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Air Hammer Operators

  • David J. Gawkrodger
  • Mili Shah
Living reference work entry

Abstract

Air hammer (handheld power tools) operators encounter a variety of irritants as well-recognized contact allergens due to the labor-intensive nature of occupation in industries such as forestry, construction, and, less commonly, the dental professionals.

Laborers are known to develop hand-arm vibration syndrome (HAVS) which is characterized by vascular, neurological, and musculoskeletal symptoms.

Vibrations emitted between 30 and 300 Hz are strongly associated with the development of HAVS.

Numerous other variables influence the development of HAVS, including type of vibration, ambient temperature, and smoking status; hence the latency period varies considerably.

The neurological component of HAVS is significantly debilitating and can interfere in daily activities resulting in a reduced quality of life.

Prevention is the focus of management of HAVS with avoidance of further vibration exposure being crucial.

Keywords

Air hammer operators Hand-arm vibration syndrome Handheld power tools Occupational disease 

1 Core Messages

  • Air hammer (handheld power tools) operators encounter a variety of irritants as well-recognized contact allergens due to the labor-intensive nature of occupation in industries such as forestry, construction, and, less commonly, the dental professionals.

  • Laborers are known to develop hand-arm vibration syndrome (HAVS) which is characterized by vascular, neurological, and musculoskeletal symptoms.

  • Vibrations emitted between 30 and 300 Hz are strongly associated with the development of HAVS.

  • Numerous other variables influence the development of HAVS, including type of vibration, ambient temperature, and smoking status; hence the latency period varies considerably.

  • The neurological component of HAVS is significantly debilitating and can interfere in daily activities resulting in a reduced quality of life.

  • Prevention is the focus of management of HAVS with avoidance of further vibration exposure being crucial.

2 Introduction

Air hammer is an umbrella term which encompasses petrol- or electricity-powered pneumatic vibrating tools, such as jackhammers, drills, saws, grinders, sanders, impact wrenches, riveting, and fettling tools. Operators must wear safety goggles and hard hats and often work on scaffolding around concrete structures. The handles of the air hammers often have black rubber grips (Tables 1 and 2).
Table 1

Irritants

Dust

Heat

Friction and pressure (calluses)

Flying rocks, gravel, and other eye and skin irritants

Ultraviolet (solar) radiation

Moisture

Compressed air

Table 2

Standard allergens

Potassium dichromate, 0.25% pet

Leather gloves, shoes, wet cement, concrete

2-Mercaptobenzothiazole, 1% pet

Rubber grips, hoses, safety goggles

Carba mix, 3% pet

Rubber, as above

Mercapto mix, 1% pet

Rubber, as above

PPD mix (black rubber mix) 0.6% pet

Hard black rubber, grips, handles

Thiuram mix 1% pet

Rubber, gloves

Nickel sulfate 2.5% pet

Tools, handles

Additional allergens

Diethylthiourea, 1% pet

Safety shoes

Poison ivy, oak, sumac, other plants

 

Sunscreen allergens and photoallergens

 

Besides reacting to the irritants and allergens listed above, air hammer operators are at a significant risk of developing hand-arm vibration syndrome, a recognized occupational disease by the International Labour Office (ILO 2002) and the European Economic Commission.

Hand-arm vibration syndrome (HAVS) is a constellation of vascular, neurological, and musculoskeletal components, characterized by symptoms that include Raynaud’s phenomenon, tingling, and/or numbness of the fingers and hands (Chetter et al. 1998). The musculoskeletal component is less well described; upper extremity pain appears to be the most common symptom (Griffin and Bovenzi 2000). However, it is difficult to differentiate the relative contribution of hand-transmitted vibration exposure and ergonomic factors in the causation of musculoskeletal problems (Hagberg 2002).

3 Occupations Affected

HAVS affects workers exposed to a variety of forms of occupational vibration (Table 3). The prominent industries include forestry, stone quarrying and carving, mining and rock drilling, road and construction work, and the foundry, aircraft, shipbuilding, and railway industries (Palmer et al. 2001). Other occupations infrequently mentioned include dentists and dental hygienists, who may get sensory nerve damage related to vibration exposure from dental drills.
Table 3

Vibrating tools and machinery

Tools

Examples

Percussive metal-working tools

Riveting, caulking, chipping, fettling, drilling, impact wrench, metal-cutting tools

Grinders and other rotary tools

Pedestal grinders, handheld grinders, flex-driven grinders and polishers, rotary burring tools

Stone working, mining, road construction

Jackhammers, rock drills, road-breaking tools

Forest, garden, wood-working machinery

Chain saws, electrical screwdrivers, mowers, shears, hedge trimmers, rotary hoes

Other processes and tools

Concrete vibratory pokers, concrete leveling vibrotables, jigsaws, vibratory rollers

4 Epidemiology

Adverse health effects from exposure to hand-transmitted vibration following the use of handheld power tools have been recognized since the 1920s.

