Occupational disease vibration disease. Preclinical evidence of vibration effects on the hands
Currently, vibration disease is one of the most common forms of occupational pathology, which is largely due to the widespread introduction of mechanized tools and equipment that generate vibration during operation.
Vibration is a type of mechanical vibration. Mechanical vibrations also include infrasound, noise, and ultrasound. Vibration encountered in industrial environments is complex nature and is obtained by adding several periodic oscillatory movements.
According to the method of transmission to humans, they are distinguished:
General vibration transmitted through supporting surfaces to the body of a sitting or standing person.
Local vibration transmitted through human hands.
Numerous experimental and clinical studies by domestic and foreign scientists have established that under the influence of vibration, various pathological abnormalities develop in the human body, up to the development of vibration disease.
It has been proven that this is a disease of the whole body that occurs as a result of exposure to vibration and is characterized by polysyndrome clinical manifestations. Vibration pathology occurs with damage to the nervous and musculoskeletal system, with reflex disorders of internal organs. Its development is based on complex mechanisms of neurohumoral, neurohormonal, reflex and regulatory disorders.
Being a strong irritant, vibration is perceived by the receptor apparatus at the point of application, damaging both superficial and deep conductors, including vibration sensitivity. Long-term stimulation of peripheral receptors leads to the appearance of stagnant foci of excitation in the subcortical formations, the development of a parabiotic state in the neurons of the spinal centers and the centers of the medulla oblongata. Various autonomic disorders nervous system in case of vibration disease, they are currently considered as a consequence of a violation of cortical-subcortical relationships, an increase in the tone of the reticular formation of the trunk. Vibration pathology is accompanied by damage to adaptive-trophic and neurohumoral regulation mainly from the sympathetic part of the autonomic nervous system. One of the first pathogenetic mechanisms of VD is an increase in venous resistance and disruption venous outflow with the further development of peripheral angiodystonic syndrome. When exposed to vibration, microcirculation and transcapillary exchange change. In the formation of neurovascular disorders, the role of disturbances in the reactivity of adrenergic receptors and biological membranes of smooth muscle cells of peripheral vessels has been established.
Under the influence of vibration, the production of physiologically active substances (histamine, prostaglandin, bradykinin, serotonin) is disrupted, affecting the activity of skin receptors. Disorders of the hypothalamic-pituitary-adrenal system and the pituitary-gonadal system are noted. With pronounced manifestations of VD, changes in immunological parameters were noted, in particular, impairment of functional activity T and B lymphocytes. The development of autoimmune reactions may contribute to the progression of the disease.
A certain significance in the pathogenesis of VD is the disruption of the supply and utilization of oxygen by tissues. Oxygen imbalance aggravates microcirculation disorders, promotes the development of trophic disorders in tissues, in particular, the occurrence of myofibrosis, arthrosis and periarthrosis, the formation of cysts, enostoses, and a decrease in the mineral component bone tissue. In the pathology of the musculoskeletal system with VB, importance is attached to physical stress, microtraumatization, and recoil phenomena from vibrating tools.
Thus, according to modern concepts, the pathogenetic mechanism of VD formation includes both local damage to tissue structures that provide homeostatic regulation of tissue metabolism, and disruption of central (neurohumoral and neuroreflex) regulatory mechanisms that contribute to the aggravation of the pathological process.
Clinical and hygienic studies have shown that the development of VB depends on the nature of vibration, duration of action, place and area of contact between the worker and the vibrating tool. The characteristics of the working tool are of a certain importance, as well as associated unfavorable factors, intense noise, local and general cooling, prolonged static voltage, functional overvoltage, awkward position. More susceptible to the effects of facial vibration young.
Currently there are:
vibration disease from exposure to local vibration,
vibration disease from exposure to general vibration.
Vibration disease from exposure to local vibration
Currently, there are more than one hundred types of hand-held mechanized impact, impact-rotary and rotational tools used in the metalworking, metallurgical, construction, aircraft and shipbuilding, and mining industries. In particular, sources of vibration in the engineering industry are chipping and riveting hammers, stripping, grinding and polishing machines, drills, impact wrenches, and in construction - jackhammers, concrete breakers, etc.
The action of local vibration causes characteristic local vegetative, vascular, sensory and trophic disorders in the hands. General neuro vascular disorders, as a rule, are caused by an unfavorable vascular background with a tendency towards generalized reflex reactions or other production conditions: noise, neuro-emotional stress. General vascular reactions are nonspecific manifestations of the disease.
In contrast to foreign classifications (Taylor and Palmer, 1977; 1986; Ring and Cornish, 1983), in addition to angiodystonic syndrome (the phenomenon of “dead” fingers or Raynaud’s syndrome, or traumatic vasospastic disease), domestic authors distinguish neurovascular, muscular and osseous in the classification. joint disorders.
Classification from 1985 reflects clinically and expertly significant manifestations of the disease, helps to navigate the severity of the pathological process.
There are three stages of vibration disease from the effects of local vibration:
Initial manifestations (I degree)
1. Peripheral angiodystonic syndrome of the upper extremities, including rare vasospasms of the fingers.
2. Syndrome of sensory (vegetative-sensory) polyneuropathy upper limbs.
Moderate manifestations (II degree)
1. Peripheral angiodystonic syndrome of the upper extremities with frequent vasospasms of the fingers.
2. Syndrome of autonomic-sensory polyneuropathy of the upper extremities:
a) with frequent vasospasms of the fingers;
b) with persistent vegetative-trophic disorders on the hands;
c) with dystrophic disorders of the musculoskeletal system of the arms and shoulder girdle (myofibrosis, periarthrosis, arthrosis);
d) with cervicobrachial plexopathy;
e) with cerebral angiodystonic syndrome
Severe manifestations (III degree)
1. Syndrome of sensory-motor polyneuropathy of the upper extremities.
2. Encephalopolyneuropathy syndrome.
3. Polyneuropathy syndrome with generalized acroangiospasms.
Clinical picture. The initial manifestations (grade I) of the disease occur in the form of peripheral angiodystonic syndrome or sensory (vegetative-sensory) polyneuropathy syndrome of the hands. The disease begins gradually with transient paresthesia (a feeling of numbness, tingling, crawling), unexpressed aching pain in the distal parts of the arms, increased chilliness of the fingers. Pain and paresthesia are usually noted only at rest (after work and at night), as well as during cooling, changes in atmospheric pressure, or heavy lifting. physical work. With sufficiently long breaks in work, the discomfort in the hands disappears.
