General Guideline Principles for Hand Arm Vibration Syndrome
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Hand Arm Vibration Syndrome.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Hand / Arm Vibration Syndrome (HAVS) of Hand, Wrist and Forearm Injuries

Since the 1980s, the term “hand arm vibration syndrome (HAVS)” has been used to refer to the collection of unfavourable physiological reactions that are causally related to high-amplitude vibratory forces, such as those felt while operating hand tools like pneumatic drills, riveters, and chain saws or while engaging in vibratory-rich activities like operating off-road vehicles.

Other names for these reactions include “vibration-induced white finger,” “white fingers,” “dead fingers,” “traumatic vasospastic disease,” and “Raynaud’s phenomenon of occupational origin.”

The negative effects of HAVS include circulatory disturbances linked to digital arteriole sclerosis, which show up as vasospasm and localised finger blanching; sensory and motor disturbances, which include numbness, loss of finger coordination and dexterity, clumsiness, and the inability to perform complex tasks; and musculoskeletal disturbances, which include swelling of the fingers, bone cysts, and vacuoles.

There are numerous reports linking CTS to both HAVS and vibration exposure.

According to epidemiologic data, there is a latency period of 1 to 16 years after exposure before the onset of HAVS, with a trend toward decreasing prevalence as anti-vibrational tools, dampening measures, and changes in work practises have been implemented.

Vibration-related pathophysiologic changes are initially reversible, but as exposure time and intensity increase, the disorder may worsen or even become irreversible.

Diagnostic Studies of Hand Arm Vibration Syndrome

1. Diagnostic Studies of Hand Arm Vibration Syndrome Cold Provocation Test, Cold Stress Thermography (Finger Skin Temperature, Infrared, Dynamic Infrared, Laser Doppler Imaging), Finger Systolic Blood Pressure, Vibrotactile Threshold Testing, Thermal Aesthesiometer, or Nerve Conduction Velocity Studies to Diagnose Hand Arm Vibration Syndrome

   Cold Provocation Test, Cold Stress Thermography (Finger Skin Temperature, Infrared, Dynamic Infrared, Laser Doppler Imaging), Finger Systolic Blood Pressure,Vibrotactile Threshold Testing, Thermal Aesthesiometer, or Nerve Conduction Velocity Studies to Diagnose Hand Arm Vibration Syndrome are not recommended to diagnose HAVS

    

2. Serologic Tests (Thrombomodulin, Soluble Intracellular Adhesion Molecule 1 [s1-CAM 1]) to Diagnose Hand Arm Vibration Syndrome

   Serologic Tests (Thrombomodulin, Soluble Intracellular Adhesion Molecule 1 [s1-CAM 1]) to Diagnose Hand Arm Vibration Syndrome is not recommended to diagnose HAVS.

    

3. Testing for Connective Tissue Disorders

   Testing for Connective Tissue Disorders are not recommended to diagnose HAVS.

   Rationale for Recommendations – There don’t seem to be any serologic tests available right now that can offer conclusive proof or staging of HAVS.

Medications of Hand Arm Vibration Syndrome

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even though the majority of research indicates it is only marginally less effective than NSAIDs.

There is proof that NSAIDs are equally as effective at relieving pain as opioids, such as tramadol, while also being less dangerous.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic HAVS Pain

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic HAVS Pain are recommended for the treatment of HAVS pain that is either chronic or subacute.

   Indications – Treatment with NSAIDs is advised for HAVS pain that is acute, subacute, or chronic. First, try over-the-counter (OTC) medications to see if they work.

   Frequency/Duration: Many Patients may find it reasonable to use as needed.

   Indications for Discontinuation: the symptom’s resolution, the medication’s ineffectiveness, or the emergence of side effects that require stopping.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors for patients at high risk of gastrointestinal bleeding when used concurrently with drug classes with cytoprotective effects.

   Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a longer course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

   Frequency/Dose/Duration: H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

   Indications for Discontinuation: Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   The advantages and disadvantages of NSAID therapy for pain should be discussed with patients who have a history of cardiovascular disease or who have multiple cardiovascular risk factors.

    

   • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

     NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended as far as adverse cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options.

      

   • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

     NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are preferred to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in patients receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

      

4. Acetaminophen for Treatment of HAVS Pain

   Acetaminophen for Treatment of HAVS Pain is recommended for the treatment of HAVS pain, especially in patients who have NSAID contraindications.

   Indications: All HAVS patients, including those with acute, subacute, chronic, and post-operative pain.

   Dose/Frequency: As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of hepatic toxicity.

   Indications for Discontinuation: relief from discomfort, negative effects, or intolerance.

    

5. Opioids of Hand Arm Vibration Syndrome

   Opioids of Hand Arm Vibration Syndrome is not recommended for HAVS pain that is either chronic or subacute.

Treatments of Hand Arm Vibration Syndrome

The most responsible course of action is to first eliminate or drastically reduce vibration exposure. A risk factor for HAVS has been identified as smoking.

Smoking Cessation

Smoking Cessation is recommended An identified risk factor is smoking.

The avoidance of beta-blockers, sympathetic stimulants like caffeine, decongestants, and amphetamines is another common recommendation based on the proposed pathophysiology of vasospasm. Maintaining body and hand temperatures in cold environments may also help prevent or lower the risk of symptoms.

Rehabilitation of Hand Arm Vibration Syndrome

Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put forth an internal effort to finish a particular exercise or task. The interventions known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their part.

Passive interventions are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active interventions should be prioritised.

To maintain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process. To facilitate functional gains, assistive devices may be used as an adjunctive measure in the rehabilitation plan.

Therapy: Active of Hand Arm Vibration Syndrome

Therapeutic Exercise

Therapeutic Exercise is recommended for the treatment of HAVS-related functional deficits.

Frequency/Dose/Duration –With documentation of ongoing objective functional improvement, the total number of visits may be as low as two to three for patients with mild functional deficits or as high as 12 to 15 for those with more severe deficits.

If there is evidence of functional improvement toward specific objective functional goals (e.g., increased grip strength, key pinch strength, range of motion, or improving ability to perform work activities), more than 12 to 15 visits may be necessary to address persistent functional deficits.

A home exercise programme should be created as part of the rehabilitation strategy and carried out alongside the therapy.

Work Activities of Hand Arm Vibration Syndrome

1. Vibration Exposure Work Restrictions for HAVS

   Vibration Exposure Work Restrictions for HAVS is recommended It is advised that HAVS patients only perform tasks that don’t expose them to hand-held tool vibrations of high amplitude and low frequency.

   Indications – HAVS caused by exposure to low-frequency, high-amplitude vibrations

   through handheld instruments that vibrate.

    

2. Cold Exposure Work Restrictions for HAVS

   Cold Exposure Work Restrictions for HAVS is recommended It is advised that certain patients with HAVS only perform tasks that don’t expose them to cold temperatures at work.

   Indications – HAVS that cannot be controlled by avoiding vibration exposures, or in patients who experience recurrent vasospasm or other complications that do not improve with other therapies.

What our office can do if you have Hand Arm Vibration Syndrome

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