In brief
Vibration white finger is the result of damage done over the years to the blood vessels and nerves in the fingers by vibrating hand tools such as breakers, hammer drills and grinders; fingertips turning white in the cold is the typical sign. In the early stage, numbness and tingling after work are seen; if exposure is reduced when these symptoms are noticed, progression can be slowed. The foundations of protection are low-vibration tools, limiting trigger time, warm and dry hands, and health surveillance wherever the action value is exceeded.
What is vibration white finger?
Vibration white finger is a vascular disease in people who work with vibrating hand tools for long periods, showing itself as attacks in which the fingers turn completely white in the cold or in damp weather. During an attack, the finger goes numb and loses sensation; as it warms up, it first turns blue, then red, and hurts. In medical terms, this condition is called secondary Raynaud's phenomenon due to vibration.
White finger is the most visible part of a broader condition. Hand-arm vibration syndrome has three components:
- Vascular component: attacks of whitening triggered by cold.
- Neurological component: numbness and tingling in the fingers, reduced sense of touch and manual dexterity.
- Musculoskeletal component: reduced grip strength, pain in the wrist and elbow.
The list of occupational diseases in Annex 2 of the Regulation on the Determination of Loss of Working Capacity and Loss of Earning Capacity in an Occupation includes, in the physical agents group (E-5), bone and joint damage caused by vibration and angioneurotic diseases, that is, diseases of vascular and nerve origin. We explain the legal framework for vibration exposure and the action and limit values in our article on the vibration regulation; this article focuses on the disease itself and its prevention.
In which jobs is it seen? Breaker and hammer drill vibration
The more strongly a tool vibrates and the longer it is actually used each day, the higher the risk. On a construction site, the most typical source is breaker and hammer drill vibration: breakers and rotary hammers used for breaking concrete, cutting chases and refurbishment work.
| Vibrating hand tool | Typical work | Point to watch |
|---|---|---|
| Breaker | Breaking concrete and asphalt, demolition | Percussive vibration; thresholds are reached in a short time |
| Rotary hammer | Holes for anchors, services and ducts | When drilling into ceilings, arms are raised and tense |
| Angle grinder | Cleaning weld seams, cutting | An unbalanced or worn disc increases vibration |
| Concrete poker vibrator | Placing concrete | Prolonged uninterrupted use |
| Impact wrench | Assembly, tyre and maintenance work | Short but very frequent use |
| Chainsaw | Felling trees, timber | Cold and damp outdoor conditions |
Maintenance staff using breakers and grinders in quarries and crushing and screening plants are also at risk; for the other risks of these plants, see our article on OHS in quarries and crushing and screening plants.
How do vascular and nerve damage develop? The role of cold
Vibration repeated over years causes damage to the walls of the small blood vessels and the nerve endings in the fingers. Damaged blood vessels overreact to cold and constrict; blood stops reaching the finger and an attack of whitening begins. Cold is therefore not the cause of the disease, but it is its strongest trigger. A construction worker starting work in the morning in winter often first notices attacks under these conditions.
Other factors that increase the risk are:
- Wet and cold hands: wet gloves or working in the rain cool the hands quickly.
- Smoking: constricts blood vessels, reducing blood flow to the fingers.
- Tight grip: gripping the tool tightly increases the transmission of vibration to the hand.
- Condition of the tool: blunt bits, unbalanced discs and poorly maintained tools vibrate more.
Internationally, the stage of the disease is defined using the Stockholm scale. The stages for the vascular component are:
| Stage | Description |
|---|---|
| 0 | No attacks |
| 1 (mild) | Occasional attacks affecting only the tips of one or more fingers |
| 2 (moderate) | Occasional attacks affecting the tip and middle segments of one or more fingers, rarely also the base segment |
| 3 (severe) | Frequent attacks affecting all segments of most fingers |
| 4 (very severe) | As stage 3, plus skin changes at the fingertips |
The neurological component is staged separately: it starts with intermittent numbness and tingling, and progresses to persistent numbness and loss of sensation and, at an advanced stage, to reduced tactile discrimination and manual dexterity. In advanced stages, symptoms may persist even after exposure ends; that is why early detection is decisive.
Early symptoms: when should you see a doctor?
Tell workers clearly that they should report the following symptoms to the workplace physician:
- Tingling or numbness in the fingers that does not go away after work.
- Waking at night with numb hands.
- Whitening of one or more fingertips in the cold, followed by turning blue and then red.
- Difficulty with fine tasks such as doing up buttons or holding screws.
- Reduced grip strength when holding a tool or a glass.
