Vibration white finger (VWF), also known as hand-arm vibration syndrome (HAVS) or dead finger, is a secondary form of Raynaud's syndrome, an industrial injury triggered by continuous use of vibrating hand-held machinery. Use of the term "vibration white finger" has generally been superseded in professional usage by broader concept of HAVS, although it is still used by the general public. The symptoms of vibrating white finger are the vascular component of HAVS.

HAVS is a widespread recognized industrial disease affecting tens of thousands of workers. It is a disorder that affects the blood vessels, nerves, muscles, and joints, of the hand, wrist, and arm. Its best known effect is vibration-induced white finger (VWF), a term introduced by the Industrial Injury Advisory Council in 1970. Injury can occur at frequencies between 5 and 2000Hz but the greatest risk for fingers is between 50 and 300Hz. The total risk exposure for hand and arm is calculated by the use of ISO 5349-1, which stipulates maximum damage between 8-16Hz and a rapidly declining risk at higher frequencies. The ISO 5349-1 frequency risk assessment does not match the estimated risks for vibration-induced white finger well.

The Control of Vibration at Work Regulations 2005, created under the Health and Safety at Work etc. Act 1974. is the legislation in the UK that governs exposure to vibration and assists with preventing HAVS occurring.

Good practice in industrial health and safety management requires that worker vibration exposure is assessed in terms of acceleration amplitude and duration. Using a tool that vibrates slightly for a long time can be as damaging as using a heavily vibrating tool for a short time. The duration of use of the tool is measured as trigger time, the period when the worker actually has their finger on the trigger to make the tool run, and is typically quoted in hours per day. Vibration amplitude is quoted in metres per second squared, and is measured by an accelerometer on the tool or given by the manufacturer. Amplitudes can vary significantly with tool design, condition and style of use, even for the same type of tool.

In the UK, Health and Safety Executive gives the example of a hammer drill which can vary from 6m/s² to 25m/s². HSE publishes a list of typically observed vibration levels for various tools, and graphs of how long each day a worker can be exposed to particular vibration levels. This makes managing the risk relatively straightforward. Tools are given an Exposure Action Value (EAV, the time which a tool can be used before action needs to be taken to reduce vibration exposure) and an Exposure Limit Value (ELV, the time after which a tool may not be used).

In the United States, the National Institute for Occupational Safety and Health published a similar database where values for sound power and vibrations for commonly found tools from large commercial vendors in the United States were surveyed. Further testing is underway for more and newer tools.

The effect of legislation in various countries on worker vibration limits has been to oblige equipment providers to develop better-designed, better-maintained tools, and for employers to train workers appropriately. It also drives tool designers to innovate to reduce vibration. Some examples are the easily manipulated mechanical arm (EMMA) and the suspension mechanism designed into chainsaws.

People vary in their tendency to get MSDs. Gender is a factor with a higher rate in women than men. Obesity is also a factor, with overweight individuals having a higher risk of some MSDs, specifically lower back.

There is a growing consensus that psychosocial factors are another cause of some MSDs. Some theories for this causal relationship found by many researchers include increased muscle tension, increased blood and fluid pressure, reduction of growth functions, pain sensitivity reduction, pupil dilation, body remaining at heightened state of sensitivity. Although research findings are inconsistent at this stage, some of the workplace stressors found to be associated with MSDs in the workplace include high job demands, low social support, and overall job strain. Researchers have consistently identified causal relationships between job dissatisfaction and MSDs. For example, improving job satisfaction can reduce 17-69 per cent of work-related back disorders and improving job control can reduce 37-84 per cent of work-related wrist disorders.

In most studies, a majority of cell phone users report experiencing occasional phantom vibrations or ringing, with reported rates ranging from 27.4% to 89%. Once every two weeks is a typical frequency for the sensations, though a minority experience them daily. Most people are not seriously bothered by the sensations.

