Vibration disease

Vibration disease is a professional disease whose characteristics and symptoms are characterized by polymorphism.

Vibration is manifested in vibrational movements that occur with a certain rhythm, and causes the perception of it by a person through direct contact. Vibration occurring in production can be general or local, local in nature.

Epidemiology

Since there are many areas of human labor associated with the use of specific tools, machines and machines that are subject to vibration, respectively, there is a certain risk group, which includes workers who can develop a vibrational disease.

With vibration, the use, above all, of pneumatic power tools by drillers, riveters, choppers, polishers, grinders, etc., is associated with vibration. People are exposed to vibration using hammers, perforators and so on. In such cases, local vibration occurs. The human body is subjected to a general vibration in the drivers of motor vehicles, as well as on construction sites, when they are located on special platforms for vibration compacting of concrete.

It should be noted that, although even if the profession is only associated with a local vibration, shocks in any case involve other parts of the body in addition to the directly involved limbs.

[1], [2], [3], [4], [5],

Causes of the vibration disease

Vibration disease has as its prerequisites a continuous, duration of 3 to 5 years, a regular vibration effect on the human body.

The development of the disease occurs as a result of the fact that there is a chronic microtraumatism and perivascular plexuses and peripheral vegetative formations, leading to disturbances in tissue trophism and blood supply. The predominant tendency is to defeat, above all the upper limbs.

Vibration disease is characterized by impaired activity of the musculoskeletal system, cardiovascular system and CNS.

In particular, bone and nervous systems are sensitive to vibration. So local vibration can cause imbalance in the work of neurohumoral and neural-reflex mechanisms. Due to vibration, which is a strong stimulus, there is an adverse effect on the nervous system, including on the nerve trunks, as well as on the skin receptor apparatus.

In addition, the disease leads to disruption of the functioning of many other tissues and organs, causes in particular increased blood pressure and can even cause angiospasm.

The causes of the vibration disease are justified by a number of etiological factors, the main one of which is vibration accompanying a large number of various production processes. In addition, the causes of the disease also lie in various factors related to the characteristics of physical labor activity. These can take place in the form of forced oblique position of the body or static muscular tension of the shoulder belt and shoulder, an increased level of noisy room, low temperature conditions, etc.

The prerequisites for the development of a vibrational disease consist in the disruption of the functioning of the nervous system as a result of prolonged exposure to it of an irritating factor in the form of vibration. At the same time, as a result of prolonged stimulation of the mechanoreceptors, deformation of the Fatera-Pacini body undergoes, which in turn causes the reticular formation and sympathetic ganglia in the spinal cord to re-irritate in the nervous system.

The causes of the vibration sickness are also the vibrational effects on the peripheral receptors in the skin of the hands and in the plantar area of the feet. Due to mechanical oscillations, processes in the inner ear cause noise in the auditory receptors.

As a result of low-frequency mechanical oscillations, no higher than 16 Hz, there may be a state of motion sickness. This phenomenon takes place in the work related to travel on vehicles.

[6], [7]

Pathogenesis

The pathogenesis of the vibrational disease is characterized by a pronounced effect of the vibrational stimulus on the sympathoadrenaline system. Due to vegetative disorders, imbalance of gastrointestinal functions occurs, which causes gastrointestinal dyskinesia. As the disease progresses, pathologies of greater severity can develop.

Vibration disease in its pathomorphology has manifestations of the emergence of destructive changes affecting the Fater-Pacini body and the phenomenon of encapsulation of receptors. In addition, there are various deformations of neuromuscular receptive functions, decay of axial cylinders and demyelination.

Experimental results were obtained that indicate changes in the dystrophic character in the reticular formation of the brainstem, as well as in the cells of the lateral horns of the spinal cord.

The pathogenesis of the vibration disease is characterized by the appearance of dystrophic changes, which also affect the skin, bone and muscle systems. The receptors of large joints in the humeral girdle are most affected, which causes persistent pain in them.

In the decompensated phase of the disease there is a disturbance of the mediator exchange in combination with other biochemical disorders.

[8], [9], [10], [11], [12], [13]

Symptoms of the vibration disease

Symptoms of vibration sickness are most pronounced in people who have a long record of work in those types of work that are associated with the phenomena of vibration.

Frequent complaints about the appearance of stupid aching pain in those limbs that are actively involved in the work process, on stiffness and numbness, increased fatigue of the hands. Such pains mostly cease with the end of work and are often disturbing during non-working hours, usually at night. Such symptoms of vibration sickness are usually accompanied by a significant decrease in sensitivity in the hands, which greatly reduces the ability to manipulate objects of small dimensions and to activities requiring high accuracy and coordination of movements.

The manifestation of vibration sickness is predisposition of the vessels of the extremities to spasms under the influence of low temperature, as well as other environmental factors acting as irritants. There is a strong paleness of the fingers in the frost and with a general cooling of the body.

Vibration disease leads to a decrease in muscle tone and worsening of working capacity, causes disturbances in healthy sleep and leads the nervous system into a state of increased excitability and irritability. Migraines can also occur.