Mild, intermittent symptoms are observed, indicating a violation of the peripheral circulation of the hands: cyanosis, less often pallor palm skin, hypothermia of the hands, hyperhidrosis, sometimes dry palms; with capillaroscopy of the nail bed, a spastic-atonic state of the capillaries is observed; on rheovasography, a mild decrease in pulse blood supply is observed; according to occlusion plethysmography, a decrease in the tone of the veins in the hands can be detected. Peripheral angiodystonic syndrome may be accompanied by whitening of the fingers during general or local cooling. Acroangiospasm develops either on both hands at the same time, or first on the hand that is more exposed to vibration. It usually appears for the first time in the cold season with general cooling: sudden whitening of the tips of one or more fingers, except the first, lasts several minutes, then gives way to cyanosis, which may be accompanied by paresthesia. As the pathological process progresses, vasospasm spreads to other phalanges and fingers and appears on the other hand. IN initial stage vibration disease Raynaud's syndrome occurs rarely (about 1-2 times a month).
Sensory disorders are characterized by a decrease in the perception of vibration and pain sensitivity. With the initial manifestations of vibration disease, finger hypersthesia sometimes develops, which is soon replaced by hypoesthesia. The area of reduced sensitivity gradually spreads to the hand and forearm. Trophic disorders at this stage of the disease are usually limited to abrasion of the skin pattern and hyperkeratosis of the palms.
Moderate manifestations (II degree) the disease is characterized by an increase in the intensity of pain and paresthesia in the hands, increased chilliness of the hands, and an increase in the development of acroangiospasm. Pain and paresthesia in the distal parts of the upper extremities become more constant throughout the day and are quite persistent. Intensifying after work and at night, they often disturb sleep. During the holiday and course of treatment, discomfort in the hands usually decreases significantly, but does not go away completely.
The severity of peripheral vegetative-vascular, sensory and trophic disorders increases. Cyanosis and hypothermia of the hands and hyperhidrosis of the palms are observed. Some patients experience swelling of the fingers and (less often) hands in the morning, and stiffness of the fingers, which, along with pain and paresthesia, usually disappear or significantly decrease shortly after the start of work. Cold vasospasm of the fingers easily develops even with moderate cooling, for example, when washing hands cold water, and sometimes spontaneously. An attack of vasospasm can involve all fingers. However, whitening of the thumb is quite rare due to its higher level of blood supply.
Peripheral autonomic-vascular disorders with moderate manifestations of vibration pathology do not develop independently, but are part of the syndrome of autonomic-sensory polyneuropathy of the upper extremities. In this case, a further increase in the threshold of vibration sensitivity and a decrease in pain sensitivity are observed not only in the distal, but also in the proximal parts of the extremities.
The syndrome of persistent vegetative-trophic disorders on the hands is diagnosed in the presence of persistent swelling of the fingers and hands, deformation of the interphalangeal joints, hyperkeratosis of the palms, and changes in the shape of the nails. The nail plates can be in the form of watch glasses, flattened, sometimes concave inward. They are often flattened or thinned, dull, longitudinally striated, and brittle.
Dystrophic disorders manifest themselves in the form of myalgia, myositis of the extensors of the hand and fingers, suprascapular and other muscles, periarthrosis and deforming arthrosis of the elbow, shoulder, wrist, and interphalangeal joints. Aseptic necrosis of the carpal bones (lunate, scaphoid) develops much less frequently. The syndromes under consideration are usually formed after a long period of work under the influence of vibration in combination with significant static-dynamic stress. This fully applies to the syndrome of cervicobrachial plexopathy, which is currently observed extremely rarely, is characterized by unilateral localization and can sometimes be accompanied by mildly expressed radicular symptoms. Patients experience shoulder pain, shoulder joint, suprascapular region, sometimes with irradiation throughout the arm. Painful top point Erba, suprascapular, axillary. The upper Lassegue sign is positive. Symptoms of loss of sensitivity and reflex activity are revealed.
Functional disorders of the central nervous system in the form of a neurosis-like syndrome with mild autonomic dysfunction can be observed even in the initial stages of vibration disease. As the process progresses, some patients experience significant increases in irritability, fatigue, headache, sleep disturbances, cardialgia, dizziness, pulse lability and blood pressure etc. The examination reveals changes in the vessels of the fundus, disturbances of cerebral hemodynamics (according to rheoencephalography, transcranial Dopplerography, electrical plethysmography). In such cases, cerebral angiodystonic syndrome can be diagnosed.
Thus, for stage II vibration disease, the most characteristic is the aggravation of the clinical manifestations of the syndrome of vegetative-sensory polyneuropathy of the upper extremities, significantly pronounced peripheral angiodystonic syndrome, persistent vegetative-trophic disorders on the hands, and frequent vasospasms of the fingers.
Severe manifestations (grade III) of the disease are now extremely rare. The progression of local neurovascular disorders can lead to the formation of a syndrome of sensorimotor polyneuropathy of the upper extremities with increased pain and paresthesia, the appearance of weakness in the arms, and a decrease in strength in them. In this case, hypotrophy of the muscles of the hands and forearms, a decrease in tendon reflexes, and the speed of excitation along the motor nerves are observed.
In some patients with vegetative-sensory or sensorimotor polyneuropathy of the upper extremities, generalization of vasospasm is observed with its appearance not only on the hands, but also on the toes. In such cases, polyneuropathy syndrome with generalized acroangiospasm is diagnosed. The development of this syndrome is possible with a long period of work under conditions of intense high-frequency vibration, especially in combination with hand cooling or general cooling.
Vibration disease- a disease caused by prolonged exposure to vibration. Symptoms. Treatment. Prevention.
Vibration is a mechanical oscillatory movement repeated at certain intervals. The main parameters of vibration are the frequency and amplitude of vibrations, as well as their derivatives - speed and acceleration. Vibration is divided into local (from hand tools) and general (from machines, equipment, moving machines). In industrial environments there is often a combination of local and general vibration.
Are exposed to vibration excavator operators, bulldozers, other road construction and quarry equipment and representatives of many other professions. Vibration causes chronic microtraumatization of peripheral vegetative formations and perivascular plexuses with subsequent disruption of blood supply, microcirculation and tissue trophism. In some cases, under the influence of intense vibration or explosion, an acute injury occurs - vibration trauma, clinically manifested by dysfunction of the inner ear, concussion and changes in other organs and tissues.
