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 kind 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 motions.
According to the method of transmission to a person, they distinguish:
The general vibration transmitted through the supporting surfaces to the body of a seated or standing person.
Local vibration transmitted through the hands of a person.
Numerous experimental and clinical studies of domestic and foreign scientists have established that under the influence of vibration in the human body, various pathological abnormalities develop, up to the development of a vibrational disease.
It has been proven to be a disease of the whole body, resulting from exposure to vibration and characterized by polysyndromicity. clinical manifestations. Vibration pathology occurs with damage to the nervous, 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 with damage to the conductors, both superficial and deep, including vibrational sensitivity. Prolonged irritation of peripheral receptors leads to the appearance of congestive foci of excitation in subcortical formations, the development of a parabiotic state in the neurons of the spinal centers and centers of the medulla oblongata. Various disorders of the autonomic nervous system with vibration disease are currently considered as a consequence of a violation of the cortical-subcortical relationships, an increase in the tone of the reticular formation of the trunk. Vibration pathology is accompanied by the defeat of adaptive-trophic and neurohumoral regulation mainly from the side of the sympathetic division of the autonomic nervous system. One of the first pathogenetic mechanisms of VP is an increase in venous resistance and impaired venous outflow with 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 adrenoreceptors 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) that affect the activity of skin receptors is disrupted. There are violations of the hypothalamic-pituitary-adrenal system, the pituitary-gonadal system. With severe manifestations of the WB, a change in immunological parameters was noted, in particular, a violation of functional activity T and B lymphocytes. The development of autoimmune reactions can contribute to the progression of the disease.
A certain importance in the pathogenesis of WB is a violation of the supply and utilization of oxygen by tissues. Oxygen imbalance exacerbates microcirculation disorders, contributes to 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 in WB, importance is attached to physical stress, microtraumatization, and recoil phenomena from a vibrotool.
Thus, according to modern concepts, the pathogenetic mechanism of WB formation includes both local damage to tissue structures that provide homeostatic regulation of tissue metabolism, and disruption of the 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 WB depends on the nature of the vibration, the duration of action, the place and area of contact between the worker and the vibrating tool. The characteristic of the working tool, as well as the accompanying adverse factors, intense noise, local and general cooling, long-term static stress, functional overvoltage, uncomfortable posture. More susceptible to the effects of facial vibration young age.
Currently distinguished:
vibration disease from exposure to local vibration,
vibration sickness from exposure to general vibration.
Vibration disease from exposure to local vibration
At present, there are more than one hundred types of manual mechanized tools of percussive, percussive-rotary and rotational action used in metalworking, metallurgical, construction, aircraft and shipbuilding, mining industries. In particular, sources of vibration in the machine-building industry are chipping and riveting hammers, cleaning, grinding and polishing machines, drills, wrenches, and in construction - jackhammers, concrete breakers, etc.
The action of local vibration causes characteristic local vegetative, vascular, sensory and trophic disorders on the hands. General neuro vascular disorders, as a rule, are caused by an unfavorable vascular background with a tendency to generalized reflex reactions or other production conditions: noise, neuro-emotional overstrain. General vascular reactions are nonspecific manifestations of the disease.
In contrast to foreign classifications (Taylor and Palmera, 1977; 1986; Ring and Cornish, 1983), in addition to angiodistonic syndrome (the phenomenon of "dead" fingers or Raynaud's syndrome, or traumatic vasospastic disease), domestic authors in the classification distinguish neurovascular, muscle and bone articular 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 impact of local vibration:
Initial manifestations (I degree)
1. Peripheral angiodystonic syndrome of the upper extremities, including rare angiospasms of the fingers.
2. Syndrome of sensory (vegetative-sensory) polyneuropathy upper limbs.
Moderate manifestations (grade II)
