Hand–arm vibration syndrome (HAVS) is common among lumberjacks, riveters and pneumatic drillers.1 This syndrome encompasses a group of vibration-induced vascular and neurological disorders, which commonly manifest as Raynaud's phenomenon, peripheral neuropathy and muscular weakness.2 However, vibration-induced bone and joint disorders are less common and mild in most cases.3 We recently encountered a patient with multifocal carpal osteonecrosis that was most likely attributable to prolonged vibration exposure.

A 31-year-old construction worker presented with severe right-sided wrist pain for the past 3 weeks. He reported working with pneumatic drills for the past 12 years with an average vibration exposure of 5 h per day for 5 days a week. On physical examination, the range of movement of …