Symptoms of vibration disease
Clinical symptoms vibration disease consists of peripheral neurovascular disorders and trophic disorders in the muscles and bones of the limbs and shoulder girdle. The disease develops after 3-15 years of working in vibration conditions. The main clinical syndromes are peripheral angiodystonic syndrome, acrospasm syndrome (Raynaud's syndrome) and sensory (vegetative-sensory) polyneuropathy of the extremities (arms or legs depending on exposure to local or general vibration). Characteristic complaints are chilliness, paresthesia of the extremities, changes in the skin color of the fingers when cooling (they turn white or bluish), decreased strength in the hands, cramps in the hands, feet and calf muscles. Hypothermia, cyanosis and hyperhidrosis of the extremities are observed, trophic changes skin (hyperkeratosis) and nails (thickening, deformation or thinning of the nail plates), swelling or pastiness of the hands with stiffness of the fingers. With progression vibration disease the frequency and duration of vasospasms increase. When exposed to general vibration, there is a decrease in the pulsation of the arteries on the back of the feet and legs. A characteristic symptom is an increase in the threshold of vibration, pain, temperature, and less often tactile sensitivity. Sensory impairment is polyneuritic in nature. As the disease progresses, segmental hypalgesia and dystrophic disorders of the musculoskeletal system are revealed. Along with pain, thickening, heaviness, and focal crepitus are detected in the muscles of the limbs and shoulder girdle. With long-term (15 years or more) exposure to general vibration (most often among tractor drivers, bulldozer drivers and excavator workers) often arise dystrophic changes in the spine (osteochondrosis, deforming osteoarthritis of the lumbosacral, less commonly cervicothoracic region) with secondary radicular syndrome.
Peripheral neurovascular and trophic disorders are often combined with functional changes in the central nervous system, which manifest themselves in the form of cerebral angio-dystonic or neurasthenic syndrome. These disorders are most pronounced when vibration disease, caused by the influence of general vibration. At the same time, patients complain of fatigue, dizziness, headaches, intolerance to travel in transport,
Conditionally allocate three degrees of vibration disease:
- I degree - initial manifestations;
- I degree - moderate pronounced manifestations;
- III degree - pronounced manifestations.
Vibration disease, stage I is asymptomatic. Patients complain of mild pain, chilliness, and paresthesia of the hands. There are mild sensitivity disorders in the terminal phalanges (hyper- or hypalgesia), a mild decrease in vibration sensitivity, a slow recovery of the skin temperature of the fingers after cooling, and a change in capillary tone. Angiospasms are rare.
For vibration disease of the 2nd degree the intensity and frequency of manifestations of the disease are increasing. Sensitivity disorders, especially vibration sensitivity, become more pronounced.
Vibration disease III degree It is rare and is characterized by severe vasomotor and trophic disturbances. Peripheral vasospasms become frequent. The intensity of sensitivity disorders, paresthesias and pain. Vibration sensitivity is sharply reduced, hypoesthesia is segmental in nature. Symptoms of asthenia are expressed.
The diagnosis is established on the basis of anamnesis, sanitary and hygienic characteristics working conditions, a set of clinical manifestations, as well as indicators of microcirculation, cold test, determination of the threshold of vibration and pain sensitivity, skin thermometry, etc. During capillaroscopy of the nail bed, spastic atony of the capillaries is observed, less often their atony or spasm. Radiographs reveal proliferation of tuberosities nail phalanges, thickening of the diaphyses and compact substance of the tubular bones, thickening of the trabeculae of the spongy substance, metaepiphyses of the phalanges, metacarpals and metatarsal bones.
Differential diagnosis is carried out with Raynaud's disease and other angiotrophoneuroses, syringomyelia, polyneuropathies (alcoholic, diabetic, etc.), vertebrogenic pathology nervous system.
Treatment of vibration disease
Treatment vibration disease includes medication, reflex therapy and physiotherapy. Ganglion blockers, vasodilators, drugs that improve trophism and microcirculation (angioprotectors, ATP, phosphaden, complamin, trental, B vitamins) are indicated. Chamber galvanic baths with emulsion are effective Naftalan oil, electrophoresis of novocaine, heparin on the hand, diathermy, UHF and UV irradiation on the area of the cervical sympathetic nodes, diadynamic currents, ultrasound with hydrocortisone, massage, exercise therapy, acupuncture and laser therapy. Have a beneficial effect mineral water(radon, carbon dioxide, hydrogen sulfide, bromide baths) and mud applications.
Rational employment and treatment in most cases lead to reverse development leading clinical manifestations of vibration disease, and sometimes to complete recovery.
Professional work ability of patients with vibration disease I degree is usually preserved. To prevent the progression of the process, preventive treatment is carried out once a year with a temporary transfer (for 1-2 months) to work not associated with exposure to vibration, cooling and overexertion of the hands. During next vacation recommended Spa treatment(Pyatigorsk, Evpatoria, Nalchik, etc.). In case of vibration disease of II and III degrees, patients should be transferred to work that is not associated with exposure to vibration, cooling and overexertion of the hands; it is necessary to carry out repeat courses treatment. Patients with stage II vibration disease remain able to work, which allows them to be employed rationally. Young and middle-aged persons (under 45 years of age) who do not have additional qualifications are recommended to be sent for retraining. With vibration disease of the third degree, the professional and general working capacity of patients is persistently reduced.
Prevention of vibration disease
Basic prevention vibration disease is the maximum possible reduction in the effect of vibration on the body. In order to prevent the development of vibration disease, it is necessary to create equipment, mechanisms and Vehicle, meeting sanitary and hygienic standards and vibration safety. Constant monitoring of vibrating installations and careful testing of vibrating tools put into operation are necessary, taking into account the utmost permissible level vibrations.
Great importance in prevention vibration disease It has proper organization labor. The time spent working with vibrating tools should be strictly limited. You should take 10-minute breaks after every hour of work; A lunch break is required, and two breaks are also required to carry out a set of industrial gymnastics and physiotherapeutic procedures (20 minutes 2 hours after the start of the shift and 30 minutes 2 hours after the lunch break). The duration of one-time continuous exposure to vibration should not exceed 15-20 minutes, the total time of contact with vibration is 2/3 of the total working time. After finishing work, physiotherapeutic procedures are recommended: showering (fan or Charcot type), warm hand baths, massage of the upper extremities.
For the purpose of prevention vibration disease conduct courses of ultraviolet irradiation in suberythemal doses. Fortification, physical hardening, rational nutrition, organization active rest also bring good results. Recommended courses preventive treatment(1-2 times a year).
