Vibration disease

Doc. R.Bodnar

Vibration disease
Vibration disease is a professional
disease, the main etiological factor of which
is industrial vibration. The favourable
background for the development of the
disease there are the following concomitant
occupational factors of risk: noise, super
cooling, significant muscle tension of
shoulder, forced position of body.

VIBRATION

Usually

vibration disease is met among

the
workers
of
machine
building,
metallurgical, aircraft, shipbuilding, mineral
resource industries, and also in transport and
agriculture. Mainly among those workers,
whose character of work is related with the
long influence of vibration during the use of
hand mechanic tools of percussion action.

Use of a vibrating tool

for road breaking

The vibration
The

vibration is the mechanic

oscillations that repeat periodically
and
are
characterized
by
the
frequency measured in hertz (Hz),
vibrovelocity (m/s) and amplitude
(cm).

Types of vibration

low-frequency (8 15 Hz),
medium-frequency (16 64 Hz),
high-frequency (more than 64 Hz).
Dangerous for the development of disease
is the vibration with the frequency 16
250 Hz.

Vibration is usually measured in three

orthogonal directions at the interfaces
between the body and the vibrating surface

According to the character of

influence on the organism there is
-

local,
- general,
combined vibration.

Local vibration
During

the local vibration the

transmission of mechanic oscillations
to the body is realized through the
arms. Most often this etiologic factor
we can be among the face-workers,
chasers, drillers, tunnellers, polishers,
grinders, wood-cutters.

Hand Arm Vibration

Syndrome

The sources of the general

vibration are
the

vibroplatform, the table vibrator,

the forming and concrete-laying
machines, the floor of weaving-mills,
agricultural
machines
(tractors,
combines),
excavators,
vehicles
(airplanes, helicopters, sea and river
ships).

Combined vibration
The

combined vibration is a combination of local

and general. For its turn, it can be with the
advantage of local influence during the work with
hand tools, when the transmission of vibration on
the workers body is realized not only through the
arms, but also through the legs, thorax, back and
other parts of body, depending on the posture
during the work and the construction of instrument.
In other cases the general influence can prevail, for
example, during the work on vibroplatforms with
simultaneous floating of concrete mix.

Pathogenesis of vibration disease.

Complexity

of
vibration
diseases
pathogenesis is explained by the polymorphy of
clinic manifestations of the affection of
cardiovascular and nervous systems, articular
and motor apparatus and also metabolic
process, in the foundation of development of
which lay the complicated mechanisms of
neurocirculatory, neurohumoral, reflex and
regulatory disorders.

Classification of vibration
disease:
1.

From
vibration.
2.
From
vibration
3.
From
vibration

influence of local
influence of combined
influence of general

According to the intensitys degree of

pathologic process symbolically mark
out 4 stages of disease:
I initial;
II moderately expressed (dystrophic
disorders);
III expressed (irreversible organic
changes);
IV generalized

Clinical syndromes:

1) angiodistonic
2) angiospastic
3) syndrome of vegetative polyneuritis;
4) syndrome of vegetative myofascitis
5) syndrome of somatic neuritis
(cubital, median), plexitis, radiculitis;
6) diencephalic with neurocirculatory
disturbance;
7) vestibular

Sensory decrement by the

peripheral type

Clinical picture
I

stage initial manifestations. This

stage is characterized by the appearance of
the peripheral angiodistonic syndrome or
sensory neuropathy of hands. Patients
complaint to a transient pain and paresthesia.
Disturbance of sensibility mostly is observed
in the area of distal phalanxes. Trophic
disturbances appear. Sometimes can be
acrospasm of fingers that passes quickly. This
stage is functional and difficult for diagnostics.
Capacity for work is not disturbed.

Clinical picture
II

stage moderately expressed

manifestations. Characterized by more stable
pain syndromes, paresthesias and vascular
disturbances. A complaint is increasing. Pains and
paresthesias are longer. It is observed a change of
tone as of the great vessels as of capillaries.
Disturbance of sensibility is more expressed, the
trophic disturbances are increasing, and syndrome
of vegetative-sensory polyneuritis declares itself
together with the dystrophic disturbances of
locomotor system. It becomes difficult for patient
to fulfil his job.

Clinical picture
III

stage

expressed
manifestations. Often attacks of angiospasm.

Disorders of sensibility not only of polyneurotic

character. Sudden reduction, and sometimes
complete fallout of vibration sensibility, expressed
trophic disturbances. The disease is accompanied
by the development of sensomotor polyneuropathy,
encefalopolyneuropathy
with
generalized
acrospasm that changes by paresis of capillaries,
cyanosis of hands. Complications are possible. Ill
persons are disabled.

Clinical picture
IV

stage generalized.

