Vibration sickness

Vibration disease is an occupational disease, the characteristics and symptoms of which are polymorphic.

Vibration manifests itself in oscillatory movements occurring with a certain rhythm and causes its perception by a person through direct contact. Vibration encountered in production can be general or have a local, local character.

Epidemiology

Since there are many areas of human work activity associated with the use of specific tools, machines and equipment, during the operation of which vibration occurs, there is accordingly a certain risk group, which includes workers who may develop vibration disease.

Vibration is associated primarily with the use of pneumatic power tools by drillers, riveters, chippers, polishers, grinders, etc. The effects of vibration are experienced by people using jackhammers, perforators, etc. in their daily work. In such cases, local vibration occurs. The human body is exposed to general vibration in drivers of motor vehicles, as well as at construction sites, when on special platforms for vibratory compaction of concrete.

It should be noted that, despite the fact that even if the profession is associated only with local vibration exposure, other parts of the body are in any case involved in the shaking, in addition to the directly involved limbs.

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Causes vibration sickness

Vibration disease is caused by prolonged, 3 to 5 years long, regular vibration exposure to the human body.

The development of the disease occurs as a result of chronic microtraumatization of both perivascular plexuses and peripheral vegetative formations, leading to disturbances in tissue trophism and blood supply. The tendency to damage, primarily, the upper extremities is predominantly manifested.

Vibration disease is characterized by disorders of the musculoskeletal system, cardiovascular system and central nervous system.

The skeletal and nervous systems are particularly sensitive to vibration. Thus, local vibration can cause an imbalance in the work of neurohumoral and neuroreflex mechanisms. Due to vibration, which is a strong irritant, there is an adverse effect on the nervous system, including 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, becomes the cause of high blood pressure in particular, and can even cause angiospasm.

The causes of vibration disease are based on a number of etiological factors, the main one being vibration accompanying a large number of various production processes. In addition, the causes of the disease are also hidden in various factors related to the characteristics of physical labor activity. These may take the form of a forced inclined position of the body or static muscle tension of the shoulder girdle and shoulder, increased noise levels in the room, low temperature conditions, etc.

The prerequisites for the development of vibration disease are the disruption of the functioning of the nervous system due to prolonged exposure to an irritating factor in the form of vibration. As a result of prolonged irritation of the mechanoreceptors, the Vater-Pacini corpuscles are subject to deformation, which in turn causes overstimulation of the reticular formation and sympathetic ganglia in the spinal cord in the nervous system.

The causes of vibration disease are also vibration effects on peripheral receptors in the skin of the hands and in the plantar region of the feet. As a result of mechanical vibrations, processes occur in the inner ear causing noise in the auditory receptors.

As a result of low-frequency mechanical vibrations, not higher than 16 Hz, a state of motion sickness may occur. This phenomenon occurs in work related to travel by car.

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Pathogenesis

The pathogenesis of vibration disease is characterized by a pronounced effect of vibration irritant on the sympathoadrenal system. Due to vegetative disorders, an imbalance of gastrointestinal functions occurs, which causes gastrointestinal dyskinesia. As the disease progresses, pathologies of greater severity may develop.

Vibration disease in its pathomorphology has manifestations of the occurrence of destructive changes affecting the Vater-Pacini bodies and the phenomena of receptor encapsulation. In addition, various deformations of neuromuscular receptive functions, disintegration of axial cylinders and demyelination are observed.

Experimental results were obtained indicating changes of a dystrophic nature in the reticular formation of the brainstem, as well as in the cells of the lateral horns of the spinal cord.

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

In the decompensated phase of the disease, a disturbance in mediator metabolism is observed in combination with other biochemical disorders.

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Symptoms vibration sickness

Symptoms of vibration disease are most clearly observed in people with extensive work experience in types of work that involve vibration phenomena.

Frequent complaints include the appearance of dull, aching pains in those limbs that are actively involved in the work process, stiffness and numbness, and increased fatigue of the hands. Such pains usually stop with the end of work and often bother outside of working hours, usually at night. Such symptoms of vibration disease are usually accompanied by a significant decrease in sensitivity in the hands, which significantly reduces the ability to manipulate small objects and to perform activities that require high precision and coordination of movements.

A manifestation of vibration disease is the predisposition of the vessels of the extremities to spasms under the influence of low temperatures, as well as other environmental factors that act as irritants. A strong pallor of the fingers is noted in the cold and with general cooling of the body.

Vibration disease leads to decreased muscle tone and decreased performance, causes disturbances in healthy sleep and leads the nervous system to a state of increased excitability and irritability. Migraines may also occur.