Periodic medical examinations are carried out once a year with the participation of a therapist, neurologist, and otolaryngologist. Contraindications for employment involving exposure to vibration are: endocrine diseases, lesions of the vestibular and auditory apparatus, diseases of cardio-vascular system, nervous system, gastrointestinal tract.
Agricultural machine operators, truck drivers, excavator operators, pile drivers, etc. are mainly exposed to general vibration.
WB classification from the action of general vibration was approved in 1982. It is built on a syndromic principle and distinguishes 3 degrees of severity of the pathological process:
Initial manifestations
1) angiodystonic syndrome (cerebral or peripheral),
2) vegetative-vestibular syndrome,
3) sensory (vegetative-sensory) polyneuropathy syndrome lower limbs.
Moderate manifestations:
1) cerebral-peripheral angiodystonic syndrome,
2) sensory (vegetative-sensory) polyneuropathy syndrome in combination:
a) with polyradicular disorders (polyradiculoneuropathy syndrome),
b) with secondary lumbosacral radicular syndrome (due to osteochondrosis of the lumbar spinal column),
c) with functional disorders of the nervous system (neurasthenia syndrome)
Expressed manifestations:
1) sensory-motor polyneuropathy syndrome,
2) discirculatory encephalopathy syndrome in combination with peripheral polyneuropathy (encephalopolyneuropathy syndrome).
Clinical picture. Modern production is characterized by relatively low levels vibrations of workplaces with a predominance of low-frequency vibration spectrum.
Stage 1 disease includes unstable cerebral or peripheral neurovascular disorders. PADS is characterized by intermittent and moderately severe paresthesia and pain in the lower extremities, sometimes cramps of the calf muscles. On examination, mild cyanosis or marbling, hypothermia of the feet, hyperhidrosis of the soles, and decreased perception of vibration and pain sensitivity on the toes are observed. Increased pain and paresthesia in the feet and legs, the severity of peripheral vegetative-vascular disorders, a decrease in superficial sensitivity (especially pain) of the polyneuritic type, mainly in the distal parts of the lower extremities, are the basis for establishing the syndrome of VSP of the lower extremities. Clear dominance in clinical picture sensory disturbances indicate sensory polyneuropathy of the lower extremities.
The presence of cerebral angiodystonic syndrome is indicated by mildly expressed symptoms of a neurasthenic or asthenoneurotic nature (recurrent headache, irritability, fatigue, sleep disturbance) in combination with autonomic dysfunction (lability of pulse, blood pressure with a predominance of hypertension, sweating, impaired dermographic reaction, etc.).
Autonomic-vegetative disorders are manifested by motion sickness syndrome, dizziness, staggering when walking and in the Romberg position, unstable horizontal nystagmus, increased vestibular-vegetative reactions under vestibular loads.
One of the variants of moderate manifestations of the disease is the simultaneous development of cerebral and peripheral angiodystonic disorders, which is regarded as cerebral-peripheral syndrome. Moreover, in some cases, along with the development of vegetative-vascular disorders in the lower extremities, similar symptoms appear in the area of the hands.
Clinical manifestations of VSP syndrome at this stage of the disease become more pronounced and are observed not only in the lower extremities, but also in the upper extremities. Against this background, radicular symptoms may appear (polyradiculoneuropathy syndrome).
Along with VSP, secondary lumbosacral radicular syndrome develops due to osteochondrosis of the lumbar spinal column. This is explained by the fact that the aperiodic shocks that occur as a result of vibration, which drivers of heavy-duty vehicles and self-propelled equipment experience at their workplaces, have a microtraumatic effect on the lumbosacral vertebrae, intervertebral discs, and joints with a violation of their trophism. This is, apparently, one of the reasons for the development or progression of osteochondrosis, deforming arthrosis of the lumbosacral spine and secondary radicular, pain and reflex syndromes.
At this stage of the disease, pronounced vegetative-vascular dystonia and functional changes in the central nervous system, occurring as neurasthenia, can be observed. These changes are usually accompanied by autonomic-vestibular disorders.
Workers exposed to general vibration often experience dysfunction of the digestive glands, menstrual cycle in women, exacerbation of the inflammatory process in the pelvic organs. These changes are explained by a violation of the regulatory influence of the central nervous system, as well as organ prolapse abdominal cavity and irritation of the celiac plexus under the influence of vibration.
With the combined effects of general and local vibration, a complex symptom complex is formed, consisting of a combination of syndromes characteristic of VD from exposure to local and general vibration. This form The disease occurs, for example, in those working on vibration compaction of concrete, drillers and miners, when not only the limbs, but also all supporting surfaces are exposed to vibration.
Diagnosis of vibration disease. Early diagnosis of VD is carried out during periodic medical examinations. At the same time, attention is paid to characteristic complaints, objective examination data, tuning fork, cold test and dynamometry indicators. Each specialist participating in the PME must carefully describe complaints, objective data in medical card. If necessary, an outpatient follow-up examination is prescribed.
In a clinic setting, it is possible to perform rheovasography, electromyography, electroencephalography, rheoencephalography, and radiography of the musculoskeletal system.
Diagnosis of VD in the occupational pathology center is based on the following data:
professional route (according to a copy of the work book confirming a sufficiently long professional experience in contact with vibration),
sanitary and hygienic characteristics of working conditions, indicating systematic exposure of workers to vibration exceeding the maximum permissible limit. The work operations performed by the patient, the nature various sources vibration and its main parameters. In addition, you should have information about other unfavorable occupational factors (significant muscle tension, forced body position, uncomfortable working posture, general cooling, as well as cooling of the hands and wetting them with solvents, water; industrial noise, etc.). Important information about preventive measures, application individual funds protection;
history of the disease: typical complaints, gradual development of the disease and significant improvement in the patient’s condition with more or less long breaks from work (during vacation, course treatment and use of additional paid sick leave,
objective examination - a thorough description of the status localis (assessment of the state of peripheral blood supply: coloring of the skin of the palms, hypothermia of the hands, hyperhidrosis, sometimes dry palms, the presence of trophic disorders in in the form of hyperkeratoses, changes in nail plates, etc.),
symptoms: “white spot” (the patient clenches his hands tightly into a fist and quickly unclenches them after 5 seconds. Normally, the resulting white spots on the palms and fingers should disappear after 5 seconds, but if traces of whitening persist longer, the test is considered positive).
Bogolepova (a person with his arms stretched forward is asked to raise one of them and lower the other for 15 seconds, and then extend them horizontally again. The color of both hands is normally restored after 15 seconds. If peripheral blood circulation is impaired, it will take much longer to restore the color of the hands) .
