Vibration disease: symptoms, treatment and prevention

Vibration disease is an occupational disease that arises from prolonged exposure to the body of a physical phenomenon such as vibration. The basis is the pathophysiological processes in the peripheral and central nervous system. Unfortunately, vibration today often accompanies the production process, despite the new technologies. Machinery and shipbuilding, aircraft manufacturing, metallurgy, construction and mining, road repair work is not conceivable without the use of impact or rotary mechanisms. Therefore, vibrational disease is often found in clinical practice.

But, nevertheless, you can not let the disease into its own right. It is very important to know the symptoms of ailment, especially if you or your loved ones are at risk. Treatment will appoint a doctor, and the prevention, which we will talk about in this article, is available to everyone.

What is vibration. The influence of vibration on the body.

Vibration is a mechanical oscillatory motion with a certain frequency. The most dangerous is vibration with a frequency of 16-200 Hz. By the type of contact with the body of the worker, the vibration happens:

• local: when the place of contact of vibration with the body - hands. Through the hands, vibration is transmitted to the whole body. It is characteristic for those professions where the work is related to the retention of the instrument in the hands (riveters, sharpeners, emery-makers, stumpers, work on machine tools, etc.);
• general: when the vibrations are transmitted to the body through the support (the place where the worker stands or sits). For example, drivers of heavy vehicles, concrete moulders.

The clinical picture depends on the type of vibration involved in the work, as well as the presence of other harmful factors of production, such as noise (often accompanied by vibration), supercooling, forced position body. In addition, quite often in production there is an effect of both local and general vibration.

Vibration constantly irritates the peripheral receptors located on the limbs (arms or legs, according to the type of vibration). Nerve impulses are transmitted to the above located structures of the nervous system - the reticular formation, the sympathetic department of the nervous system. With prolonged exposure to vibration, these structures undergo redistribution, ultimately leading to a disruption in the regulation of vascular tone in the central nervous system. Vascular spasm develops (at first in the places of vibration, and later - generalized, in the whole body). This leads to a violation of microcirculation and blood supply, tissue nutrition, increased blood pressure, which accompanied by changes in the nervous system, cardiovascular system, musculoskeletal apparatus. Further, dystrophic changes in organs and tissues develop. Even if the provoking factor is eliminated (change of job), it is not always possible to completely cure, especially if the process has generalized.

In order for the diagnosis of vibration sickness to be justified, you need a sufficient record of working with the vibration (documented). Usually the first "bells" appear after 3 years, but for a reliable diagnosis, doctors need an experience of at least 5 years.

Symptoms

There are three types of vibration disease:

• effect of local vibration;
• from the effects of general vibration;
• impact of both types of vibration.

According to the severity of the pathological process, it is customary to distinguish 4 stages:

• initial, with minimal manifestations of the disease, which are functional and reversible;
• moderate;
• expressed;
• generalized: recently it is rare, because people change their profession and stop contact with vibration.

In addition, in the clinical picture, the following syndromes are distinguished (can be observed to varying degrees in this or that type of vibration disease):

• angiospastic;
• angiodystonic;
• polyneuropathic;
• polyradicular;
• asthenic;
• vegetative-vestibular;
• diencephalic;
• nonspecific changes from the internal organs (for example, dyskinesia of the intestine).

Vibration disease from local vibration

This form of the disease is found among people working with a manual mechanized tool. Patients complain of aching and pulling pain in the hands, mainly at night and during rest. Pain can be accompanied by the appearance of paresthesias: a feeling of crawling, tingling, numbness. The chilliness of the extremities is characteristic. Pain ceases when resuming work with the vibrating instrument in 10-15 minutes. Periodically, there are attacks of whitening of the fingers of the hands. There is a characteristic feature: the rubbers (choppers) have white fingers on their left hand, and polishes, polishers, and similar workers have both on both. Attacks of whitening can occur both independently and under the influence of cold (washing hands with cold water, general hypothermia).

There is a deterioration in well-being. There is general malaise, headaches without clear localization, poor sleep, dizziness, palpitation, increased irritability.
Vascular disorders are clinically manifested in changes in the color of the skin (hands are pale or purple-cyanotic), changes in blood circulation. Violated the tone of the capillaries, the indices of hemodynamics indicate a change in blood pressure, the minute volume of blood flow. Vascular disorders may masquerade as neurocirculatory dystonia.