Stages

The stages of vibration disease are each distinguished by their own specific symptoms and the degree of intensity of the disease.

• At stage 1, transient pain symptoms and numbness appear in the fingers. In addition, sensations caused by paresthesia arise.
• Stage 2 is characterized by the fact that the intensity of pain and paresthesia increases, they become more pronounced and persistent. Vascular tone undergoes changes, and obvious disorders of sensory functions appear. The development of vegetative dysfunctions and asthenic manifestations is possible.
• Stage 3 of the disease is characterized by the severity of trophic and vasomotor disorders. At this stage of the disease progression, paresthesia and numbness are observed, and the probability of pain attacks is high. Vasospasm syndrome is clearly revealed - that is, a tendency to whitening of the fingers or the phenomena of peripheral and segmental sensory disorders. A tendency to neuroticism of an asthenic personality appears, hypertensive hyperhidrosis vegetative-vascular dystonia may develop. There is also a possibility of gastrointestinal disorders. According to the results of X-ray studies, changes in bones and joints are observed.
• If the pathological process has reached the 4th stage of vibration disease, this is expressed in the development of generalized organic lesions, one of the manifestations of which may be the emergence of encephalomyelopathy. The severity of sensory and trophic disorders is sharp. The appearance of pain syndrome in the fingers is observed, which is characterized by a persistent nature in the joints. In addition to the peripheral vessels of the hands, coronary and cerebral vessels are subject to angiodystonic crises.

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Forms

The classification of vibration disease in clinical neurology implies the division of this disease into three main forms. The criteria for such division are the extent to which the body is exposed to vibration, i.e., whether it is completely covered by vibration, or only certain individual parts, extremities, are involved in such processes.

Based on this, there is a local vibration disease, which manifests itself as a result of local, local vibration.

Another type of it is characterized by the occurrence of this disease as a result of the action of general vibration on the entire body.

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

The classification of vibration disease is also based on the degree of expression of the pathological process. This factor determines the division of vibration disease into the following 4 degrees of expression.

So, there are:

• Initial
• Moderate
• Expressed
• Generalized stage.

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

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Diagnostics vibration sickness

Diagnosis of vibration disease involves a comprehensive objective examination of the patient and the use of a number of diagnostic measures, including various clinical and physiological methods. The essence of such a comprehensive examination is the need for a clear differentiation of vibration disease from Raynaud's disease, vegetative polyneuritis, myositis, syringomyelia and other diseases not associated with professional etiology. Carrying out diagnostics helps to identify signs indicating the onset of the disease and helps to determine the functional capabilities of the body, which is essential in the case of medical examination.

The process of establishing an accurate diagnosis also involves a close examination of the sanitary and hygienic aspects of the conditions in which work activities are carried out.

Factors that a medical specialist should pay attention to during an examination are the general condition and color of the skin, skin temperature. Actions are taken to determine the pain threshold and the degree of sensitivity to vibration. The cardiovascular, bone-joint and muscular systems are subject to a thorough examination. Polycardiography, capillaroscopy, electromyography, electrotopometry and electroencephalography may be prescribed.

Diagnosis of vibration disease can also be carried out using a method such as a cold test.

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Cold test for vibration disease

The cold test for vibration disease is a diagnostic technique, the application of which occurs as follows.

The hands of the person being diagnosed are exposed to low temperatures in cold water (about 4 degrees Celsius). The duration of this procedure is 3 minutes, after which a visual assessment of the degree of pallor of the fingers is made and the facts of how many phalanges are subject to this phenomenon are recorded. These actions are performed three times.

If no whitening of the fingers is observed, a description is given of how pronounced the hyperemia, marbling and cyanosis of the hands are. In this case, in contrast to a positive assessment of the test, as in the above case, such a result is given a weakly positive assessment.

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

The cold test for vibration disease has its own variation, the test for detecting acrospasm. In order to provoke angiospasm, the patient is required to immerse his hands in ice water for 3-4 minutes. An alternative may be to use a stream of cold tap water for cooling for 5-6 minutes.

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

The result is considered positive when the distal phalanges become pale.

If whitening of two phalanges on one or more fingers is observed, this means a sharply positive result.

Since angiospasm often may not appear in the initial period of development of pathologies caused by vibration exposure, it is impossible to unambiguously state the absence of vibration disease based on a negative result of a cold test.

