Occupational Medicine Advance Access originally published online on May 22, 2006
Occupational Medicine 2006 56(5):317-321; doi:10.1093/occmed/kql022
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Hand–arm vibration syndrome with concomitant arterial thrombosis in the hands
61 Queen Street East, 8th Floor, Toronto, Ontario M5B 1W8, Canada
Background Hand–arm vibration syndrome (HAVS) refers to the vascular, neurological and musculoskeletal effects that may occur in workers with prolonged exposure to vibrating tools. Hypothenar hammer syndrome (HHS) is a lesion of the ulnar artery at the level of the hamate bone secondary to single or repeated episodes of trauma to the hypothenar eminence. The literature suggests that digital arterial thrombosis and HHS may be associated with the use of vibrating tools.
Aim This study will familiarize investigators with the range of vascular abnormalities seen in workers using vibrating tools, and highlight the importance of screening for arterial thrombosis in the hand when assessing hand–arm vibration-exposed patients.
Methods In the patients referred to our clinic for HAVS assessment, three were identified during the period 2001 to 2004 who had vascular occlusions in the hands in addition to HAVS. In addition to standardized HAVS vascular investigations, all three patients had arteriograms based on a significantly positive Allen's test.
Results All three cases had documented HAVS based on vascular testing. Arteriograms revealed a spectrum of severity of arterial thromboses from severe HHS, to occlusion limited to the digital arteries.
Conclusion Our study reports three cases of HAVS with concomitant HHS and/or digital artery thrombosis. These findings support previous reports of an association between HAVS and vascular thrombosis in the hands. Screening for arterial occlusive problems in the hands should be included in the HAVS work up.
Keywords Allen's test; hand–arm vibration syndrome; hypothenar hammer syndrome; occupational
Correspondence to: Aaron Thompson, 61 Queen Street East, 8th Floor, Toronto, Ontario M5B 1W8, Canada. e-mail: Aaron.thompson{at}utoronoto.ca