What causes a vibration sensation in the hand and how is it treated?

Vibration Sensation in the Hand: Causes and Treatment

A vibration sensation in the hand is most commonly caused by Hand-Arm Vibration Syndrome (HAVS) from occupational exposure to vibrating tools, presenting with paresthesias, tingling, and numbness that may progress to vascular and musculoskeletal complications requiring immediate cessation of vibration exposure and symptomatic management. 1, 2

Pathophysiology and Clinical Presentation

HAVS develops through cumulative vibration exposure causing both vascular and sensorineural damage that progress independently:

• The syndrome encompasses paresthesias or tingling in digits, pain or tenderness in the wrist and hand, digital blanching (Raynaud's phenomenon), cold intolerance, weakness of finger flexors or intrinsic muscles, and potential trophic skin changes 1
• Neurological symptoms can exist without detectable signs, and conversely, neurological changes may be present without numbness or tingling symptoms 3
• The vascular component manifests as well-demarcated finger blanching attacks, with low finger systolic blood pressure following cooling being indicative of vibration-induced white finger 3
• Both Wallerian degeneration and segmental demyelination are possible direct consequences of vibration exposure, along with potential development of entrapment neuropathies like carpal tunnel syndrome 4, 5

Diagnostic Approach

Immediate assessment must include:

• Thorough neuromuscular and skeletal examination evaluating for digital pulses, capillary refill, skin temperature, color changes, and any signs of pale/blue discoloration 6
• Assessment for peripheral neuropathy by specifically asking about numbness and tingling in hands and feet and the characteristics of those symptoms 7
• Plain radiographs (3 views) of the hand as initial imaging to evaluate for fracture, arthritis, or bone abnormalities 6
• Duplex ultrasound if venous obstruction, tenosynovitis, joint effusion, or soft tissue pathology is suspected 6
• Work history documenting vibration exposure duration, intensity, and tool characteristics, as duration needed to produce HAVS cannot be readily defined due to individual susceptibilities and different physical characteristics of vibration exposure 1

Critical differential considerations:

• Polyneuropathy from other causes (diabetes, alcohol, neurotoxic agents, systemic disorders) must be excluded through medical history and appropriate testing 4, 3
• Entrapment neuropathies may coexist or be exacerbated by vibration exposure 4, 5
• Age, smoking, medication, and other ergonomic stressors (repetitive movements, grip forces, non-neutral postures) can contribute to symptoms 3

Treatment Algorithm

Immediate Interventions

Primary management requires complete cessation of vibration exposure:

• Any person found to have developed vibration-induced disorders should not be returned to the same vibration exposure without changes expected to lessen the risks 3
• HAVS can be reversible in earlier stages, but resolution is unusual in severe cases, and continued use of vibrating tools is unwise 1

Pharmacological Management

First-line therapy:

• Apply topical NSAIDs as first-choice pharmacological treatment for pain, given superior safety profile compared to systemic agents 6, 8
• Topical capsaicin may be used as an alternative first-line option 8

Second-line therapy if topical treatments insufficient:

• Prescribe acetaminophen up to 4g daily as first-choice oral analgesic 6, 8, 9
• Oral NSAIDs at the lowest effective dose for the shortest duration if inadequate response to acetaminophen 8, 9
• Provide gastroprotection with proton pump inhibitor in patients with increased gastrointestinal risk taking non-selective NSAIDs 6, 9

For neuropathic symptoms:

• Offer duloxetine for patients with neuropathic pain, numbness, and tingling 7

Non-Pharmacological Interventions

Implement immediately:

• Active, active-assisted, or passive range of motion exercises focusing on gentle stretching and mobilization techniques 9
• Joint protection education concerning ergonomic principles to avoid adverse mechanical factors 8, 9
• Local heat application (paraffin wax or hot packs) before exercise sessions 8, 9
• Physical activity programs for both pain and neuropathy management 7, 8

Adjunctive measures:

• Splints or orthoses for thumb base involvement or lateral angulation deformities 8, 9
• Referral to physical therapy or occupational therapy for structured rehabilitation 7
• Acupuncture may be offered as an additional intervention option 7

Monitoring and Prognosis

Follow-up strategy:

• Reassess within 48-72 hours to evaluate response to initial management and ensure no progression of symptoms 6
• Schedule formal evaluation at 6 weeks if symptoms persist 6
• Adapt long-term follow-up to individual patient needs based on response to treatment 6, 8

Prognostic considerations:

• HAVS is chronic and progressive; early recognition and prevention is key to managing exposures and health effects 2
• The cumulative effect of vibration affects both vascular and sensorineural components, which occur and progress independently 1
• Lifetime vibration dose correlates with disease severity, with doses as low as 1.5 × 10⁹(m²/s⁴)hd associated with multiple comorbidities 5

Critical Pitfalls to Avoid

• Do not recommend pulsed vibration therapy, which is conditionally recommended against for treatment 7
• Do not use TENS, which is strongly recommended against due to lack of benefit 7
• Avoid returning patients to vibration exposure without workplace modifications, as this will lead to progression of irreversible damage 3, 2
• Do not overlook coexisting conditions (carpal tunnel syndrome, tendonitis, Raynaud's phenomenon) that commonly present together in HAVS 5