Hand-arm disorders disorders Occasional attacks affecting only - PowerPoint PPT Presentation

Hand-arm vibration syndrome Vibratory Tools and Processes • Percussive metal-working tools • Causes Vibration-induced Hand-arm vibration white finger, VWF • Grinders and other rotary tools • Classification – staging and scoring syndrome • Percussive hammers and drills used in mining, • Tests to support diagnosis chain saw demolition and road construction • Control of Vibration at Work Presenter: Michael J Griffin • Forest and garden machinery Regulations 2005 • Other processes and tools. • Compensation 9 th Southampton Hand Course The Working Hand Chilworth Manor, Southampton – 27 th June 2014 Hand-arm Vibration Syndrome Stockholm Workshop vascular scale Stockholm Workshop vascular scale Stage Grade Description Stage Grade Description Many tools powered by: 0 - No attacks. 0 - No attacks. Vascular Neurological • compressed air Hand-arm disorders disorders Occasional attacks affecting only Occasional attacks affecting only 1 Mild 1 Mild • electricity the tips of one or more fingers. the tips of one or more fingers. Vibration Occasional attacks affecting distal & Occasional attacks affecting distal & • hydraulic power 2 Moderate 2 Moderate Articular Muscle middle (rarely also proximal) middle (rarely also proximal) phalanges of one or more fingers. phalanges of one or more fingers. disorders disorders • internal combustion engines. Syndrome Frequent attacks affecting all Frequent attacks affecting all 3 Severe 3 Severe phalanges of most fingers. phalanges of most fingers. Other As is stage 3, with trophic skin As is stage 3, with trophic skin 4 Very severe 4 Very severe changes in the finger tips. changes in the finger tips. disorders Undefined adjectives Undefined verb Ambiguous word or phrase Blanching scores Stockholm Workshop sensorineural scale Stockholm Workshop sensorineural scale Stage Symptoms Stage Symptoms Exposed to vibration but no symptoms. Exposed to vibration but no symptoms. 0 SN 0 SN Neurological effects of hand-transmitted 5 5 Intermittent numbness with or without tingling. Intermittent numbness with or without tingling. vibration 1 SN 1 SN 4 4 3 3 Intermittent or persistent numbness, reduced Intermittent or persistent numbness, reduced 2 SN 2 SN 3 3 2 3 3 3 3 2 sensory perception. sensory perception. 2 2 1 1 2 2 Intermittent or persistent numbness, reduced tactile Intermittent or persistent numbness, reduced tactile 3 SN 3 SN 2 2 discrimination and/or manipulative dexterity. discrimination and/or manipulative dexterity. 1 1 1 1 1 1 Undefined symptoms Undefined signs Undefined adjectives 01300 right 01366 left Standardised tests Level 5 Numbness and tingling scores HSE tiered system of health surveillance Tests for vibration-induced white finger: peripheral vascular response to cold The HSE currently suggest:- Diagnosis by doctor Level 4 “Health surveillance should be provided for vibration- exposed employees who: The two most common tests of vascular function: Clinical history and examination by qualified Level 3 • are likely to be regularly exposed above the exposure 5 1. Measurement of finger skin temperature following 5 action value; person 4 cold provocation (finger rewarming test) 4 3 • are likely to be exposed occasionally above the action 3 If symptoms reported 3 value and where the risk assessment identifies that 3 3 2 3 3 3 2 2. Measurement of finger systolic blood pressure the frequency and severity of exposure may pose a 2 2 1 2 1 2 Regular following cold provocation. 2 risk to health; or 2 1 health Level 2 1 1 1 1 • have a diagnosis of HAVS (even when exposed below 1 surveillance the action value).” Initial 01300 right 01366 left Level 1 questionnaire