Over time, the fingers become edematous, take the form of "drumsticks" - with thickening at the ends; joints are deformed, the volume of movements in them decreases. Trophic disorders are manifested by hyperkeratosis, the pattern on the distal phalanx is smoothed, the nails thicken, become cloudy. Multiple cracks in the palms are often observed. With a far-reaching process, trophic disorders capture and deeper lying tissue: subcutaneous fat, muscles and tendons, which manifests itself in the form of myositis, tendinitis, and tendomyositis. X-ray in the bones are determined foci of osteoporosis, racemose formations. Degenerative-dystrophic changes are found in the spine (mainly in the intervertebral discs) and in the joints.

Coldness of the extremities to the touch is noted, either dry skin of the hands, or excessive sweating is possible.

All these manifestations of angiospastic and angiodystonic syndromes.

Polyneuropathic syndrome is the development of sensitivity disorders. Suffer mainly pain, temperature and vibration sensitivity. Initially, hyperesthesia (increased sensitivity to irritants) is possible, which eventually gives way to hypesthesia (correspondingly, a decrease in this sensitivity). Gradually, the above areas are involved in the process: from the brushes the changes go over to the forearms (on the feet - from the feet to the shins), by the type of "gloves" and "socks". The pronounced stage of vibration sickness from local vibration is accompanied by loss of sensitivity by segment type. Rarely observed and motor disorders in the form of malnutrition (atrophy) of small muscles of the hand: tenar, hypotenar, interosseous muscles.

When the noise is applied to the body, cochlear neuritis develops in addition to vibration. decrease in hearing, which can be detected during audiometry.

Vibration disease from the effects of general vibration

One of the manifestations of vibration sickness is polyneuropathy of the lower extremities.

This variety is found in workers of machine installations, truck drivers. As a rule, the onset of the disease is gradual. Gradually, a variety of complaints appear: headache, fatigue, sleep disturbances, dizziness, nausea, irritability, memory impairment, general malaise, increased sweating, which, of course, nonspecific. Vegetative-vestibular syndrome comes to the fore. Along with this, there are signs of angiodystonic syndrome and sensory polyneuropathy in the lower extremities.

On examination, microsymptomatics is revealed: tremor of eyelids, fingers of elongated arms, anisoreflection (unequal reflexes on the right and left), instability standing with closed eyes and arms outstretched, in the so-called posture Romberg. There are pains in the extremities, coldness and chilliness of the legs, which is associated with spasm of blood vessels. Gradually, changes in biochemical processes in tissues, inflammation with compression of the nerve roots in the spinal cord, also join the manifestations of systemic damage to the peripheral nerves. Developed muscle atrophy. In some cases there is a breakdown in the functions of internal organs, for example, a violation of the secretion of the glands of the digestive system. From the side of the cardiovascular system, pathological changes are also noticeable: blood pressure rises, cardiac rhythm disturbances appear.

With prolonged exposure to general vibration on the body, vasospasm becomes generalized, i.e., captures and the vessels of the whole body. Patients complain of pain in the region of the heart by the type of coronary, signs of chronic disorders of cerebral circulation (more often it is discirculatory encephalopathy, but there may be diencephalic manifestations). In women due to a violation of blood flow in the pelvic organs, menstrual irregularities occur, men have problems with potency.

Vibration disease from both types of vibration

Clinical manifestations are the same as in the conditions described above. Only usually the disease manifests itself a little earlier than itself and progresses somewhat faster, since the harmful effect of vibration on the body is doubled.

Diagnostics

To establish the diagnosis, an important role is played by a professional anamnesis and sanitary and hygienic Characteristics of working conditions, in which the vibration indicators with which it contacts employee. It is mandatory to conduct additional research methods: skin thermometry, capillaroscopy, algesimetry (study of pain sensitivity), and determination of vibration sensitivity. Capillaroscopy reveals salvage-atony of blood vessels, rarely - only spasm or atony.

