Vibration disease

1. Vibration disease Doc. R.Bodnar

2. 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.

3. VIBRATION

4. 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.

5. Use of a vibrating tool for road breaking

6. 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).

7. 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.

8. Vibration is usually measured in three orthogonal directions at the interfaces between the body and the vibrating surface

9. According to the character of influence on the organism there is • -local, • -general, • combined vibration.

10. 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.

11. Hand Arm Vibration Syndrome

12. 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).

13. 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 worker’s 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.

14. Pathogenesis of vibration disease. • Complexity of vibration disease’s 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.

15. Classification of vibration disease: • 1.From influence of local vibration. • 2.From influence of “combined” vibration • 3.From influence of general vibration

16. According to the intensity’s 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

17. 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

18. Sensory decrement by the peripheral type

19. 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.

20. 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.

21. 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.

24. 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 system’s 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.

25. Vibration induced gangrene

26. 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.

27. Low Vibration Tools

28. 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.

29. Vascular disorders. More frequent they show up violations of peripheral circulation of blood, change of capillaries’ tone, violations of general hemodynamics.

30. 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".

31. 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”.

32. Atrophy of muscles during vibration diseases

33. Roentgenograms can reveal ossific formations and centers of osteosclerosis. In a spinal column, the changes in intervertebral disks and joints prevail, mainly of degenerative-dystrophic character.

34. 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.

35. Main syndromes of vibration disease: • 2. Angiospastic syndrome - meets at I, ІІ and ІІІ 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.

36. 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)

37. 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.

38. 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.

39. 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.

40. Main syndromes of vibration disease: • 7. Vestibular syndrome - develops at influence of general vibration. It is characterized by dizziness, nystagmus, ataxy, vestibular crises.

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

42. 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.

43. 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.Pile’s 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 hand’s 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.

44. 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.

45. The typical additional signs of vascular disorders • 5. Cold test. The hands of explored are dipped into a cold water (+10°С) 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.

46. Capillaroscope

47. Diagnostic of sensory during vibration disease

48. Diagnostic of sensory during vibration disease

49. 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).

50. 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.