Disclosures: Marilyn Wilburn, MD: No financial relationships or conflicts of interest

Case Diagnosis: A patient developed bilateral upper extremity painful paresthesias from extensive use of power tools.

Case Description: A 58-year-old male factory worker presented with bilateral upper extremity painful paresthesias, worsening over the past 7 years. He also endorsed nocturnal paresthesias and progressive weakness in both hands. He reported exacerbation of symptoms when using large power tools at work. Physical exam showed normal strength and decreased sensation to light touch in all fingertips evenly.

Setting: Outpatient Electrodiagnostic LaboratoryAssessment/

Results: EDX studies demonstrated evidence of a bilateral upper extremity sensory axonal polyneuropathy, without electrodiagnostic evidence of a radiculopathy or isolated mononeuropathy. Ultrasound examination at the wrist revealed a borderline enlarged right median nerve compared with the left median nerve. Given the patient’s clinical history/exam and EDX studies, these results were considered more consistent with a diffuse neuropathic process instead of an entrapment neuropathy at the wrist.

Discussion: This patient’s electrodiagnostic (EDX) results in combination with his clinical history of extensive use of high vibration power tools is consistent with Hand-Arm Vibration Syndrome (HAVS). This syndrome can be reversed in early stages, however, it is unlikely to improve in later stages. If completely stopping use of power tools is not feasible, utilizing vibration-damping techniques (specialty gloves) is advised. Carpal tunnel release has not been shown to be beneficial for HAVS and may even cause worsening of the condition.

Conclusion: This patient presents a case of a unique syndrome that might have been missed if a thorough history and physical exam had not been conducted in addition to the clinical nerve studies. Although sometimes overlooked in a routine EDX study, a focused history and physical exam can be crucial for not only determining an accurate diagnosis but also for providing a patient with appropriate clinical recommendations. Further research is needed into the role of ultrasound for distinguishing HAVS from entrapment mononeuropathies.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-shaken-nerves-a-unique-case-of-hand-arm-vibration-syndrome/