Stages

The stages of the vibration disease differ in each of their specific symptoms and the degree of intensity of the disease.

• At the 1 st stage there is an appearance in the fingers of the hands of transient pain symptoms and numbness. In addition, there are sensations caused by paresthesia.
• The second stage is characterized by the intensification of pain and paresthesia, they become more pronounced and persistent. The vascular tone undergoes changes, and obvious disorders of sensitive functions appear. Possible development of autonomic dysfunction and asthenic manifestations.
• The third stage of the disease is characterized by the severity of trophic and vasomotor disorders. At this stage of the progress of the disease there is paresthesia and numbness, the likelihood of pain attacks is high. Clearly, the syndrome of vasospasm - that is, the tendency to whiten fingers or the phenomenon of peripheral and segmental sensory disorders. There is a tendency to neurotic personality asthenic character, hypertensive hyperhidrosis vegetative-vascular dystonia may develop. There is also the possibility of gastrointestinal disorders. According to the results of X-ray studies, changes in bones and joints are observed.
• If the pathological process came to the 4th stage of the vibration disease, it manifests itself in the development of generalized organic lesions, one of the manifestations of which can be the emergence of encephalomyelopathy. The severity of sensitive and trophic disorders is severe. There is an appearance in the fingers of the pain syndrome, differing in the joints by the persistent character. In addition to the peripheral vessels of the hands, angiodystonic crises undergo coronary, as well as vessels in the brain area.

[14], [15], [16]

Forms

Classification of vibration sickness in clinical neurology implies the isolation of the disease in its three main forms. The criteria for such a separation is the extent to which the organism is exposed to vibratory action, that is, whether it is covered by vibration all, or in such processes only those or other parts of it, limbs are involved.

Based on this, there is a local vibration disease, manifested due to local, local vibration.

Another of its kind is characterized by the appearance of this disease as a result of the action of a general vibration on the whole organism.

The third, combined form of the vibration disease arises from the combination of the two above-mentioned, local and general, varieties of the disease.

Classification of the vibration sickness is also made on the basis of the severity of the pathological process. This factor causes the division of the vibration disease according to the following 4 degrees of severity.

So, there are:

• Initial
• Moderate
• Expressive
• Generalized stage.

It should be noted that the occurrence of generalized vibration sickness is observed in extremely rare cases.

[17], [18], [19]

Diagnostics of the vibration disease

Diagnosis of the vibration disease involves a comprehensive objective examination of the patient and the use of a number of diagnostic measures that include a variety of clinical and physiological techniques. The essence of such a comprehensive survey is the need for a clear differentiation of the vibration disease from Raynaud's disease, vegetative polyneuritis, myositis, syringomyelia and other diseases not associated with professional etiology. The diagnosis makes it possible to identify signs that indicate the onset of the disease, and help determine the functional capabilities of the body, which is essential in the case of medical examination.

The process of establishing an accurate diagnosis also provides for a close examination of the sanitary and hygienic aspects of the conditions in which work is performed.

Factors that the medical specialist should pay attention to when examining are the general condition and color of the skin, skin temperature. Actions necessary to determine the pain threshold and the degree of sensitivity to vibration are performed. A cardiovascular, osteoarticular and muscular system is subjected to a thorough examination. Possible appointment of polycardiography, capillaroscopy, electromyography, electrotopometry and electroencephalography.

Diagnosis of vibration sickness can also be carried out by a method such as a cold sample.

[20], [21], [22], [23], [24]

Cold sample in vibration disease

A cold sample in a vibration disease is a diagnostic technique, the application of which occurs as follows.

The hands of the person being diagnosed are exposed to a lower temperature in the cold water (about 4 degrees Celsius). The duration of such a procedure is equal to 3 minutes, after which a visual assessment of the degree of paleness of the fingers is made and the facts of how many phalanges are exposed to this phenomenon are recorded. These actions are carried out three times.

If finger whitening is not observed, a description is given of how pronounced is the appearance of hyperemia, marbling and cyanosis of the hands. In this case, unlike the positive evaluation of the sample, as in the above case, this result is given a weakly positive estimate.

The most dramatic positive reaction is the fact that Raynaud's syndrome appears as a result of the test.

A cold sample in a vibration disease has such a variety as a test for the detection of acrospasms. In order to provoke angiospasm, the patient is required to immerse his hands in water with ice for a time equal to 3-4 minutes. Alternatively, it can be used to cool a tap of cold tap water for 5-6 minutes.

A weakly positive result of such a test is manifested in the appearance of whitened areas on the palms and fingers.

The result is considered positive when the phalanges become pale.

In the case of whitening of two phalanges on one or several fingers, this means a sharply positive result.

Since in the initial period of development of pathologies caused by vibration, angiospasm may often not appear, on the basis of a negative result of a cold sample, it is impossible to state unequivocally the absence of a vibrational disease.

[25], [26], [27], [28], [29],

Differential diagnosis

Differential diagnosis of the vibration disease is necessary due to the fact that in order to establish an accurate diagnosis it is necessary to separate it from all other diseases that have a connection with the unprofessional etiology. These are Raynaud's disease, autonomic polyneuropathy, myositis, and syringomyelia.

