Improving hand sensibility in vibration induced neuropathy: A case-series

All participants had sensory hand problems in terms of numbness (median touch thresholds > 70 mg) and impaired hand function influencing ADL (mean DASH score 22).After an initial identical self-administered treatment period of 8 weeks (12-15 treatments with increasing intervals) they did one treatment every 2-3 month.After one year sensibility (touch thresholds and tactile discrimination) as well as hand function (mean DASH score 13) were improved in a majority of the cases. Seven of the participants choose to continue the treatment after the first year and two of them have continued at a regular basis for up to four years. A surprising, secondary finding was diminishing nocturnal numbness of the hand and arm in eight of the nine subjects from "frequently" to "hardly ever or never".Our observations open new perspectives for treatment of impaired sensibility and hand function in a group of patients with vibration induced hand problems where we have no treatment to offer today.The use of handheld vibrating tools is common in many occupations where low- as well as high frequency vibrating tools is used. However, long-term use of vibrating tools constitutes an occupational health risk, and various neurological and vasospastic symptoms are common, for example sensory disturbances, pain, intolerance to cold, reduced grip strength, and reduced tactile dexterity with fumbling [1-4]. Hand function may be severely impaired over the years and may affect the ability to work and quality of life [5-7]. In the long term perspective vibration exposure can lead to hand-arm-vibration syndrome, a complex condition with sensory and musculoskeletal as well as vascular symptoms [4]. Vibration-induced neuropathy is sometimes combined with carpal tunnel syndrome, and it is often difficult to differentiate between them [8,9]. Apart from ergonomic measures there is, at present, no effective treatment for the neuropathy.Peripheral nerve injury and neuropathy result in changes in the central n