Informative is the cold test: after measuring the skin temperature, the hands are immersed in cold water (water temperature 8-10 ° C) for 5 minutes. If finger whitening occurs, the sample is considered positive. Then, the skin temperature and the time of its restoration to the initial value are again measured. Normally, the temperature of the skin on the fingers varies from 27 ° C to 31 ° C, and the recovery time is up to 20 minutes.
In addition, methods such as the study of complex electrical resistance of the skin, electromyography, rheography, ECG, polycardiography, electroencephalography, audiometry, joint radiography, study organs of the digestive tract. X-ray patterns show the growth of tuberosity of nail phalanges, thickening of diaphysis and compact substances of tubular bones, thickening of trabeculae of spongy substance, metaepiphysis of phalanges, metacarpal and metatarsal bones.

The data of all additional methods of research are taken into account in conjunction with the clinical picture, only then the diagnosis becomes true, verified.

Treatment

A patient with a diagnosis of "Vibration disease" is not allowed to work with vibration, i.e., necessarily re-employment. Also, it becomes contraindicated work associated with hypothermia and significant physical stress, noise.

Treatment of the disease should be comprehensive, includes both medicamental and physiotherapy methods.

Medication Methods

• blockade of impulses in the autonomic nervous system: benzohexonium, pachycarpine, hexamethonium, difacil, aminazine, amisyl, pyrroxane;
• improvement of microcirculation and removal of vascular spasm: trental (pentoxifylline), nicotinic acid, compliance, calcium channel blockers, Cavinton;
• drugs that improve trophism and metabolism: vitamins B and C, ATP, phosphaden, aloe, glutamic acid, riboxin, calcium gluconate;
• antiaggregants (because spasm is accompanied by a violation of the rheological properties of the blood): aspirin, cardiomagnet;
• with cardiovascular symptoms: papaverine, dibazol, mildronate, β-adrenoblockers and other cardiovascular drugs;
• at astheno-vegetative syndrome: sedative (preparations of bromine, valerian, motherwort, adaptol, tranquilar, etc.);
• with pain syndrome: non-steroidal anti-inflammatory drugs (ibuprofen, nimesulide, etc.).

With severe pain syndromes (radicular, reflex), paravertebral segmental or periarticular blockades (novocaine or lidocaine with hydrocortisone, injections of lidase) are widely practiced.

Physiotherapy methods

• electrophoresis with novocaine (5%) or aqueous solution of benzohexonium (2%), hydrocortisone, heparin on the hands, feet or collar zone: the duration of the procedure is 10-15 minutes, the current strength is 10-15 mA;
• UHF on the collar zone for 10 minutes with a course of 10-15 procedures;
• UFR in small and suberitemic doses;
• diadynamic currents;
• mud, paraffin, ozocerite applications;
• hydrogen sulphide, radon, oxygen, nitrogen-thermal baths with a temperature not exceeding 37 ° C;
• chamber galvanic baths with the emulsion of naphthalan oil;
• acupuncture, especially effective in pain and angiospastic syndrome;
• therapeutic gymnastics, massage of hands, feet, collar zone;
• laser therapy.

Prevention

The rational organization of labor plays a special role in the prevention of vibration disease. It is necessary to comply with sanitary and hygienic standards at work, to ensure that the level of vibration does not exceed the remote control. When working with a vibrating tool, recycling is not allowed.

The total operating time when vibration is exposed should not be more than 2/3 of the work shift, with mandatory interruptions. Recommended after work are such preventive measures as dry heat on the area of ​​hands, self-massage for 5-10 minutes, warm baths for hands. Twice a year, it is possible to conduct a preventive course for UFOs. It is desirable to sanatorium and health resort.

When applying for work related to vibration, it is necessary to take into account contraindications (Reynaud's syndrome, obliterating endarteritis, polyneuropathies, etc.). Periodic medical examination is necessary to determine the latent forms and initial symptoms of the disease.

Prevention measures include modernization and technological progress. It is necessary to create and implement new tools and technologies to minimize human contact with vibration.
Compliance with sanitary and hygienic and medical preventive measures can prevent the development of a vibration disease.

Vibration disease can be cured with a timely diagnosis, properly prescribed treatment and hygiene of work. If you ignore the symptoms, the disease can lead to loss of ability to work and disability.