1. Peripheral angiodystonic syndrome of the upper extremities with frequent angiospasms of the fingers.
2. Syndrome of vegetative-sensory polyneuropathy of the upper extremities:
a) with frequent angiospasms 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 cervical-brachial plexopathy;
e) with cerebral angiodystonic syndrome
Severe manifestations (III degree)
1. Syndrome of sensory-motor polyneuropathy of the upper extremities.
2. Syndrome of encephalopolyneuropathy.
3. Syndrome of polyneuropathy with generalized acroangiospasms.
clinical picture. The initial manifestations (I degree) of the disease occur in the form of peripheral angiodystonic syndrome or sensory syndrome (vegetative-sensory) polyneuropathy of the hands. The disease begins gradually with transient paresthesia (feeling of numbness, tingling, crawling), unexpressed aching pain in the distal parts of the hands, 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, performing heavy physical work. With sufficiently long breaks in work, the discomfort in the hands disappears.
Unsharply pronounced 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 dryness of the palms, with capillaroscopy of the nail bed, a spastic-atonic state of the capillaries is observed, on rheovasography, a mildly pronounced decrease in pulse blood filling, according to occlusal 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 with general or local cooling. Acroangiospasm develops either on both hands at the same time, or first on the arm that is more exposed to vibration. For the first time, it usually appears in the cold season with general cooling: a sudden whitening of the tips of one or more fingers, except for the first one, lasts several minutes, then is replaced by cyanosis, which may be accompanied by paresthesia. With the progression of the pathological process, angiospasm spreads to other phalanges and fingers, appears on the other hand. AT initial stage disease Raynaud's vibration 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, hyperesthesia of the fingers sometimes develops, soon giving way to hypesthesia. The zone of decreased sensitivity gradually extends to the hand and forearm. Trophic disturbances in this stage of the disease are usually limited to abrasion of the skin pattern and hyperkeratosis of the palms.
Moderate manifestations (II degree) diseases are 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 upper extremities become more constant throughout the day and quite persistent. Getting worse after work and at night, they often disturb sleep. During the vacation and course treatment, discomfort in the hands usually decreases significantly, but does not completely disappear.
The severity of peripheral vegetative-vascular, sensory and trophic disorders is increasing. There is cyanosis and hypothermia of the hands, hyperhidrosis of the palms. In some patients, swelling of the fingers and (less often) of the hands, stiffness of the fingers appear in the morning, which, together with pain and paresthesia, usually disappear or decrease significantly soon after the start of work. Cold angiospasm of the fingers easily develops even with moderate cooling, for example, when washing hands cold water and sometimes spontaneously. An attack of angiospasm can capture all fingers. However, whitening of the thumb is quite rare due to its higher blood supply.
Peripheral vegetative-vascular disorders with moderate manifestations of vibrational pathology do not develop independently, but are part of the syndrome of vegetative-sensory polyneuropathy of the upper extremities. At the same time, a further increase in the threshold of vibration sensitivity, a decrease in pain sensitivity are observed not only in the distal, but also in the proximal parts of the limbs.
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. Nail plates can be in the form of watch glasses, flattened, sometimes concave inward. Often they are flattened or thinned, dull, longitudinally striated, brittle.
Dystrophic disorders are manifested 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, interphalangeal joints. Aseptic necrosis of the carpal bones (lunate, scaphoid) develops much less frequently. The syndromes under consideration are usually formed with a long work experience under the influence of vibration in combination with significant static-dynamic stress. This fully applies to the syndrome of cervical-brachial plexopathy, which is currently observed extremely rarely, is characterized by unilateral localization and can sometimes be accompanied by mild radicular symptoms. Patients have shoulder pain shoulder joint, suprascapular region, sometimes with irradiation throughout the arm. Painful top point Erba, suprascapular, axillary. Upper Lasègue's 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 vegetative dysfunction can be observed even in the initial stages of vibration disease. As the process progresses, irritability, fatigue, headache, sleep disturbances, cardialgia increase significantly in some patients, dizziness, pulse lability and blood pressure etc. The examination reveals changes in the vessels of the fundus, disorders of cerebral hemodynamics (according to rheoencephalography, transcranial Dopplerography, electrical plethysmography). In such cases, cerebral angiodystonic syndrome can be diagnosed.
