Chronic exposure of hands to vibration is now a well described cause of Raynaud's phenomenon. According to Palmeret al , it is estimated that 220 000 cases of Raynaud's phenomenon are attributable to exposure to vibration in Great Britain.1 These epidemiological data, based on a questionnaire, are considered to be reasonably accurate.2About 4.2 million workers are exposed to hand transmitted vibration but the real impact on health and the economy is unknown.3More precise clinical data are therefore necessary before implementing a large preventive programme.

The hand-arm vibration syndrome encompasses a wide range of disorders as it is responsible for digital blanching and paraesthesias.4 Different vascular problems—such as a pure vasospastic phenomenon, a digital organic microangiopathy, or an occlusive arterial thrombosis—can be found. A diffuse vibration neuropathy with involvement of mechanical skin receptors or carpal tunnel syndrome are also often associated.5 The relation between these neurovascular disorders is not clear but autonomic dysfunction in carpal tunnel syndrome can induce a Raynaud's phenomenon which is curable with surgery.6 The prognosis of these neurovascular troubles depends on the underlying problem and cannot be evaluated with a simple questionnaire. As …

Dr K T Palmer