Can be
met seldom, appear during the long progressing of
disease. Pathologic process is characterized by the
generalization of vascular disturbances as a result
of central nervous systems affection, namely of
those sectors that regulate the activity of vascular
system. Such patients have vascular disorders not
only on hands, but also expressed on legs.

Vibration induced gangrene

Clinical picture of vibration

disease from local influence of
vibration
The

vibration disease conditioned by the

local vibration more frequent meets among the
workers with the hand mechanized instruments.
The disease develops gradually, mainly at
workers with large experience of work (10 - 15
years).
A clinical picture is conditioned by
vegetative-vascular, neuromuscular, sensible and
trophic disturbances.

Low Vibration Tools

The most characteristic complaints are:

-sudden

appearance of attacks of albication of fingers

on the hands which arise up at local or general cooling
(symptom of dead fingers),
-dull aching of arms which disturbs patient at night
and in rest,
-often pains are accompanied by paresthesias in the
form of numbness, feeling of formication,
general weakness, headache without clear localization,
dizziness, bad sleep, promoted irritability, there can be
complaints for the pain in the area of heart.

Vascular disorders. More frequent they

show up violations of peripheral circulation of

blood, change of capillaries tone, violations of
general hemodynamics.

There

is violation of sensibility by the

polyneurotic type. At the initial stages of
disease the decline of pain sensitiveness turns
out only on the ends of fingers, with progress of
illness there is the considerable decline of pain,
temperature and vibration sensitiveness as a
"jacket" or "semi jacket".

Trophic

disorders show up hyperkeratosis

on the palms and lateral surfaces of fingers.
Quite often is observed an erasing of picture on
the skin, especially on distal phalanxes. Nails
are thickened, turbid, deformed or polished as
watch crystals.

Atrophy of muscles during

vibration diseases

Roentgenograms

can reveal ossific

formations and centers of osteosclerosis. In a
spinal column, the changes in intervertebral
disks and joints prevail, mainly of degenerativedystrophic character.

Main syndromes of vibration disease:

1. Angiodistonic - it is observed at influence

of high-frequency vibration in initial one and

moderately marked stages. Basic complaints on
pains in hands at night, paresthesias.
Objectively there are insignificant vegetative
vascular disorders (chilling and cyanosis of
hands, hyperesthesia on separate phalanxes.

Main syndromes of vibration disease:

2. Angiospastic syndrome

- meets at I, and stage

of vibration disease at influence of high-frequency and
medium-frequency vibration. For this syndrome the
marked paresthesias and moderate arm aches are typical,
attacks of angiospasm of the type of "white fingers".
Objectively we find the reduction of skin temperature on
hands, the increase of the threshold of vibration sensibility,
disturbance of all types of sensitiveness of the type of
"gloves", spasm of capillaries. The angiospastic reactions
depending on severity of disease can spread on lower
extremities, vessels of heart, cerebrum.

Main syndromes of vibration disease:

3.

The syndrome of vegetative-sensory

polyneuritis arises up at influence of vibration of
different frequencies, meets at moderate and marked
VD. The syndrome is characterized by the intensive
pains and paresthesias in extremities, disturbance of
superficial sensitiveness after a polyneurotic type,
reduction of skin temperature, more expressed
vegetative disorders (chilling, hyperhidrosis, cyanosis
of hands)

Main syndromes of vibration disease:

4.

Syndrome of vegetative myofascitis is

characterized by the combination of vegetative-sensory
polyneuritis with the dystrophic changes in the muscles
of shoulder (fasciculitis, myositis, fibromyositis) and
tendinous apparatus. A syndrome is characterized by
the presence of expressed pains and paresthesias in
hands, by the diminution of strength, by the dystrophic
changes in muscles and other tissues of locomotor
system, by the disorder of sensitiveness after a
polyneurotic and segmental types.

Main syndromes of vibration disease:

5.

Syndrome of somatic nerves lesion

(neuritis, plexitis, radiculitis). Neuritis and
plexitis in pure form at influence of vibration
meet rarely; it is possible to speak about its
combination with other symptoms, typical for
VD, vegetative-sensory polyneuritis, vegetative
myofascitis.

Main syndromes of vibration disease:

6.

Diencephalic with neurocirculatory

disturbances. Cerebral symptoms develop on a
background of peripheral vegetative-vascular
and sensible disturbances, characteristic for VD
of long duration. Cerebral symptoms are
characterized by cerebral vasomotor and
vestibular disturbances, which are developed as
vegetative-vascular crises.

Main syndromes of vibration disease:

7.

Vestibular syndrome - develops at

influence of general vibration. It is
characterized by dizziness, nystagmus, ataxy,
vestibular crises.

Vibration disease from

the influence of general vibration
Syndromes of vibration disease conditioned
by general vibration:
- cerebral-peripheral,
- angiodistonic,
- vegetative-vestibular,
vegetative-sensory polyneuropathy.