Thus, for the II degree of vibration disease, the most characteristic is the aggravation of the clinical manifestations of the syndrome of vegetative-sensory polyneuropathy of the upper extremities, a significantly pronounced peripheral angiodystonic syndrome, persistent vegetative-trophic disorders on the hands, and frequent angiospasms 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 hands, and a decrease in strength in them. At the same time, hypotrophy of the muscles of the hands, 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 angiospasm is observed with its appearance not only on the hands, but also on the toes. In such cases, a polyneuropathy syndrome with generalized acroangiospasm is diagnosed. The development of this syndrome is possible with a long work experience under conditions of intense high-frequency vibration, especially in combination with hand cooling or general cooling.
vibration sickness- a disease caused by prolonged exposure to vibration. Symptoms. Treatment. Prevention.
Vibration is a mechanical oscillatory movement that repeats at regular intervals. The main parameters of vibration are the frequency and amplitude of oscillations, 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.
exposed to vibration excavator drivers, 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 lesion occurs - vibrotrauma, which is clinically manifested by a violation of the functions of the inner ear, concussion and changes in other organs and tissues.
Vibration disease symptoms
Clinical symptoms vibration sickness consists of peripheral neurovascular disorders and trophic disorders in the muscles and bones of the limbs, shoulder girdle. The disease develops after 3-15 years of work 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 the impact of local or general vibration). Characterized by complaints of chilliness, paresthesia of the extremities, discoloration of the skin of the fingers on cooling (they turn white or become cyanotic), 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 pastosity of the hands with stiffness of the fingers. With progression vibration sickness the frequency and duration of angiospasms increase. When exposed to general vibration, there is a decrease in the pulsation of the arteries on the rear of the feet and legs. characteristic symptom is an increase in the threshold of vibration, pain, temperature, less often tactile sensitivity. Violation of sensitivity has a polyneuritic character. As the disease progresses, segmental hypalgesia and dystrophic disorders of the musculoskeletal system are revealed. Along with pain, in the muscles of the limbs and shoulder girdle, seals, heaviness, and focal crepitus are determined. With prolonged (15 years or more) exposure to general vibration (most often for tractor drivers, bulldozer drivers and excavators) often occur dystrophic changes in the spine (osteochondrosis, deforming osteoarthritis of the lumbosacral, less often cervicothoracic) with secondary radicular syndrome.
Peripheral neurovascular and trophic disorders are often combined with functional changes in the central nervous system, which manifest themselves as cerebral angiodystonic or neurasthenic syndrome. These disturbances are most pronounced in vibration sickness due to the effect 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 - moderately pronounced manifestations;
- III degree - pronounced manifestations.
Vibration disease I degree proceeds asymptomatically. Patients complain of mild pain, chilliness, paresthesia of the hands. There are mild sensitivity disorders in the terminal phalanges (hyper- or hypalgesia), a slight decrease in vibration sensitivity, a slow recovery of the temperature of the skin of the fingers after cooling, a change in capillary tone. Angiospasms are rare.
With vibration disease II degree the intensity and frequency of manifestations of the disease are increasing. Disorders of sensitivity, especially vibration, become more pronounced.
vibration sickness III degree meets seldom, differs in sharp vasculomotor and trophic disturbances. Peripheral angiospasms become frequent. The intensity of sensitivity disorders, paresthesias and pain. Vibration sensitivity is sharply reduced, hypesthesia has a segmental character. Expressed symptoms of asthenia.
The diagnosis is established on the basis of anamnesis, sanitary and hygienic characteristics working conditions, a combination of clinical manifestations, as well as indicators of microcirculation, a cold test, determining the threshold of vibration and pain sensitivity, skin thermometry, etc. With capillaroscopy of the nail bed, spastic atony of capillaries is observed, less often their atony or spasm. X-rays show bulges nail phalanges, thickening of the diaphysis and compact substance of tubular bones, thickening of the trabeculae of the spongy substance, metaepiphyses of the phalanges, metacarpal and metatarsal bones.