Palya (in a sitting patient, a synchronous pulse is found on both radial arteries, and then with a quick movement, both of the patient’s arms are raised up, while the pulse may disappear on one or both sides for several seconds. Such a test is assessed as positive).
clinical and functional research methods that allow assessing the functional state of the peripheral and central blood supply, peripheral nerves, determine vibration and pain sensitivity thresholds, etc. Thus, the study of vibration sensitivity is carried out on VCh or VT devices, as well as on a vibration thermal analyzer and using a tuning fork test. Algesimetry is used to study pain sensitivity. Peripheral vascular disorders are studied using capillaroscopy, rheovasography, thermal imaging studies, as well as a cold test with determination of the time of recovery of temperature on the fingers after it. In addition, dynamometry, electromyography (global and stimulation), radiography of the musculoskeletal system are performed, according to indications: electroencephalography, rheoencephalography, Dopplerography of peripheral vessels.
Treatment of vibration disease. The etiological principle of therapy involves eliminating the impact on the body of vibration and such unfavorable production factors as cooling and physical stress. Pathogenetic therapy is aimed at normalizing peripheral circulation and eliminating foci stagnant excitement etc. The goal of symptomatic therapy is to normalize polymorphic reflex disorders, etc. The most effective is complex treatment of patients using medications, physical and reflex methods.
For angiospasms, vasodilators are recommended (nicotinic acid, halidor, trental (pentoxifylline), drugs that improve the rheological properties of blood (reogluman, reopolyglucin). In case of severe pain syndrome, combined with neuro vascular disorders, the use of ganglion blockers in combination with small doses of anticholinergics and vasodilators is indicated.
To improve microcirculation processes (correction of oxygen balance, collagen metabolism, etc.), injections of ATP, pyridoxine, angiotrophin, as well as ascorbic acid are indicated.
In case of severe pain, the complex of therapy must include injections of vitamins B1 and B12, non-steroidal anti-inflammatory drugs (indomethacin, ortofen, etc.), novocaine blockades. In the complex of treatment, the use of biostimulants and adaptogens is practiced.
Physiotherapeutic methods of treatment: phonophoresis with analgesic mixtures, amplipulse therapy, electrophoresis of a 5% novocaine solution, 1% analgin solution or 1% papaverine solution on the limbs, applications with a 25% dimexide solution, electrophoresis with peloidin, laser therapy for hands, paraffin-ozokerite applications, 2- and 4-chamber baths, SMT on the cervicothoracic segments of the sympathetic nervous system, reflexology, circular shower.
In the complex treatment of vibration disease, great importance is attached to balneotherapy. Hydrogen sulfide, iodine-bromine, nitrogen-thermal baths, and mud applications have a beneficial effect on the course of the disease.
Work ability examination. Issues of assessing the ability to work in cases of vibration disease are resolved taking into account the stage, leading clinical syndrome, features of the course of the disease, the presence of concomitant diseases, and the effectiveness of treatment.
The main reasons for the decreased ability to work in patients with VD are persistent pain, decreased hand strength and endurance to static force, frequent and long-lasting vasospasms of the fingers, and severe peripheral vegetative-vascular disorders.
With the first degree of VD, there is a temporary loss of ability to work (full - sick leave, partial - additional paid sick leave). Gives a lasting therapeutic effect hospital treatment in a specialized department of occupational pathology or a neurological department, recovery in a sanatorium, subject to the temporary transfer of the patient for a period of 1-2 months to work outside the influence of vibration, physical overexertion and cooling with the issuance of an additional paid sick leave. DBL is formalized as BL, only with “labor” indicated at the top, and is extended every 10 days by a neurologist indicating the dynamics of the pathological process. During a calendar year, DBL is issued for a period of up to 2 months.
Clinical examination sick carried out depending on the stage and clinical syndromes. Patients with VD need to be examined by a neurologist, therapist and otorhinolaryngologist once a year for periodic medical examinations. In addition, every year, in a specialized occupational pathology center, to clarify the severity of clinical syndromes, they undergo an examination (vibration sensitivity study, algesimetry, dynamometry, electrothermometry, cold test, capillaroscopy, thermal imaging examination). According to indications, radiography of the osteoarticular apparatus, electromyography, determination of vibration and temperature (heat and cold) sensitivity on a vibration-thermal analyzer, rheovasography, electroencephalography, etc. are prescribed. If necessary, patients are consulted by an angiosurgeon or traumatologist (orthopedist).
Treatments are carried out twice a year, taking into account the syndromes and degree of VD. One course is carried out in the occupational pathology department, the second - in a health care facility or in a sanatorium-preventorium of the enterprise.
Persons with residual manifestations of VD are subject to dispensary observation according to the same scheme. When signs of VD disappear, they are considered practically healthy in the absence of concomitant diseases. These individuals are able to work in a wide range of professions, except for vibration ones. Returning to your previous job is not advisable, especially at the age of 45 and older, because... they may develop early vibration pathology.
According to Order No. 90 of the Ministry of Health and the MP of the Russian Federation, periodic medical examinations of persons working in contact with local vibration are carried out once a year and once every 2 years when the general vibration limit is exceeded according to the “Sanitary Standards...”. The frequency of examinations at the occupational pathology center is once every 3 years (local vibration), once every 5 years (general vibration).
Additional medical contraindications for working in contact with local and general vibration:
Obliterating arterial diseases, peripheral vasospasm,
Chronic diseases of the peripheral nervous system,
Anomalies in the position of the female genital organs. Chronic inflammatory diseases of the uterus and appendages with frequent exacerbations,
High and complicated myopia (above 8.0 D).
Vibration is the mechanical vibrations of elastic bodies. According to the nature of the contact with the body of the worker, industrial vibration is divided into local (local) and general. This division is somewhat arbitrary, but convenient for practice.
The strength of the impact of vibration on the body depends on the amount of absorbed vibrational energy, the most adequate expression of which is vibration velocity.
As a rule, industrial vibration has a complex spectrum of vibrations with a wide range of frequencies. The nature of its influence is determined by the location of the maximum vibrational energy in a particular frequency range. The range of local vibration frequencies normalized by the levels of root-mean-square speed covers the area from 8 to 1000 Hz. Based on the predominant energy, low-frequency (8-16 Hz), mid-frequency (16-64 Hz) and high-frequency (64-1000 Hz) regions can be distinguished.
Vibration disease- complex pathological changes observed in individuals systematically exposed to vibration. In this case, there is a combination of the direct irritating and damaging effect of vibration on nerve endings and perivascular plexuses with reflex influences (sensitive-vegetative reflexes) and the phenomena of parabiosis developing in the central nervous system at its various levels.
