title: Hand-arm vibration syndrome: What family physicians should know.
abstract: OBJECTIVE
  To provide family physicians with an understanding of the epidemiology, pathogenesis, symptoms, diagnosis, and management of hand-arm vibration syndrome (HAVS), an important and common occupational disease in Canada.
  
  
  METHODS
  A MEDLINE search was conducted for research and review articles on HAVS. A Google search was conducted to obtain gray literature relevant to the Canadian context. Additional references were obtained from the articles identified.
  
  
  RESULTS
  Hand-arm vibration syndrome is a prevalent occupational disease affecting workers in multiple industries in which vibrating tools are used. However, it is underdiagnosed in Canada. It has 3 components-vascular, in the form of secondary Raynaud phenomenon; sensorineural; and musculoskeletal. Hand-arm vibration syndrome in its more advanced stages contributes to substantial disability and poor quality of life. Its diagnosis requires careful history taking, in particular occupational history, physical examination, laboratory tests to rule out alternative diagnoses, and referral to an occupational medicine specialist for additional investigations. Management involves reduction of vibration exposure, avoidance of cold conditions, smoking cessation, and medication.
  
  
  CONCLUSIONS
  To ensure timely diagnosis of HAVS and improve prognosis and quality of life, family physicians should be aware of this common occupational disease and be able to elicit the relevant occupational history, refer patients to occupational medicine clinics, and appropriately initiate compensation claims.
authors.affiliation: Resident in the Department of Family and Community Medicine at St Michael's Hospital and in the Public Health and Preventive Medicine Residency Program at the University of Toronto in Ontario. cindy.shen@mail.utoronto.ca.
authors.forename: Shixin Cindy
authors.initials: SC
authors.lastname: Shen
authors.affiliation: Occupational medicine specialist in the Department of Occupational and Environmental Health at St Michael's Hospital and Associate Professor Emeritus in the Department of Occupational and Environmental Health at the University of Toronto.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: House
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D005194:Family Practice; D053421:Hand-Arm Vibration Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D011379:Prognosis; D011928:Raynaud Disease / Q000209:etiology