Differential diagnosis is carried out with Raynaud's disease and other angiotrophoneurosis, syringomyelia, polyneuropathies (alcoholic, diabetic, etc.), vertebrogenic pathology nervous system.
Vibration Disease Treatment
Treatment vibration sickness includes drug, reflex therapy and physiotherapy. Ganglioblockers, vasodilators, drugs that improve trophism and microcirculation (angioprotectors, ATP, phosphaden, complamin, trental, B vitamins) are shown. Effective chamber galvanic baths with emulsion naftalan oil, electrophoresis of novocaine, heparin on the hand, diathermy, UHF and UV irradiation on the cervical sympathetic nodes, diadynamic currents, ultrasound with hydrocortisone, massage, exercise therapy, acupuncture and laser therapy. Favorable effect is mineral water(radon, carbon dioxide, 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 working capacity of patients with vibration sickness I degree is usually saved. 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 the period next vacation recommended Spa treatment(Pyatigorsk, Evpatoria, Nalchik, etc.). In case of vibration disease II and III degree, patients should be transferred to work not associated with exposure to vibration, cooling and overstrain of the hands; need repeated courses treatment. Patients with vibration disease II degree remain able-bodied, which allows them to be rationally employed. Persons of young and middle age (under 45 years old) who do not have additional qualifications are recommended to be sent for retraining. With vibration disease of the III degree, the professional and general working capacity of patients is steadily reduced.
Prevention of vibration disease
The main prevention vibration sickness is the maximum possible reduction of 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, corresponding to sanitary and hygienic standards and vibration safety. It is necessary to constantly monitor vibrating installations and carefully test the vibrating tools put into operation, taking into account the limit acceptable level vibrations.
Great importance in prevention vibration sickness It has proper organization labor. The time of work with vibrating tools should have strictly limited intervals. Take 10-minute breaks after every hour of work; a lunch break is obligatory, and two breaks are also required for a complex of industrial gymnastics and physiotherapy procedures (for 20 minutes 2 hours after the start of the shift and for 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 - 2/3 of the entire working time. After work, physiotherapeutic procedures are recommended: taking a shower (fan or Charcot type), warm baths for hands, massage of the upper limbs.
For the purpose of prevention vibration sickness conduct courses of ultraviolet irradiation in suberythemic doses. Vitaminization, 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, neuropathologist, otolaryngologist. Contraindications for employment with exposure to vibration are endocrine diseases, lesions of the vestibular and auditory apparatus, diseases of cardio-vascular system, nervous system, gastrointestinal tract.
The impact of general vibration is mainly exposed to agricultural machine operators, truck drivers, excavator drivers, pile drivers, etc.
WB classification from the action of general vibration was approved in 1982. It is built according to the 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 extremities.
Moderate manifestations:
1) cerebral-peripheral angiodistonic syndrome,
2) syndrome of sensory (vegetative-sensory) polyneuropathy in combination:
a) with polyradicular disorders (polyradiculoneuropathy syndrome),
b) with secondary lumbosacral radicular syndrome (due to osteochondrosis of the lumbar spine),
c) with functional disorders of the nervous system (neurasthenia syndrome)
Expressed manifestations:
1) syndrome of sensory-motor polyneuropathy,
2) syndrome of dyscirculatory encephalopathy in combination with peripheral polyneuropathy (encephalopolyneuropathy syndrome).
clinical picture. Modern production is characterized by relatively low levels workplace vibrations with a predominance of the low-frequency vibration spectrum.