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Differential diagnosis

Differential diagnostics of vibration disease seems necessary due to the fact that in order to establish an accurate diagnosis it is necessary to separate it from all other diseases associated with non-professional etiology. These are Raynaud's disease, autonomic polyneuropathy, myositis, syringomyelia.

For example, one of the distinctive features of Raynaud's disease is vasospasms, also known as white finger syndrome.

Vascular disorders generally tend to spread throughout all extremities and are not characterized by segmental sensory disturbances.

Myositis is characterized by an acute onset of the disease and its course without the appearance of sensory disorders. They also do not present significant difficulties in treatment.

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

Differential diagnostics of vibration disease is also carried out in order to exclude plexitis and neuritis, which have a different etiology, when establishing a diagnosis. It should be noted that the sensitivity disorders that arise in them are of a different nature than those that occur in the development of vibration pathology. In particular, the appearance of angiospasm does not seem to be unconditional; the presence of certain pain points, etc. is characteristic.

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Treatment vibration sickness

Vibration disease treatment is more effective the earlier it is diagnosed and the earlier the appropriate therapy is prescribed and timely treatment is started. Among the main factors of healing, it should be noted that in the presence of the disease, complete exclusion of vibration effects is required. In addition, it is recommended to avoid hypothermia, and the patient should refrain from activities that require significant physical exertion.

Vibration disease treatment and the choice of therapeutic measures are based on an individual approach, which involves the use of appropriate therapeutic agents determined by the predominance of certain symptoms in each specific case.

If vibration disease is accompanied by neurosensory disorders, treatment is prescribed using drugs with ganglionic blocking properties. They are represented by hexamethonium, difacil, pachycarpine. It is also advisable to use vasodilators - drotaverine, cavinton and nicotinic acid, and drugs of central chronolytic action, such as aminazine and amizil. Microcirculation processes are improved by pentoxifylline and trental.

In cases where vegetative paroxysms occur during vibration disease, medical specialists prescribe the use of pyrroxane.

The course of treatment for 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 vibration disease is the basis for the use of cardiovascular drugs, validol, dibazol, papaverine.

The list of treatment measures related to the development of pathologies due to vibration exposure includes general strengthening therapy. Vitamins B1, B6, B12, intravenous infusions of 40% glucose solution, calcium carbonate are prescribed.

Physiotherapeutic procedures such as reflexology, UHF, benzohexonium and novocaine electrophoresis of the hands or collar zone, massage, baths for hands and feet respectively, general baths with nitrogen, oxygen, radon and hydrogen sulfide have a positive effect.

Prevention

Prevention of vibration disease 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 and technical measures aimed at reducing the impact, vibration when using mechanisms and technical means, such as pneumatic tools, vibrating installations, etc.

A preventive measure is to draw up a well-thought-out schedule for distributing working hours, which should include breaks in work every hour and a half. It is better to spend the time for such a short rest on performing a small set of special gymnastic exercises.

Prevention of vibration disease also involves dispensary treatment of workers and the organization of medical and preventive institutions at production facilities.

In order to detect the disease and timely stop the disease at its early stages, an annual medical examination is mandatory for workers who deal with pneumatic tools. The medical commission includes a therapist, a neurologist and an otolaryngologist. In some cases, also a radiologist and a gynecologist.

Another preventive measure is taking vitamin B1 in doses of at least 15 mg per day. Massage will help relieve tension in the hands and reduce the effects of vibration exposure.

Hiring for work related to such working conditions, in which there is a high level of vibration, should be carried out only after a thorough preliminary medical examination. This type of work is a professional contraindication for those who have neuropathological and endocrine diseases, peptic ulcer, hearing loss, polyarthritis, polyneuritis and vestibulopathy, frostbite of the hands.

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Forecast

The prognosis for vibration disease appears to be most favorable with the complete exclusion of the possibility of adverse effects, which is substantiated by the professional contraindications to employment in the relevant job, as established by a special medical commission. Those who, as a result of this, may develop complications of a number of existing diseases that may exhibit increased sensitivity to vibration and obviously classify such a worker as a risk group for developing vibration disease cannot be admitted to work associated with a pronounced vibration factor.

The prognosis of vibration disease is directly dependent on how accurate and timely its diagnosis was and its clear differentiation from other diseases of non-professional etiology. Symptoms of vibration pathology, detected at an early stage of the disease, and immediately prescribed appropriate treatment determine a high probability of complete recovery.

On the other hand, the prognosis is unfavorable if the disease is neglected and its course has taken a more serious form, which is aggravated by the incessant harmful vibration impact. In particularly severe cases, a state of disability may even occur.

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