Hand-arm vibration syndrome.

The hand-arm vibration syndrome affects workers who perform tasks that generate vibration. Raynaud's phenomenon and sensory impairment of the fingers are the predominant effects. A history of hand-arm vibration (HAV) exposure in a patient with these symptoms should alert the physician to the diagnosis. Referral to a special clinic or hospital department for multiple clinical tests is required to confirm the diagnosis and, using the Stockholm classification, to grade the severity in each hand. The assessment permits the patient to be monitored either for progression of or recovery from the syndrome. Avoidance of further vibration exposure is recommended, together with the prescription of a slow-release calcium channel blocker to improve peripheral circulation. Hand-arm vibration syndrome should be distinguished from carpal tunnel syndrome (CTS), which may have similar symptomatology but requires different treatments. Surgery is contraindicated in the former and should be the last resort for carpal tunnel syndrome in a worker requiring good grip-strength in future employment.