Grade 1 disease includes unstable cerebral or peripheral neurovascular disorders. PADS is characterized by intermittent and moderate paresthesia and pain in the lower extremities, sometimes cramps of the calf muscles. On examination, there is slight cyanosis or marbling, hypothermia of the feet, hyperhidrosis of the soles, decreased perception of vibration and pain sensitivity on the toes. Increased pain and paresthesia in the feet and legs, the severity of peripheral vegetative-vascular disorders, a decrease in surface sensitivity (especially pain) of the polyneuritic type, mainly in the distal lower extremities, are the basis for establishing the lower extremity VSP syndrome. A clear predominance in clinical picture sensory disturbances indicates sensory polyneuropathy of the lower extremities.
The presence of cerebral angiodystonic syndrome is indicated by mildly pronounced symptoms of a neurasthenic or asthenoneurotic nature (periodic headache, irritability, fatigue, sleep disturbance) in combination with autonomic dysfunction (lability of the pulse, blood pressure with a predominance of hypertension, sweating, impaired dermographic reaction, etc.).
Vegetative-vestibular disorders are manifested by motion sickness syndrome, dizziness, staggering when walking and in the Romberg position, intermittent horizontal nystagmus, and increased vestibulo-vegetative reactions during vestibular loads.
One of the variants of moderate manifestations of the disease is the simultaneous development of cerebral and peripheral angiodistonic disorders, which is regarded as a cerebral-peripheral syndrome. At the same time, 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 the RCA 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, a secondary lumbosacral radicular syndrome develops due to osteochondrosis of the lumbar spine. This is explained by the fact that aperiodically arising as a result of vibration shocks that drivers of heavy 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 can be observed, proceeding according to the type of neurasthenia. These changes are usually accompanied by vegetative-vestibular disorders.
Workers exposed to general vibration often exhibit dysfunction of the digestive glands, impaired 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 the prolapse of organs. abdominal cavity and irritation of the celiac plexus under the influence of vibration.
With the combined effect of general and local vibration, a complex symptom complex is formed, consisting of a combination of syndromes characteristic of WB from the impact of local and general vibration. This form diseases occur, for example, in those working on vibroconsolidation of concrete, drillers-miners, when not only limbs, but also all supporting surfaces are exposed to vibrations.
Diagnosis of vibration disease. Early diagnosis of WB is carried out at periodic medical examinations. At the same time, attention is drawn to characteristic complaints, objective examination data, indicators of the tuning fork, cold test and dynamometry. Each specialist participating in the PMO must carefully describe the complaints, objective data in medical card. If necessary, an outpatient follow-up examination is prescribed.
In a polyclinic, it is possible to perform rheovasography, electromyography, electroencephalography, rheoencephalography, radiography of the musculoskeletal system.
Diagnosis of WB in the center of occupational pathology 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 the systematic impact on the worker of vibration exceeding the MPD. The work operations performed by the patient are taken into account, the nature various sources vibration and its main parameters. In addition, you should have information about other adverse professional 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 means protection;
anamnesis of the disease: typical complaints, gradual development of the disease and a significant improvement in the patient's condition with more or less long breaks in work (during vacation, course treatment and use of additional sick leave,
objective examination - a thorough description of the status of localis (assessment of the state of peripheral blood supply: skin coloration of the palms, hypothermia of the hands, hyperhidrosis, sometimes dry palms, the presence of trophic disorders in in the form of hyperkeratosis, changes in the nail plates, etc.),
symptoms: “white spots” (the patient tightly squeezes the hands into a fist and after 5 seconds quickly unclenches them. Normally, the formed white spots on the palms and fingers should disappear after 5 seconds, but if the traces of whitening last longer, the test is considered positive).
