Prolonged exposure to hand-transmitted vibration (HTV) can result in vascular, neurosensory or musculoskeletal manifestations; this is collectively referred to as hand-arm vibration syndrome (HAVS). When associated with secondary Raynaud's, this is called vibration white finger, where there is damage to nerves, blood vessels and joints in the hand. HAVS caused by exposure to vibration is preventable, however once the damage is done it is irreversible. Alongside numbness in the body's extremities due to impaired circulation, an individual may also suffer from paraesthesia (pins and needles) or pain. These symptoms of Raynaud's caused by HAVS can have a drastic impact on quality of life and work ability, which is compounded by the lack of effective medication. It is therefore crucial that those who are exposed to HTV and presenting with early symptoms are identified as quickly as possible to prevent further progression.
Leading from this knowledge, a team of scientists from Umeå University in Sweden investigated the risk of developing Raynaud's phenomenon and paraesthesia in a cohort of male manual and office workers at an engineering plant in Sweden over a period of 21 years. The first baseline tests were carried out in 1987 and 1992, with follow up tests in 1992, 1997, 2002 and 2008, through the use of questionnaires and measured vibration exposure. Out of 241 study participants, 21 individuals developed Raynaud's phenomenon and 43 developed paraesthesia.
The results of the study demonstrated that the risk of developing Raynaud's was significantly increased amongst those who had previously reported a sensation of cold hands. This was not the case for paraesthesia symptoms however. The data supports the proposal for reports of the sensation of cold hands to be considered for inclusion in the future development of a screening procedure to identify persons at risk for secondary Raynaud's.
There are a range of actions that anyone who is at risk of developing HAVS can take to limit the likelihood of presenting symptoms. Any vibrating tool that causes tingling or numbness in fingers can propagate the onset of vibration white finger. This includes hammer drills, chainsaws, power hammers and chisels, and powered lawn mowers. Employers also have a responsibility to protect their employees from vibration white finger. If it is necessary to use vibrating tools, employees should ask to use suitable low-vibration tools, wear anti-vibration gloves and reduce the amount of time spent on one tool by doing other jobs in between. It is essential to tell your employer if you are diagnosed with HAVS, and you may be entitled to an Industrial Injuries Disablement Benefit, a payment given to those who have become ill or suffered injuries through their work. Those who think they may qualify for this can learn more here on the GOV.UK website.
Further information can be found on the HSE website, through leaflets for both employees and employers. We strongly encourage anyone working with high-vibration tools to recognise the early signs of HAVS, report any symptoms promptly to their employer, and to work within the control measures implemented in the workplace to reduce the risk of HAVS.
From an industry and research perspective, further analysis needs to be undertaken to identify groups that need to be better informed on hand-arm vibration and closely monitored to rapidly recognise early stages of vibration white finger. Furthermore, additional research is necessary to evaluate early signs of HAVS, in terms of both symptoms and biomarkers, in order to understand if there are factors that reliably predict the likelihood of developing HAVS.
If you are interested in helping SRUK to fund more work like this, then please visit our donations page here: https://www.sruk.co.uk/donate/. We rely on the generosity of our community to continue to support groundbreaking research in both scleroderma and Raynaud's.
If you would like information on vibration white finger, then please visit: https://www.sruk.co.uk/scleroderma/managing-scleroderma/vibration-white-finger-and-notes-employees/ if you are an employee, and https://www.sruk.co.uk/scleroderma/managing-scleroderma/vibration-white-finger-and-notes-employers/ if you are an employer.
Information on another new piece of research on Raynaud's can be found here: https://www.sruk.co.uk/about-us/news/do-we-need-new-way-assess-raynauds-phenomenon-clin/