Clinical picture
The clinical picture of vibration disease is determined not only by the frequency characteristics of vibration, but also by the place of its application, the characteristics of the profession, and the presence of associated harmful factors, operating mode. The leading place in the clinic of vibration disease is occupied by dysfunctions of the nervous and vascular systems, as well as bone changes. Depending on the nature and location of application of vibration, it is customary to distinguish three forms of vibration disease;
1) vibration disease from the “local” action of vibration (low or high frequencies);
2) vibration disease from the combined (general and “local”) effects of medium- and high-frequency vibration;
3) vibration disease from the general effect of low-frequency vibration and tremors.
Vibration disease from the “local” action of vibration is observed in workers with various hand-held vibration machines of impact and rotational action at frequencies from 8 to 150 Hz and higher (in the metalworking industry - trimmers, chasers, riveters, mechanics working with grinding machines, molders; in the mining industry industry - drillers, drifters, as well as a number of other professions).
The clinical picture consists of symptoms of vegetative polyneuritis and the phenomena of angiodystonia with a predominant tendency to spasm of peripheral vessels and emptying of capillaries.
Vibration of low frequencies (8-20 Hz) mainly causes the phenomena of vegetative polyneuritis and damage to bones and joints, vibration of higher frequencies - angiospastic syndrome (attacks of whitening of the fingers). However, almost most often there is a combination of these and other symptoms.
Symptoms
Typical complaints: attacks of whitening of the fingers (mainly when cooling), night pain and paresthesia in the hands (a feeling of numbness, “pins and needles” in the fingers).
Objective symptoms: cyanosis and hypothermia of the hands, mild swelling of the fingertips, excessive sweating palms and fingers. Positive "symptom" white spot" White spots that form on the palm and fingers after tightly clenching the latter into a fist (for 5 s), after straightening them, last longer than 10 s. Positive Pahl's sign (disappearance or asymmetry of pulsation radial arteries when the patient's arms are quickly raised upward). Positive Bogolepov test (one arm of the patient is raised up, the other is lowered; this position is maintained for 0.5 minutes, then both arms are extended horizontally on command; the difference in the color of the hands is normally smoothed out within 15 s). Positive cold test (whitening of fingers, solid or spotty, after lowering the patient’s hands into water at 10-12°C for 3 minutes).
Capillaroscopy of the nail bed reveals a violation of capillary tone, as well as changes in vascular permeability.
Data from plethysmography, oscillography and rheovasography indicate a dysregulation of the tone of large vessels in the shoulder and forearm, which is expressed in the asymmetry of their indicators and impaired blood flow speed.
Sensitivity disorders occupy a significant place in the clinical picture.
Vibration sensitivity is especially affected, a decrease in which is observed already in early stages diseases.
Pain sensitivity is most severely impaired, temperature sensitivity to a lesser extent, and tactile sensitivity even less. Muscular-articular sensation, as a rule, does not suffer.
Disorders in the area motor sphere are relatively rare (only in severe forms of the disease), they are manifested by a decrease in muscle tone and muscle strength, hypotrophy of small muscles of the hands (elevations of the thumb and smallest fingers, interosseous muscles) and weakening of their functions.
In severe forms of the disease, there are disturbances in skin trophism and subcutaneous tissue hands, nails, interphalangeal joints. X-rays reveal disturbances in bone trophism. The disease usually occurs against the background of general autonomic dysfunction or neurasthenic syndrome. In rare cases, organic lesions may develop spinal cord type of syringomyelia or lateral sclerosis.
Vibration, or shaking, is an oscillating motion that repeats itself at regular intervals. The main quantities characterizing vibration are the frequency of vibrations per second (hertz), the amplitude of vibrations and vibration energy, measured in kilograms. Vibration is perceived by a person through contact. The tips of the toes and the arch of the foot are most sensitive to vibration. A person perceives mechanical vibrations as vibrations with frequencies ranging from 25 to 8192 Hz; vibrations with frequencies less than 25 Hz are perceived as shocks.
Who is affected by vibration disease?
In the national economy, tools, machines and machines whose operation is accompanied by vibration are currently widely used. People who work with pneumatic and power tools (riveters, chippers, drillers, polishers, grinders, etc.) are mainly exposed to vibrations. Vibration encountered in production is conventionally divided into general and local (local).
The changes that occur in workers exposed to so-called local vibration have been studied in most detail. When working with pneumatic tools (jackhammers, hammer drills, etc.) and when processing parts on rotating mechanisms, mainly the upper limbs are exposed to shock. However, during some work, for example, when vibrating concrete, workers in some cases have to be on vibrating platforms and, therefore, be exposed to general vibration. Many vehicle workers also experience general vibration. It must be borne in mind that even in professions where workers are exposed to local vibration, shocks occur not only to the working limb, but also to other parts of the body.
The effect of vibration on the body
The frequencies and amplitudes of vibration are of greatest biological importance. At high frequency and low amplitude, vibration primarily affects nerve endings in tissues. Vibration of low frequency and large amplitude mainly causes irritation vestibular apparatus and body displacement.
A certain relationship has been identified between physical characteristics vibrations and its biological effect. Vibration disease is caused by vibrations with frequencies above 35 Hz, and the higher the vibration frequency and the greater the amplitude, the faster the disease develops. Normalization of the vibration factor in production conditions is carried out primarily taking into account these values.
Vibration, which is an irritant to the nervous system, can, under certain conditions, have some positive influence on the body due to the functional changes it produces in cells and organs (normalizes the activity of the cardiovascular system, stimulates the function of the stomach). Vibration massage, for example, has long been used for therapeutic purposes.
However, with prolonged exposure certain types vibrations on the body in unfavorable conditions, vibration disease can develop, which is expressed in serious violations from the outside the most important organs and systems (nervous system, circulatory system, etc.).
The changes that arise as a result of the effect of local vibration on the body were first described in 1911 by the Italian Loriga, who discovered pronounced changes in the form of angiospastic syndrome in masons working with pneumatic tools, mainly in the “working” hand: “the phenomenon of dead fingers.”
Symptoms of vibration disease
For vibration disease caused by exposure to local vibration, clinical phenomena usually develop gradually and are observed mainly in workers with significant experience in vibration-related work. Patients complain about being stupid, aching pain in the hands, more pronounced in the working hand, forearm, sometimes in the interscapular region, a feeling of numbness and stiffness in the hands, fatigue of the hands when working.
