Vibration white finger (VWF) occurs in workers who use vibrating tools. On exposure to vibration or cold, patients experience blanching, numbness and pain in the fingers due to exaggerated vasoconstriction. This may involve both central sympathetic hyper-reactivity and local vasoactive factors. In advanced cases, hypertrophy of vascular smooth muscle causes arterial occlusion and ulceration. Diagnostic tests for VWF are unreliable. In early cases, cessation of vibration exposure arrests the progression of disease and may cause symptom remission. Patients with VWF should keep themselves warm, especially their hands, which they should place in warm water at intervals during the day; they should not smoke. Vasoactive drugs may be beneficial in some patients. In the UK, Industrial Injuries Disablement Benefit and compensation are sometimes available. Improved design of tools and restrictions on their operating time have been the main factors leading to a worldwide decline in the incidence of VWF since the early 1970s.