Tests for sensorineural dysfunction: Measurement of finger Measurement of finger Measurement of tactile perception skin temperature following systolic blood pressure vibrotactile perception cold provocation following cold thresholds The two most common tests of tactile function: provocation ISO 14835-1: 2005 ISO 13091-1:2001 1. Measurement of vibrotactile perception thresholds ISO 14835-2: 2005 2. Measurement of thermotactile perception thresholds Tactile perception meter Finger systolic blood pressure Normal (i.e. Gaussian) distribution Tests of musculoskeletal function Summary report of symptoms and signs Measurement of Right Left thermotactile perception Possible disorder Symptoms thresholds Unusual finger numbness 03663 N3 01100 N1 Unusual finger tingling 03333 T2 00010 T1 Probable disorder Finger clumsiness 1 1 Weakness of grip 2 2 Finger pain 1 0 Hand pain 1 2 Arm pain 0 2 Shoulder pain 2 2 Signs Vibrotactile thresholds: 31.5 Hz 0+‡‡+ 00++0 Thermal -3 sd -2 sd -1 sd mean +1 sd +2 sd +3 sd 125 Hz 0+‡‡+ 00++0 Thermotactile thresholds: hot ++‡+0 0+00+ aesthesiometer 64% cold ++‡+0 0+00+ Dexterity + 0 95% Grip force ‡ + Jaymar grip meter Purdue pegboard Vibration 99.7% Location of contact with vibration 23221 V 01123 V Finger blanching probability: ISO 5349-1 (2001) Control of Vibration at Work If ‘exposure action value’ is exceeded: Exposure limit value Regulations 2005 Exposure, D y , for 10% finger blanching • inform and warn exposed workers D y = 31.8 [ A (8)] -1.06 12 Exposure action Exposure limit 10 • use working methods with less vibration exposure Exposure (years) “workers shall not be exposed above the value value exposure limit value” • limit duration and intensity of vibration exposures 5.8 Hand- • …. and arrange health surveillance. 2.5 ms -2 r.m.s. 5.0 ms -2 r.m.s. transmitted vibration EU Exposure EU Exposure 0.5 ms -2 r.m.s. 1.15 ms -2 r.m.s. Limit value Action value Whole-body or or vibration 9.1 ms -1.75 (VDV) 21 ms -1.75 (VDV) 1 1 2.5 2.5 10 5.0 5.0 -2 r.m.s.) A (8) (ms Prescription for vibration-induced white finger Prescription for the hand-arm vibration syndrome The court may expect that if there is a Compensation for vibration injuries - since 1st April 1985 - - updated - foreseeable risk: Episodic blanching, occurring throughout the year, Civil Courts In 2004, the Industrial Injury Advisory Council The employer should affecting the middle or proximal phalanges (or in recommended that prescription should be Many successful claims for the HAVS (both the case of the thumb the proximal phalanx) of any i. provide warning of the risks, extended to include the sensorineural component: three fingers . VWF and sensorineural symptoms): most ii. instruct on the proper use of tools, Occupations: (1) persistent numbness or persistent settled out of court but many at court. • the use of hand-held chain saws in forestry; or tingling, or both, together with iii. select tools with minimum vibration and arrange • the use of hand-held rotary tools in grinding, or in the sanding or polishing of metal, or the holding of material being ground, or metal being sanded or efficient tool and machine maintenance, (2) significant and measurable reduction in Prescription polished, by rotary tools; or both sensory perception and manual • the use of hand-held percussive metal-working tools, or the holding of metal iv. restrict the duration of exposure to vibration in any VWF has been a prescribed industrial being worked upon by percussive tools, in riveting, caulking, chipping, dexterity day, and hammering, fettling or swaging; or disease in the UK since 1 st April 1985 • the use of hand-held powered percussive hammers in mining, quarrying, The new scheme commenced in 2007-2008. v. arrange suitable health surveillance. demolition, or on roads or footpaths, including road construction; or • the holding of material being worked upon by pounding machines in shoe manufacture.

Prescription for carpal tunnel syndrome Prescription for carpal tunnel syndrome New cases of Prescribed Vibration-induced White (VWF) and - since 19 th April 1993 - Carpal Tunnel Syndrome (CTS) in Great Britain 2003 - 2012 - Recommendation of the IIAC- July 2006 Carpal tunnel syndrome is recommended by the Carpal tunnel syndrome is a prescribed disease - Industrial Injuries Advisory Council for prescription only for the use of hand-held vibrating tools. Hand-arm vibration for two types of job: (a) The use, at the time the symptoms first develop, It is unclear whether the disorder is a consequence syndrome of hand-held powered tools whose internal parts of the vibration or the posture and grip required to vibrate so as to transmit that vibration to the hand, use such tools. but excluding those which are solely powered by Presenter: Michael J Griffin hand; or Other factors associated with carpal tunnel (b) Repeated palmar flexion and dorsiflexion of the syndrome are: various hormonal non-occupational wrist for at least 20 hours per week in those who factors including female sex, pregnancy, oral have undertaken such work for at least 12 months Vibration-induced white finger (VWF) is the most commonly prescribed contraceptive use, bilateral oophorectomy, diabetes 9 th Southampton Hand Course disease under the Industrial Injuries Disability Benefit scheme for the last 10 in aggregate in the 24 months prior to the onset of mellitus and rheumatoid arthritis. The Working Hand years. However the number of new cases of VWF has fallen over that symptoms. Chilworth Manor, Southampton – 27 th June 2014 period.