It is estimated that almost 1–4% of the working population are exposed to vibrating tools. The prevalence of vascular symptoms of HAVS can be as high as 70%, depending on the type and duration of vibration exposure (Letz et al. 1992). In the high-risk occupations mentioned above, the incidence and prevalence of HAVS can be 90% or more.

According to one national survey, an estimated 1.2 million men and 40,000 women in Britain are exposed to adequate weekly levels of vibration exposure in their workplaces that could lead to HAVS (McDowell et al. 2012; Palmer et al. 2000).

5 Etiology

Almost any vibratory source within the range 4 Hz–5000 Hz can produce HAVS if sufficiently intense with the necessary time exposure ranging from 1 month to 30 years. Vibrations between 30 and 300 Hz are most strongly associated with development of the disorder.

Numerous variables determine whether or not the condition occurs. Hence, low ambient temperature, lower frequencies of vibration, firm gripping of the equipment, and smoking are risk factors. Existing vascular disease and vasoconstrictive medications may be risk factors in some cases (Virokannas et al. 1991; Griffin 1994).

Physical characteristics of exposure that play a role in development of HAVS include the type of vibration (frequency, amplitude, and direction), the vibratory force and impulse type, the cumulative hours of exposure, the state of tool maintenance, and a cold environment. Symptoms typically do not appear until 2000 h of vibration, although the latency period can vary considerably (Friden 2001).

6 Pathophysiology

An understanding of the pathophysiology of HAVS is still evolving and the initial events are not well understood. It is generally agreed that the mechanical stimulus of vibration results in disruption of endothelial cells, with adherence of platelets which stimulates smooth muscle proliferation of the small arteries and arterioles of the digits (Okada 1990). Epineural edema together with the subsequent spasmodic ischemia from the cold-induced vasospasm, mediated by α-2 adrenoreceptors in vessel walls, damages the mechanoreceptor nerve ending and nonmedullated nerve fibers. An increase in fibrous tissue within and around blood vessels also occurs. Subsequently, an irreversible demyelinating neuropathy of the peripheral nerve trunk develops (Takeuchi et al. 1986). A rat model reveals disruption of myelinated axons and loss of nerve endings in the skin (Raju et al. 2011).

7 Symptoms

Following a highly variable latent period, the initial symptom is usually tingling in the hands and aching in the wrists and forearms. This often occurs after using the vibrating tool and resolves within hours. With repetitive and chronic exposure, patients complain of tingling and numbness toward the end of the day, with cessation of symptoms when away from work (e.g., at weekends or while on holiday). Further exposure results in an increase in the severity of the symptoms, which may become permanent (Bovenzi 1990).

Subsequently, the onset of Raynaud’s phenomenon, characterized by episodic cold-induced blanching of the distal aspects of the digit(s), ensues (Cherniack 1990). The affected fingers are those most exposed to vibration, and the extent of involvement increases with cumulative vibration exposure. These attacks can last 20–60 min and are followed by reactive hyperemia, which may be accompanied by painful tingling, especially if there has been rapid rewarming.

Progression of the condition is indicated by reduction in touch sensation, diminution in fine manual dexterity, and muscle weakness in the hands. These neurological symptoms are more debilitating than the intermittent vascular symptoms and can interfere significantly in normal daily activities involving the upper limb (Cederlund et al. 2001) and thus result in a reduced quality of life (Poole and Mason 2005).

Later on, the attacks of pallor wane, but there is persistent dusky cyanosis, swelling, and stiffness of the digits and focal areas of necrosis of the fingertips. When the latent period is short, HAVS tends to be more severe and rapidly progressive.

The toes can be affected, either directly from exposure to a vibrating platform or by reflex sympathetic spasm in subjects with severe hand symptoms (Sakakibara et al. 1991). Reflex sympathetic vasoconstriction may also account for the increased severity of noise-induced hearing loss in HAVS subjects (Palmer et al. 2002).

Regular and prolonged use of handheld vibratory tools or exposure to tasks involving hand grip with heavy forces increases the risk of carpal tunnel syndrome (CTS) by greater than twofold (Palmer et al. 2007). It has been suggested that vibration exposure may damage the median nerve in the carpal tunnel by causing myelin breakdown and interstitial and perineural fibrosis. However, another possibility is nerve entrapment in the carpal tunnel, due to repetitive and forceful wrist movements. It is important to distinguish CTS from HAVS as surgical procedures for CTS do not alleviate HAVS.

Other changes attributed to vibration injury include bony changes, e.g., aseptic necrosis, fatigue fractures and degenerative joint disease, and tendinitis.

