MEDICO LEGAL M A G A Z I N E
MEDICO-LEGAL ASPECT OF HAND ARM VIBRATION SYNDROME By Mr Michael Gaunt MD(Dist), MA (Cantab), FRCS. Consultant Vascular Surgeon
Hand Arm Vibration Syndrome (HAVS) is a medical syndrome of symptoms and signs affecting the vascular, neurological and musculoskeletal systems of the upper limb associated with occupational exposure to hand transmitted vibration. HAVS has become one of the commonest prescribed diseases of the industrial world and is a frequent source of claims. Many occupations are associated with significant exposure to vibration and it has been estimated that 1.2 million men and 40,000 women in Britain have weekly exposures high enough to justify health surveillance 1,2.
History of Hand Arm Vibration Syndrome The first condition recognised to be associated with vibration was a form of secondary Raynaud’s phenomenon characterised by abnormal vasospasm of the palmar and digital arteries in response to cold. Maurice Raynaud first described the condition in 1862 3. The high prevalence in workers using
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vibrating tools was first described in Italy by Loriga in 1911 and confirmed in the USA in 1918 by Dr Alice Hamilton who undertook a US Government commissioned study of Stone Cutters 4,5. In these early years progression of the condition to gangrene and loss of fingers was not uncommon. Subsequent reports confirmed this association which came to be known as Vibration White Finger (vWF) and its severity classified using the Taylor-Pelmear scale 6. Further research identified neurological and musculoskeletal vibration related conditions which could occur either in conjunction with vWF or independently. In recognition of this multisystem involvement affecting the upper limb, an international consensus agreed to the condition being renamed Hand Arm Vibration Syndrome (HAVS) and the Stockholm Workshop Scale replaced the Taylor-Pelmear scale for the assessment and staging of the condition 7,8. A recent review identified over 8000 scientific publications related to HAVS 9. In 1985 HAVS became a prescribed disease in the UK under the National Insurance (Industrial Injuries)