The cause of phantom vibrations is not known. Preliminary research suggests it is related to over-involvement with one's cell phone. Vibrations typically begin occurring after carrying a phone for between one month and one year. It has been suggested that, when anticipating a phone call, the cerebral cortex may misinterpret other sensory input (such as muscle contractions, pressure from clothing, or music) as a phone vibration or ring tone. This may be understood as a human signal detection issue, with potentially significant influences from psychological attributes. Factors such as experiences, expectations, and psychological states influence the threshold for signal detection. Some phantom vibration experiences may be a type of pareidolia and can therefore be examined as a psychological phenomenon influenced by individual variances in personality, condition, and context. Attachment anxiety can also be seen as a predictor for the frequency of phantom vibration experiences since it is associated with psychological attributes related to insecurity in interpersonal relationships.

Dupuytren’s disease has a high recurrence rate, especially when a person has so called Dupuytren’s diathesis. The term diathesis relates to certain features of Dupuytren's disease and indicates an aggressive course of disease.

The presence of all new Dupuytren’s diathesis factors increases the risk of recurrent Dupuytren’s disease by 71% compared with a baseline risk of 23% in people lacking the factors. In another study the prognostic value of diathesis was evaluated. They concluded that presence of diathesis can predict recurrence and extension. A scoring system was made to evaluate the risk of recurrence and extension evaluating the following values: bilateral hand involvement, little finger surgery, early onset of disease, plantar fibrosis, knuckle pads and radial side involvement.

Minimally invasive therapies may precede higher recurrence rates. Recurrence lacks a consensus definition. Furthermore, different standards and measurements follow from the various definitions.

People with diabetes mellitus are at higher risk for any kind of peripheral neuropathy, including ulnar nerve entrapments.

Cubital tunnel syndrome is more common in people who spend long periods of time with their elbows bent, such as when holding a telephone to the head. Flexing the elbow while the arm is pressed against a hard surface, such as leaning against the edge of a table, is a significant risk factor. The use of vibrating tools at work or other causes of repetitive activities increase the risk, including throwing a baseball.

Damage to or deformity of the elbow joint increases the risk of cubital tunnel syndrome. Additionally, people who have other nerve entrapments elsewhere in the arm and shoulder are at higher risk for ulnar nerve entrapment. There is some evidence that soft tissue compression of the nerve pathway in the shoulder by a bra strap over many years can cause symptoms of ulnar neuropathy, especially in very large-breasted women.

The international debate regarding the relationship between CTS and repetitive motion in work is ongoing. The Occupational Safety and Health Administration (OSHA) has adopted rules and regulations regarding cumulative trauma disorders. Occupational risk factors of repetitive tasks, force, posture, and vibration have been cited.

The relationship between work and CTS is controversial; in many locations, workers diagnosed with carpal tunnel syndrome are entitled to time off and compensation.

Some speculate that carpal tunnel syndrome is provoked by repetitive movement and manipulating activities and that the exposure can be cumulative. It has also been stated that symptoms are commonly exacerbated by forceful and repetitive use of the hand and wrists in industrial occupations, but it is unclear as to whether this refers to pain (which may not be due to carpal tunnel syndrome) or the more typical numbness symptoms.

A review of available scientific data by the National Institute for Occupational Safety and Health (NIOSH) indicated that job tasks that involve highly repetitive manual acts or specific wrist postures were associated with incidents of CTS, but causation was not established, and the distinction from work-related arm pains that are not carpal tunnel syndrome was not clear. It has been proposed that repetitive use of the arm can affect the biomechanics of the upper limb or cause damage to tissues. It has also been proposed that postural and spinal assessment along with ergonomic assessments should be included in the overall determination of the condition. Addressing these factors has been found to improve comfort in some studies. A 2010 survey by NIOSH showed that 2/3 of the 5 million carpal tunnel cases in the US that year were related to work. Women have more work-related carpal tunnel syndrome than men.

Speculation that CTS is work-related is based on claims such as CTS being found mostly in the working adult population, though evidence is lacking for this. For instance, in one recent representative series of a consecutive experience, most patients were older and not working. Based on the claimed increased incidence in the workplace, arm use is implicated, but the weight of evidence suggests that this is an inherent, genetic, slowly but inevitably progressive idiopathic peripheral mononeuropathy.