8 Diagnosis and Classification

The diagnosis is based on history of vibration exposure prior to symptom development, typically 5–10 years with the exclusion of other causes of Raynaud’s phenomenon (Pelmear 2003). Details of the type, daily duration, and length of vibration exposure are required to calculate total vibration exposure. Information about drug ingestion, alcohol consumption, and smoking history should be recorded together with relevant past medical history. The Disabilities of the Arm, Shoulder, and Hand Work Module questionnaire may help as a screening tool, as subjects with HAVS show high scores, mainly due to pain (House et al. 2012).

The physical examination must include an assessment of the vascular, musculoskeletal, and neurological systems, including blood pressure, light touch, temperature perception, two-point discrimination (often manifesting as inability to handle and distinguish small objects such as coins and buttons), vibration perception threshold (tuning fork), and the exclusion of thoracic outlet syndrome. The severity of the HAVS can be determined by clinical assessment. This is graded using the widely accepted Stockholm Workshop Scale, which is based upon the vascular and sensorineural components of HAVS (Brammer et al. 1987; Gemne et al. 1987).

A variety of tests have been used; however, the most reliable tests are finger systolic blood pressure following cooling to assess vascular abnormalities (Harada and Mahbub 2008), aesthesiometry (Lawson and McGeoch 2003), and the assessment of vibrotactile thresholds (Ye and Griffin 2017) as indicators of sensorineural dysfunction. The measurement of rewarming following cold provocation appears to be specific enough to identify subjects with HAVS (Stankovic et al. 2011). Finger plethysmography and thermography are advocated by some to identify vascular changes (Mahbub and Harada 2011). Others point out that there is insufficient evidence to support the use of measurement of grip or pinch strength to identify the musculoskeletal injuries of HAVS, though the Purdue Pegboard which detects loss of fine manual dexterity may have some diagnostic value (Mason and Poole 2004; Mahbub et al. 2015). Wherever possible, a range of investigations is needed.

9 Prognosis, Treatment, and Prevention

Abstinence from vibration exposure may halt or reverse progression of the vascular symptoms, but this depends on the stage of HAVS, the period of continuing exposure after onset of symptoms, and the age when exposure ceased (Friden 2001). There is little evidence of improvement in the neurological symptoms with time (Mason and Poole 2004). HAVS may result in significant upper limb extremity impairment and disability, with the sensorineural and musculoskeletal components contributing more than the vascular component to this disability (House et al. 2009). A follow-up study conducted at a mean of 8.5 years after diagnosis showed that, although one third of subjects reported improvement in symptoms, two thirds were either stable or had deteriorated with a decline in work ability and in quality of life (Sauni et al. 2015).

Treatment of the condition is difficult. Further vibration exposure should be avoided, which may result in job modification or change in job role. If this is not feasible, frequent work breaks should be allowed. In order to prevent an attack, it is essential for sufferers to keep their core temperature high and avoid exposure to cold. Smoking cessation is highly recommended, given the vasoconstrictive effects of cigarette smoking and the finding that consumption of tobacco products additionally worsened postural tremor (Bast-Pettersen et al. 2017).

Calcium channel antagonists such as nifedipine can help with vascular symptoms. Drugs such as pentoxifylline, moxisylyte, and some prostanoids may also be useful. Iloprost infusions have been reported to be promising in advanced disease (Meloni et al. 2004). Splinting at night may help to treat the neuropathies. Surgical intervention, e.g., sympathectomy, is neither successful nor warranted (Piligian et al. 2000).

Preventative measures and surveillance of at-risk workers in the workplace are extremely important. Vibration exposure may be controlled by the use of ergonomic tools, anti-vibration padding and gloves, vibration-dampening techniques, job rotations, and scheduled rest periods (Friden 2001). Anti-vibration gloves have some advocates who claim a 10% reduction in vibration for some tools (Welcome et al. 2016), though the Health and Safety Executive in the UK and the National Institute for Occupational Safety and Health in the USA regard gloves as unreliable as devices to control hand-transmitted vibration (Hewitt et al. 2015). Furthermore, anti-vibration gloves may reduce manual dexterity though in cold conditions, gloves to maintain warmth are advisable (Health and Safety Executive 2017).

Workers should be informed of the hazards of their occupation, encouraged to avoid smoking, and undergo regular medical surveillance. It is best for those at risk to avoid vasoconstrictive medications, e.g., β-blockers.

Evidence-based limits of vibration exposure have been established, and a legal obligation has been placed on employers to assess and identify measures to eliminate or reduce risks from exposure to hand-arm vibration and that information, training, and health surveillance are provided (Health and Safety Executive 2005).

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Oncology and Human MetabolismUniversity of Sheffield Medical SchoolSheffieldUK
  2. 2.Department of DermatologyRoyal Liverpool HospitalLiverpoolUK

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