[Focus on the Hand - an Interface Between Surgery and Vascular Medicine]

Damage to the hand caused by vibration has been observed with a range of trades and professions and in connection with various types of sport. Osseous, neurogenic and vascular lesions can lead to chronic ailments and permanent functional impairment. Hand-arm vibration syndrome (HAVS) and hypothenar/thenar hammer syndrome (HHS, THS) are interesting for vascular medicine. From a surgical perspective, there is a special significance in the fact that both syndromes are recognised occupational diseases (BK 2104 and BK 2114) which have to be acknowledged by an accident insurance doctor and in the medical report. Hypothenar/thenar hammer syndrome is caused by repeated force exerted in the region of the small finger or the ball of the thumb and is characterised by a trauma-induced lesion of the ulnar artery or radial artery that can lead to pain due to ischaemia in the acral area supplying blood to the arteries of the affected hand, usually the dominant hand. It is considered to be hand-arm vibration syndrome when there is a heightened sensitivity to coldness with vasospastic circulatory disturbance. The paper presents various clinical and functional diagnostic tests to enable a diagnosis. Doppler and duplex ultrasound exploration play an important role. Various radiological methods can augment diagnostic testing. The symptoms can be treated using medication or physiotherapy to improve perfusion by stimulating vasodilatation. An effective causal therapy is currently not available. Thus, when drawing up the medical report, particular attention should be paid to gathering information about the patient's medical history so that an unequivocal link can be made between the cause of the damage and the physical damage, as this could have sociomedical and pension-relevant consequences for the patient.