In terms of the prognosis of ulnar neuropathy early decompression of the nerve sees a return to normal ability (function). which should be immediate.Severe cubital tunnel syndrome tends to have a faster recovery process in individuals below the age of 70, as opposed to those above such an age. Finally, revisional surgery for cubital tunnel syndrome does not result well for those individuals over 50 years of age.

Most people relieved of their carpal tunnel symptoms with conservative or surgical management find minimal residual or "nerve damage". Long-term chronic carpal tunnel syndrome (typically seen in the elderly) can result in permanent "nerve damage", i.e. irreversible numbness, muscle wasting, and weakness. Those that undergo a carpal tunnel release are nearly twice as likely as those not having surgery to develop trigger thumb in the months following the procedure.

While outcomes are generally good, certain factors can contribute to poorer results that have little to do with nerves, anatomy, or surgery type. One study showed that mental status parameters or alcohol use yields much poorer overall results of treatment.

Recurrence of carpal tunnel syndrome after successful surgery is rare.

In one study, those with stage 2 of the disease were found to have a slightly increased risk of mortality, especially from cancer.

Most patients diagnosed with cubital tunnel syndrome have advanced disease (atrophy, static numbness, weakness) that might reflect permanent nerve damage that will not recover after surgery. When diagnosed prior to atrophy, weakness or static numbness, the disease can be arrested with treatment. Mild and intermittent symptoms often resolve spontaneously.

Among the causes of ulnar neuropathy are the following-

Much more commonly, ulnar neuropathy is caused by overuse of the triceps muscle and repetitive stress combined with poor ergonomics. Overused and hypertonic triceps muscle causes inflammation in the tendon and adhesions with the connective tissue surrounding that tendon and muscle. These in turn impinge on or trap the ulnar nerve. Ulnar neuropathy resulting from repetitive stress is amenable to massage and can usually be fully reversed without cortisone or surgery.

Center for Occupational and Environmental Neurology , Baltimore, MD has this to say:

“Repetitive Strain Injuries (RSI) refers to many different diagnoses of the neck/shoulder, arm, and wrist/hand area usually associated with work-related ergonomic stressors. Other terms used for Repetitive Strain Injuries are overuse syndrome, musculoskeletal disorders, and cumulative trauma disorders. Some of the more common conditions under these headings include:

Cubital Tunnel Syndrome-compression of the ulnar nerve in the cubital tunnel at the elbow.”

Although not all phantom limbs are painful, people will sometimes feel as if they are gesturing, feel itches, twitch, or even try to pick things up. The missing limb often feels shorter and may feel as if it is in a distorted and painful position. Occasionally, the pain can be made worse by stress, anxiety, and weather changes. Phantom limb pain is usually intermittent. The frequency and intensity of attacks usually declines with time.

Some people who have undergone gender reassignment surgery have reported the sensation of phantom genitals. The reports were less common among post-operative transgender women, but did occur in transgender men. Similarly, subjects who had undergone mastectomy reported experiencing phantom breasts; these reports were substantially less common among post-operative transgender men, but did occur in transgender women.

In tennis players, about 39.7% have reported current or previous problems with their elbow. Less than one quarter (24%) of these athletes under the age of 50 reported that the tennis elbow symptoms were "severe" and "disabling," while 42% were over the age of 50. More women (36%) than men (24%) considered their symptoms severe and disabling. Tennis elbow is more prevalent in individuals over 40, where there is about a four-fold increase among men and two-fold increase among women. Tennis elbow equally affects both sexes and, although men have a marginally higher overall prevalence rate as compared to women, this is not consistent within each age group, nor is it a statistically significant difference.

Playing time is a significant factor in tennis elbow occurrence, with increased incidence with increased playing time being greatery for respondents under 40. Individuals over 40 who played over two hours doubled their chance of injury. Those under 40 increased it 3.5 fold compared to those who played less than two hours per day.