The pain usually occurs outside of work, most often at night, and subsides after starting work. There is a significant decrease in the sensitivity of the hands, as a result of which the patient is deprived of the ability to feel small items and do delicate work. The hands become chilly, and a tendency to spasm of the blood vessels in the extremities develops, which is most often detected when exposed to cold, as well as other irritants. Patients often indicate whitening of their fingers from the cold, more often from general cooling.
Along with the above disorders, patients complain of headaches, increased fatigue, irritability, bad dream.
Differential diagnosis of vibration disease
During the examination, attention is drawn to swelling of the fingers, often swelling of the hand, cyanosis skin, hypothermia and sweating of the hands, limited mobility, thickening and deformation of the interphalangeal joints, erased finger patterns, hyperkeratosis, changes in the nails. Capillaroscopy at high vibration frequencies indicates a tendency toward spasm, while at low vibration frequencies, spastic-atonic phenomena predominate. Sometimes there is a decrease in muscle strength, hand tremors, and lethargy of tendon reflexes.
A very characteristic decrease in pain, vibration, temperature and tactile sensitivity.
In the skeletal system the following is determined: osteoporosis, sclerosis of the bones of the hand and wrist, phenomena of deforming arthrosis in the small joints of the hand, deforming changes in the head humerus and upper thoracic vertebrae.
Changes in the bone apparatus are caused by developing dystrophic processes. In severe forms of vibration disease caused by exposure to local vibration, there is a high prevalence of vegetative, trophic disorders and sensitivity disorders, which are also noted outside the upper extremities.
In addition to the changes described above on the part of the working arm, which in the literature are called angioneurosis of the upper extremities, or autonomic neuritis, with the described form of vibration disease, general changes in the body are usually noted. These changes are expressed primarily in disorders of the central nervous system, circulatory system and gastrointestinal tract. Patients exhibit autonomic dysfunction with angiodystonic phenomena, arterial hypotension, bradycardia and the phenomena of myocardial dystrophy.
The electrocardiogram shows an increase in the border of the heart to the left, muffled tones, a change in the T wave and lengthening P-Q interval. Angiospasm may occur coronary vessels and cerebral vascular crises. Changes in the gastrointestinal tract during vibration disease are expressed in disruption of the motor and secretory functions of the stomach (decreased acidity gastric juice and gastric peristalsis). In advanced stages of the disease, it is possible metabolic disorders: changes in carbohydrate and mineral metabolism.
Thus, the changes caused in the body by the so-called local vibration represent a syndrome for which the most characteristic are, first of all, local vascular disorders. Changes in vascular tone occur in phases: initially, spastic phenomena predominate, then paretic ones. Pallor and necrosis of the fingers - peripheral vascular spasm - are the most important, but not the only symptom of this disease. As the frequency increases, vibration intensifies vasoconstrictor effect it, however, after vibration with a frequency of 250-300 Hz, vasospasm rarely appears. Consequently, with vegetative vibration neuritis, vasospasm may be absent.
The changes described above from various organs and systems caused by the influence of local vibration, give reason to classify the described form of vibration disease as a general suffering of the body.
Vibration disease, caused by exposure to local vibration, can develop under unfavorable conditions within a few months after the start of work. If you continue to work after the appearance of symptoms of vibration disease and untimely implementation of therapeutic measures, the changes usually progress, which leads to pronounced and persistent disorders. Sometimes the phenomena of vasospasm caused by exposure to local vibration can persist and even progress after stopping work. Severe vasospasm can lead to gangrene. The rapidity of development of vibration disease in to a large extent depends on individual sensitivity. Not everyone who works necessarily gets sick. Sometimes the symptoms of the disease are not observed for decades of work associated with vibration.
Degrees of vibration disease
There are four stages of the disease.
initial stage
The first (initial) stage refers to the period of asymptomatic development of the disease. In this case, mild pain and mild sensitivity disorders (hyper- or hypoesthesia) in the fingers may periodically be observed. Capillaroscopy reveals a known tendency to a spastic state of the capillaries of the nail bed.
Second stage
In the second stage clinical symptom complex expressed moderately.
Third stage
In the third stage, the process is characterized by the presence of distinct vascular disorders, accompanied by attacks of vascular spasm and the phenomena of “dead” fingers; the spasm is usually replaced by an atonic state of the capillaries and cyanosis of the fingers. During capillaroscopy, spastic-atonic phenomena are expressed. Sensory disturbances are also evident. They are often combined with changes in the muscles, the activity of the central nervous system (asthenic reactions), cardiovascular and endocrine systems is disrupted. This stage of the disease can be observed in workers with extensive experience who have been exposed to high-frequency vibration for a long time, often in combination with exposure to significant impact and other unfavorable production factors.
Fourth stage
The fourth stage is relatively rare. It can occur in conditions of long-term progression of the process due to continued exposure to vibration and mainly in people who suffered from a certain insufficiency of the endocrine autonomic system in the premorbid period.
Some cases of vibration disease have to be differentiated from Raynaud's disease (in both cases, the main manifestation of the disease is attacks of whitening of the fingers).
The following signs speak in favor of vibration disease:
1) development of the disease during the period of work in a “vibration” profession;
2) pain in the arms and paresthesia not associated with attacks of whitening;
3) significant disturbances in sensitivity, especially vibration;
4) finger deformation, hyperkeratosis, nail changes;
5) osteoarticular lesions, typical for exposure to vibration;
6) muscle atrophy;
7) localization of the lesion, typical for this profession (earlier or more severe damage to the left hand in those working with pneumatic tools);
8) absence of damage to the lower extremities.
Severe cases of vibration disease
Severe cases of vibration disease, occurring with severe trophic disorders and widespread sensitivity disorders, are sometimes mistaken for syringomyelia. However, the similarity here is purely external. With vibration disease, there is never a complete dissociation of sensitivity (partial dissociation can occur); the boundaries of the sensitivity disorder are not sharp and do not exactly coincide with the segmental zones. Moreover, these boundaries can be unstable. Tendon reflexes are usually preserved. Attacks of whitening of the fingers are completely uncharacteristic for syringomyelia.
When the body is exposed to general vibration, if health measures are not carried out in a timely manner, serious changes in various organs and systems can develop, often significantly limiting the patient’s ability to work. With vibration disease associated with exposure to general vibration, patients complain of headaches, a feeling of noise and heaviness in the head, dizziness, weakness, fatigue, irritability, poor sleep, loss of appetite, nausea. Patients experience a decline in nutrition, increased muscle excitability, arterial hypotension, bradycardia, myocardial dystrophy, angiodystonic phenomena with a tendency to fainting states, sometimes with symptoms of angina pectoris.