For example, one of the hallmarks of Raynaud's disease is the angiospasm known as the white finger syndrome.

Violations of the vascular nature mainly tend to spread across all limbs, and they are not characterized by segmental sensitivity disorders.

Myositis is characterized by an acute onset of the disease and its course without the appearance of sensitive disorders. Also, they do not represent significant complications in treatment.

Syringomyelia is characterized by signs of pronounced disorders of the musculoskeletal system, it is also accompanied by bulbar disorders, arthropathies and gross muscular atrophy.

Differential diagnosis of vibration sickness is also carried out with the purpose of excluding plexitis and neuritis, which differ in their etiology, in the diagnosis. It should be noted that the nature of sensitivity disorders that arise in them is inherent in a different nature than in the development of vibrational pathology. In particular, the appearance of angiospasm does not seem to be unconditional, the presence of certain pain points, etc.,

[30], [31], [32], [33], [34], [35]

Treatment of the vibration disease

Vibration disease treatment is to that extent more effective than at an earlier stage it is diagnosed and the earlier the corresponding therapy is prescribed and timely treatment is started. Among the most important factors of healing, it should be emphasized that in the presence of the disease, a complete elimination of vibration effects is required. In addition, it is recommended not to allow hypothermia of the body, and the patient should refrain from activities that require significant physical exertion.

Vibration disease treatment and the choice of therapeutic measures is based on an individual approach, which involves the use of appropriate medications due to the prevalence of certain symptoms in each case.

If the vibration disease is accompanied by the phenomena of neurosensory disorders, treatment is prescribed with the use of drugs that have ganglion-blocking properties. They are represented by hexamethonium, difacil, pachycarpine. It is also advisable to use vasodilators-drotaverina, cavinton and nicotinic acid, and central chronolitic agents, such as aminazine and amisil. Microcirculation processes are improved due to pentoxifylline and trental.

In the case when vegetative paroxysms occur during the vibration illness, the medical specialists prescribe the use of pyrroxane.

The course of treatment of this disease, the course of which is accompanied by the development of astheno-neurotic syndrome, involves the inclusion of biogenic stimulants - aloe, glutamic acid, and drugs that have a sedative effect.

Cardiovascular syndrome present together with the vibration disease is the justification for the use of cardiovascular drugs, validol, dibazol, papaverine.

In the list of therapeutic measures associated with the development of pathologies due to vibration effects, general restorative therapy is included. Prescribed vitamins B1, B6, B12, intravenous infusions of 40 percent glucose solution, calcium carbonate.

Positive effect is provided by physiotherapeutic procedures such as reflexotherapy, UHF, benzohexonium and novocain electrophoresis of brushes or collar zone, massage, baths for hands and feet respectively, common baths with nitrogen, oxygen, radon and hydrogen sulfide.

Prevention

Prevention of vibration sickness is reduced to a certain number of measures aimed at reducing negative production factors associated with the impact of vibration on the body. In this regard, it is prescribed to carry out appropriate sanitary measures aimed at reducing the impact, vibration with the use of mechanisms and technical means, such as pneumatic tools, vibrating installations, etc.

A preventive measure is the preparation of a well thought-out schedule for the distribution of working hours, which should be provided for breaks in work every half hour. Time for such a short rest is better spent on performing a small complex of special gymnastic exercises.

Prevention of vibration sickness also involves dispensary treatment of workers and organization in the production of treatment and prevention facilities.

To diagnose the disease and timely arrest of the disease in its early stages, an annual medical examination is mandatory for workers dealing with pneumatic tools. The medical examination includes a therapist, a neuropathologist and an otolaryngologist. In some cases, also a radiologist and gynecologist.

Another method of prevention is the intake of vitamin B1 in doses of at least 15 mg per day. Relieve stress in the hands and reduce the effects of vibrating effects will help massage.

The recruitment associated with such working conditions, in which there is a high level of vibration, should only be carried out after a thorough preliminary medical examination. The professional contraindication of this type of work is for those who have neuropathological and endocrine diseases, peptic ulcer, hearing damage, polyarthritis, polyneuritis and vestibulopathy, and suffered from frostbite.

[36], [37], [38], [39], [40]

Forecast

The prognosis of the vibration sickness is most favorable with the complete exclusion of the possibility of adverse effects, which is justified by the professional contraindications established by the special medical commission for admission to the relevant work. They can not tolerate the work associated with a pronounced vibration factor, those who as a result of this may experience complications of a number of existing diseases, which may show increased sensitivity to vibration and knowingly attribute such an employee to a group at risk of developing a vibrational disease.

The prognosis of the vibration disease is directly dependent on how accurate and timely its diagnosis and clear differentiation from other diseases of unprofessional etiology. The symptomatology of the vibration pathology, revealed at an early stage of the disease, and immediately prescribed appropriate treatment causes a high probability of complete cure.

On the other hand, the prognosis is unfavorable if the disease is triggered and its course has taken a more serious form, which is exacerbated by the continuing disastrous vibration effect. In particularly difficult cases, even a disability condition may occur.

[41], [42], [43], [44], [45]