Diagnostics of vibration disease

The

diagnosis of vibration disease is

proposed on the basis of the collected
complaints, anamnesis of disease and life, study
of professional route, sanitary and hygienic
description work conditions.

The typical additional

signs of vascular disorders
1.

Symptom of "white spot". You ask a patient to clench firmly

the fist of hand and through 5 sec quickly unclench it. In a norm the
white spots which appeared have to vanish in 5 sec. If spots do not
disappear quickly the test is positive.
2.
Piles symptom. A pulse is found on both radial arteries, and
then by rapid motion lift up the hands of patient. Thus a pulse can vanish
on a few seconds. Such test is positive.
3.
Test on reactive hyperemia. You impose a cuff on a shoulder
and pump a pressure 180 - 200 mm of column of mercury. Then ask to
lift hands up, in 2 min. to put hands down, take cuff off and write down
time of hands reddening. In a norm the reddening begins in 1,5 - 2 sec.
and passes in 15 sec. Lengthening of this time testifies to the spasm of
vessels, and shortening - about their atony.

The typical additional

signs of vascular disorders
4.

Test of Boholyepov. A patient stretches both hands with the

unbended fingers ahead. At that you pay attention on colouring of
skin, state of veins and capillary net of nail bed of fingers. Then a
patient lifts a right hand up, and put down a left on 30 sec. After it,
returns hands in previous position. We look after the change of vein
and capillary circulation of blood. Normally, the changes of blood
filling are normalized in 30 sec. At insufficiency of circulation of
blood, pallor or cyanosis, which arose up disappear slower, than the
more expressed is a disorder of peripheral circulation of blood.

The typical additional

signs of vascular disorders
5.

Cold test. The hands of explored are dipped into a

cold water (+10) on 5 min. At albication of fingers
the test is considered positive. Pay attention on
prevalence and intensity of the process, mark the time
of renewal of skin temperature after cooling. Normally
it does not exceed 20 min. At patients with vibration
disease there is an acute deceleration of renewal of skin
temperature.

Capillaroscope

Diagnostic of sensory during

vibration disease

Diagnostic of sensory during

vibration disease

Medical treatment
During

VD conditioned by the influence of local

vibration, which flows mainly with neurovascular
disorders and pangs, are recommended
the ganglionic blockers (Gexameton,
Benzogexoniy),
small doses of central anticholinergic drugs
(Difacil, Aminazin, Amizil),
and vasorelaxants (Nicotinic acid, No-shpa,
Novocaine).

For

medical treatment of asthenoneurotic syndrome indicate

sedative (valerian, Novopasit) and tonics, and also biogenic
stimulators (aloe, glutamic acid, plazmol, ginseng tincture,
eleuterococ).
For the removal of pain syndrome: Analgin, nonsteroid
antiphlogistics (Ibuprofen, Voltaren, Indometacin, Butadion).
For the improvement of circulation (peripheral, coronal and
cerebral) of blood indicate the medicines which extend coronal
vessels and improve the cerebral circulation of blood: Devincan,
Vincapan, Apresin, Papaverine hydrochloride, Aprofen,
Cinarizin, Piracetam, Cavinton.

For the increase of the tone of parasympathetic nervous

system, reduction of disturbances at vegetative-sensory
polyneuropathy prescribe: Prozerin, Oxazil, Galantamin.

For

the improvement of microcirculation are indicated:

ATF, Parmidin, Riboxin, anabolic hormones - Retabolil,
Nerabol.
With

the purpose of improvement

metabolism prescribe: Unitol, Penicilamid.

of

protein

good effect has application of medicines which normalize

vein tone: Venoruton, vein vasodilators - nitrates (Nitrosorbid,
Nitroglycerine), arterial vasodilators - Apresin, antagonists of
calcium - Nifedipin, Corinfar, Adalat.
From

tonics is effective introduction of 40% s-n of glucose,

calcium gluconate, calcium chloride, preparations of bromine,
coffeine.
Vitamins B1, B12, B6, PP.
Physiotherapy.

Prophylaxis
The

contra-indications to the employment on the

work related with influence of vibration are the
chronic diseases of the peripheral nervous system,
obliterating endarteritis, Raynaud's disease, disease of
locomotor system, marked asthenic states, expressed
vegetative dysfunction, vagopaties with susceptibility to
angiospasms, stenocardia, arterial hypertension of -III
stages, disease of endocrine glands with stable disturbance
(saccharine diabetes), stomach and duodenal ulcer,
neuritis, polyneuritis, stable hearing loss of any aetiology,
otosclerosis, chronic diseases of female breeding organs.

Periodic

medical examinations are realized

not rarer once in 12 months with participation of
internist, neurologist, otolaryngologist. At the
inspection it is necessary to realize
capillaroscopy, measuring of skin temperature,
cold test, to explore a vibration, pain
sensitiveness, if necessary radiography of
hands, spine.