When assessing the link between Raynaud's and vibration, the physician also takes into account Raynaud's phenomenon unrelated to vibration, diseases affecting circulation and certain medicines. With numbness that causes waking at night, carpal tunnel syndrome must also be ruled out; our article on carpal tunnel syndrome and occupation covers this subject.
Health surveillance
In practice, health surveillance follows these steps:
- Pre-employment: the physician asks about pre-existing Raynaud's phenomenon, hand and wrist complaints and diseases affecting circulation, and assesses fitness for vibration work accordingly.
- Periodic examination: the symptom questionnaire and hand examination are repeated. The physician decides, according to exposure, which tests, for example cold provocation or sensory threshold tests, are to be carried out and how often. We plan tests with authorised laboratories and health facilities.
- If there are findings: exposure is reduced, the worker is moved to work without vibration if necessary, and other workers doing the same job are also assessed.
- Suspected occupational disease: the physician refers the worker to the relevant health facility; the employer reports to the Social Security Institution (SGK) within 3 working days of learning of the occupational disease. For the process, see our article on the physician's role when an occupational disease is suspected.
You can track examination and test dates with the OHS calendar.
Limiting exposure time: a worked example
Art. 8 of the Vibration Regulation lists measures for the plan to be prepared when the action value is exceeded, such as choosing low-vibration equipment, maintenance programmes, limiting the duration and level of exposure, rest breaks, and clothing that protects against cold and damp. To limit time, you first need to know the trigger time: the time the tool is actually running. On a day when workers say "I was on the breaker all day", the real trigger time is often much shorter; measure it by observation over a few days.
For hand-arm vibration, the daily action value is 2.5 m/s² and the limit value is 5 m/s². The time taken to reach the thresholds with a tool is found using the formula T = 8 × (threshold / tool vibration value)².
Example (with representative values): a refurbishment job needs a total of 3 hours of breaker trigger time per day.
- With a breaker with a vibration value of 15 m/s², the action value is reached in about 13 minutes and the limit value in about 53 minutes. To do 3 hours of work without exceeding the limit value, at least four people need to work in rotation, and all four exceed the action value.
- With a breaker with a vibration value of 7 m/s², the action value is reached in about 61 minutes and the limit value in about 4 hours. When the same job is shared among three people rotating every hour, everyone stays at the action value level.
- Fitting the breaker to a construction machine or using a remote-controlled demolition machine eliminates hand-arm exposure completely.
The example shows that rotation alone is not enough and that the tool or method must be changed first.
Purchasing is also a means of protection. When buying vibrating hand tools, make the vibration value declared in the instructions one of your comparison criteria and prefer models with vibration-damped handles. Because declared values are obtained under laboratory conditions, vibration on site may be higher with a worn bit or hard material; the estimate therefore needs to be verified by measurement. We plan measurements with authorised laboratories. Add bit and disc replacement, checks on handle rubbers and imbalance complaints to the maintenance programme.
Working in the cold and daily measures
The effect of gloves sold as anti-vibration gloves is limited, depending on frequency; their real benefit is keeping the hands warm and dry. For glove selection, see our article on choosing work gloves; for cold weather, see protective clothing for cold and wet weather.
At construction sites and industrial plants in Bursa and the surrounding provinces, we monitor workers exposed to vibration through our health surveillance and workplace physician services. Our approach to the construction sector is on our construction page.
Frequently Asked Questions
Does vibration white finger go away?
If exposure is reduced at an early stage, the progression of symptoms may slow. At advanced stages, symptoms may persist even after exposure ends. That is why a doctor should be consulted without delay when numbness after work and whitening in the cold are noticed.
Is vibration white finger an occupational disease?
The list of occupational diseases includes bone and joint damage caused by vibration and diseases of vascular and nerve origin in the physical agents group. Diagnosis and establishing the link with the occupation are carried out by authorised health facilities.
Do anti-vibration gloves prevent white finger?
Not on their own. The vibration-reducing effect of these gloves is limited. The main measures are low-vibration tools, limiting trigger time and keeping the hands warm and dry.
Can a worker whose fingers have started to turn white continue in the same job?
The workplace physician makes this decision according to the stage of the symptoms and the level of exposure. At an early stage, reducing exposure, shortening trigger time and protecting against cold are often the first steps; if symptoms are progressing, the worker may need to be moved to work without vibration.
How often should users of vibrating hand tools be examined?
Health surveillance is mandatory where exposure exceeds the action value. The workplace physician sets the frequency of examinations and tests according to the level of exposure and the worker's condition.
An exposure-based test plan, pre-employment and periodic examinations, confidential health files and an examination schedule tracked per person.
Bursa SİSTEMER OSGB Technical Team — written from the field experience of our OHS specialists and workplace physicians. Legal information is valid as of the publication/update date; contact us for an assessment specific to your business.