

…to prevent a serious form of HAVS developing and in particular to avoid disability.

No cases to progress to stage 3 Removal from exposure within the gamut

of stage 2

Carpal Tunnel Syndrome Primary Raynaud’s

Stockholm scale is key, but not definitive Staging/scoring allows monitoring of the

progression/regression of HAVS Requirement for good medical interview

from physician/nurse with support from clinical assessment and testing

Classification of HAVS is largely an exclusory diagnosis