Hand-arm vibration syndrome

Use of vibrating tools often leads to development of hand-arm vibration syndrome. It manifests with vascular symptoms, neurologic (carpal tunnel syndrome) and musculoskeletal symptoms (impaired grip strength, osteoarthritis, bone necrosis). Kienböck's disease is osteonecrosis of the lunate. A 61-year-old construction worker was referred to a rheumatologist because of suspected arthritis. On examination tenderness and swelling of the dorsal aspect of the right wrist were recorded without features of inflammation. The patient reported paresthesia in the right hand when working with a pneumatic drill. He reported no morning stiffness or Raynaud's phenomenon. He had undergone surgery because of right carpal tunnel syndrome two years earlier. Rheumatoid factor was negative, CRP 0.2 mg/l, uric acid 4.7 mg/dl. In magnetic resonance avascular necrosis of the lunate was diagnosed and scaphoid fracture. Kienböck's disease was diagnosed. Non-steroidal anti-inflammatory drugs were used. The patient did not give consent for surgery.