Fremitus is a vibration transmitted through the body. In common medical usage, it usually refers to assessment of the lungs by either the vibration intensity felt on the chest wall ("tactile fremitus") and/or heard by a stethoscope on the chest wall with certain spoken words ("vocal fremitus"), although there are several other types.

When a person speaks, the vocal cords create vibrations ("vocal fremitus") in the tracheobronchial tree and through the lungs and chest wall, where they can be felt ("tactile fremitus"). This is usually assessed with the healthcare provider placing the flat of their palms on the chest wall and then asking a patient to repeat a diphthong such as "blue balloons" or "toys for tots" (the original diphthong used was the German word Neunundneunzig but the translation to the English 'ninety nine' was not a diphthong and thus not as effective in eliciting fremitus). An increase in tactile fremitus indicates denser or inflamed lung tissue, which can be caused by diseases such as pneumonia. A decrease suggests air or fluid in the pleural spaces or a decrease in lung tissue density, which can be caused by diseases such as chronic obstructive pulmonary disease or asthma.

A phantom limb is the sensation that an amputated or missing limb is still attached. Approximately 60 to 80% of individuals with an amputation experience phantom sensations in their amputated limb, and the majority of the sensations are painful. Phantom sensations may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome).

The site and type of brachial plexus injury determine the prognosis. Avulsion and rupture injuries require timely surgical intervention for any chance of recovery. For milder injuries involving buildup of scar tissue and for neurapraxia, the potential for improvement varies, but there is a fair prognosis for spontaneous recovery, with a 90–100% return of function.

In terms of prognosis radial neuropathy is not necessarily permanent, though sometimes there could be partial loss of movement/sensation.Complications may be possible deformity of the hand in some individuals.

If the injury is axonal (the underlying nerve fiber itself is damaged) then full recovery may take months or years ( or could be permanent). EMG and nerve conduction studies are typically performed to diagnose the extent and distribution of the damage, and to help with prognosis for recovery.

Prevention of the condition requires restoration of blood flow after injury and reduction of compartmental pressure on the muscles. Any splints, bandages, or other devices that might be obstructing circulation must be removed. A fasciotomy may be required to reduce pressure in the muscle compartment. If the contracture occurs, surgery to release the fixed tissues may help with the deformity and function of the hand.

Ape hand deformity, also known as simian hand, is a deformity in humans who cannot move the thumb away from the rest of the hand. It is an inability to abduct the thumb. Abduction of the thumb refers to the specific capacity to orient the thumb perpendicularly to the ventral (palmar) surface of the hand. Opposition refers specifically the ability to "swing" the first metacarpal such that the tip of the thumb may touch the distal end of the 5th phalanx and if we put the hand on the table as the palm upward the thumb can not point to the sky. The Ape Hand Deformity is caused by damage to the distal median nerve (also called a Median Claw lesion), and subsequent loss of opponens pollicis muscle function. The name "ape hand deformity" is misleading, as apes have opposable thumbs.

It can occur with an injury of the median nerve either at the elbow or the wrist, impairing the thenar muscles and opponens pollicis muscle.

Ape hand deformity is one aspect of median nerve palsy, which is usually caused by deep injuries to the arm, forearm and wrist area.

Ape hand caused by median and ulnar nerve lesions

One way to prevent this injury from occurring is to be informed and educated about the risks involved in hurting your wrist and hand. If patients do suffer from median nerve palsy, occupational therapy or wearing a splint can help reduce the pain and further damage. Wearing a dynamic splint, which pulls the thumb into opposition, will help prevent an excess in deformity. This splint can also assist in function and help the fingers flex towards the thumb. Stretching and the use of C-splints can also assist in prevention of further damage and deformity. These two methods can help in the degree of movement the thumb can have. While it is impossible to prevent trauma to your arms and wrist, patients can reduce the amount of compression by maintaining proper form during repetitive activities. Furthermore, strengthening and increasing flexibility reduces the risk of nerve compression.

Brachial plexus injury is found in both children and adults, but there is a difference between children and adults with BPI.