The course of vibration disease
In the clinical picture of the disease in a number of cases, especially when exposed to vibration of significant intensity, diencephalic disorders come to the fore. In severe cases of the disease, attention is drawn to increased body temperature, asthenia, vestibular disorders, sudden weight loss, baldness, increased gastric secretion, leukocytosis, tendency to lymphocytosis, disturbance of basal, carbohydrate, fat and water metabolism.
Changes in morphological and biochemical parameters blood appears to be associated with a disorder of the central nervous regulation. In women suffering from vibration disease, hyperfunction is detected thyroid gland and menstrual irregularities. Cases of impotence have been reported among young workers.
In addition to functional disorders of the central nervous system (changes in the cortex and subcortical-diencephalic region), microsymptoms may occur, according to available literature data focal lesion cerebral hemispheres brain, brainstem and spinal cord.
Along with the described general phenomena local angioneurosis of the lower and upper extremities, changes in the peripheral nervous system and the musculoskeletal system may be observed.
Vibration disease in concrete workers, who are exposed mainly to general vibration, occurs in a unique form. Compared to the usual form of vibration disease, attention is drawn to the significantly greater severity of general disorders.
The most typical is the general angiodystonic syndrome, against the background of which autonomic crises are often observed. Often, even outside of crises, individual diencephalic symptoms (sleep disturbance, impotence, low-grade fever) are noted. In some cases, organic microsymptoms are noted. From the outside internal organs dystrophic changes in the heart muscle, disorders coronary circulation, secretory and motor functions of the stomach and intestines, peptic ulcer.
Cholesterol metabolism is disrupted, and in some cases the basal metabolism increases significantly. Against the background of these general disorders, concrete workers (especially those working with manual vibrators) also experience the usual phenomena of peripheral angiospastic syndrome or vegetative polyneuritis with a tendency to vasospasms, and in some cases, damage to the peripheral motor neuron.
Vibration disease of concrete workers is persistent and difficult to treat, which significantly affects the ability of patients to work.
There are three stages of vibration disease of concrete workers:
The first stage is nonspecific. There are complaints about headache, deterioration general well-being, moderate symptoms of autonomic dysfunction.
The second stage is characterized by obvious angiodystonic phenomena of both peripheral and general, mild diencephalic syndromes, neurotic phenomena.
The third stage is characterized by clearly defined diencephalic syndromes with impaired coronary circulation, severe asthenic condition with organic microsymptoms.
Under unfavorable conditions, the disease can develop within the first year of work. A previous infection can contribute to the occurrence of vibration disease.
Pathogenesis of vibration disease
Some researchers explain the occurrence of angioedema disorders by trauma to the capillary walls with the subsequent development of autonomic neuritis and local vasospasm.
However, as established by experiments and clinical and physiological observations, the mechanism of vibration disease is very complex. Vibration disease, caused by local vibration, is a general disease of the body, in the development of which important They undoubtedly have reflex reactions, leading to the development of foci of stagnant excitation and persistent changes in the receptor apparatus and the central nervous system.
As a result of the impact of vibrations on the body, peripheral receptors are irritated. Impulses entering the central nervous system change its functional state. The regulatory function of the central nervous system and mainly the system that regulates vascular tone is disrupted. Changes in the central and peripheral nervous systems caused by exposure to vibration cause vascular and trophic disorders characteristic of vibration disease in the form of a kind of trophoneurosis, which tends to generalize. Some authors believe that when exposed to vibration, irritations coming from the periphery to the central nervous system cause phenomena of parabiosis in it.
In the development of vibration disease, significant importance is currently attached, in addition to vibration, to the influence of other factors with which vibration work is associated. These include “recoil”, static tension of the limbs, noise, cooling, etc.
The changes observed as a result of the impact of general vibration on the body are also mainly associated with reflexively developing vascular disorders (angiospasms). Exposure to general vibration causes neurodynamic changes that lead to disruption of the interaction between the cortex and subcortex. Young people and women are more predisposed to vibration disease.
Treatment of vibration disease
In case of vibration disease, which is a general disease of the body, it is necessary, first of all, to use restoratives, as well as methods that normalize the functional state of the central nervous system and help relieve the phenomena of vasospasm.
Courses of intravenous glucose infusions with ascorbic acid, ingestion glutamic acid 0.5 g 3 times a day, administration of bromine with caffeine, glycerophosphates, small doses of sleeping pills at night, pine baths, physiotherapy.
For vasospasms it is recommended subcutaneous injections 1% solution nicotinic acid 1 ml 2 times a day for 15 days, as well as vitamin B1 30 mg for 15-20 days. Significant benefit can be provided by the use of ganglion-blocking drugs (injections of 0.25% novocaine solution 5-10 ml intravenously for 10-15 days, oral administration of difacil 0.25 g 3 times a day for a month or administration of 1% difacil solution intramuscularly 10 ml with an interval of 2 days for 10 days). For local phenomena good effect They also provide massage of the limbs, warm baths, hand diathermy, paraffin, iontophoresis with sonicated naphthalan oil and other physiotherapeutic procedures. In severe cases of vibration disease, hospital treatment is necessary. Complex therapy provides the greatest effect for vibration disease.
Spa treatment can be of great benefit. Reinforced is recommended rich in proteins, vitamins and carbohydrates nutrition.
In the initial forms of vibration disease it is necessary temporary transfer to another job for the period of treatment. In severe and recurrent forms of the disease, it is recommended to transfer to another job that is not associated with exposure to vibrations, as well as cooling and straining the hands.
In these cases, the patient is subject to referral to VTEK to determine the group of professional disability.
Prevention of vibration disease
When hired for work involving exposure to vibration, in order to prevent vibration disease, workers must undergo a preliminary medical examination.
Persons suffering from nervous and endocrine system, circulatory system, peptic ulcer, vestibulopathy, hearing damage, those who have suffered frostbite on the hands, polyneuritis, polyarthritis, should not be accepted for work associated with exposure to vibration. For the purpose of early diagnosis of the disease, everyone working with pneumatic tools should be periodically subjected to medical examination, which should be carried out with the participation of a therapist, neurologist and otolaryngologist, and, if necessary, a gynecologist and radiologist with the necessary laboratory tests.
In order to prevent the development of vibration disease, sanitary and technical measures should be taken to reduce the vibration (recoil) of pneumatic tools, prohibit the presence of workers in vibrating installations, etc.