Bogolepova (a person who stretched his arms forward is offered to raise one of them and lower the other for 15 seconds, and then stretch them horizontally again. The color of both hands is normally restored after 15 seconds. If the peripheral circulation is disturbed, 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 both arms of the patient are raised with a quick movement, while the pulse may disappear from one or both sides for a few seconds. Such a test is assessed as positive).
clinical and functional research methods to assess the functional state of the peripheral and central blood supply, peripheral nerves, determine the thresholds of vibration and pain sensitivity, etc. So, the study of vibration sensitivity is carried out on devices VCh or VT, as well as on a vibrothermal analyzer and using a tuning fork test. Algesimetry is used to study pain sensitivity. Peripheral vascular disorders are studied using capillaroscopy, rheovasography, thermal imaging, as well as a cold test with the determination of the temperature recovery time 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.
Vibration disease treatment. The etiological principle of therapy provides for the exclusion of the impact on the body of vibration and such adverse production factors as cooling, physical overstrain. Pathogenetic therapy is aimed at normalizing peripheral circulation, eliminating foci congestive arousal etc. The goal of symptomatic therapy is the normalization of polymorphic reflex disorders, etc. The most effective is the complex treatment of patients with the use of drugs, physical and reflex methods.
With angiospasms, vasodilators are recommended (nicotinic acid, halidor, trental (pentoxifylline), drugs that improve the rheological properties of blood (reogluman, reopoliglyukin). pain syndrome, combined with neuro vascular disorders, shows the use of ganglioblockers in combination with small doses of anticholinergics and vasodilators.
To improve microcirculation processes (correction of oxygen balance, collagen metabolism, etc.), injections of ATP, pyridoxine, angiotrophin, and ascorbic acid are indicated.
With severe pain syndrome, the complex of therapy should include injections of vitamins B 1 and B 12, non-steroidal anti-inflammatory drugs (indomethacin, ortofen, etc.), novocaine blockades. In the complex of treatment, the use of biostimulants, adaptogens is practiced.
Physiotherapeutic methods of treatment: phonophoresis with analgesic mixtures, amplipulsotherapy, electrophoresis of 5% solution of novocaine, 1% solution of analgin or 1% solution of papaverine on the limbs, applications with 25% solution of dimexide, electrophoresis with peloidin, laser therapy of brushes, paraffin-ozocerite applications, 2- and 4-chamber baths, CMT on the cervicothoracic segments of the sympathetic nervous system, reflexology, circular shower.
Balneotherapy is of great importance in the treatment of vibration disease. Favorable effect on the course of the disease is provided by hydrogen sulfide, iodine-bromine, nitrogen-thermal baths, mud applications.
Employability examination. Issues of examination of working capacity in case of vibration disease are solved taking into account the stage, the leading clinical syndrome, the characteristics of the course of the disease, the presence of concomitant diseases, and the effectiveness of treatment.
The main reasons for the decrease in the working capacity of patients with VD are persistent pain syndrome, a decrease in hand strength and endurance to static force, frequent and long-term angiospasms of the fingers, and pronounced peripheral vegetative-vascular disorders.
With the first degree of WB, there is a temporary disability (full - sick leave, partial - additional paid sick leave). A lasting therapeutic effect hospital treatment in a specialized department of occupational pathology or a neurological department, recovery in a sanatorium-dispensary, subject to the temporary transfer of the patient for a period of 1-2 months to work outside the impact of vibration of physical overvoltage and cooling, with the issuance of an additional sick leave. DBL is issued as a BL, only “labor” is indicated on top, it is extended every 10 days by a neurologist indicating the dynamics of the pathological process. During the calendar year, DBL is issued for 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, annually in the conditions of 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 (thermal and cold) sensitivity on a vibrothermoanalyzer, rheovasography, electroencephalography, etc. are prescribed. If necessary, patients are consulted by an angiosurgeon, traumatologist (orthopedist).
Therapeutic measures are carried out 2 times a year, taking into account the syndromes and the degree of WB. One course is carried out in the department of occupational pathology, the second - in a medical institution or in a sanatorium-dispensary of the enterprise.
Persons with residual manifestations of WB are subject to dispensary observation according to the same scheme. With the disappearance of signs of WB, they are considered practically healthy in the absence of concomitant diseases. These persons are able-bodied in a wide range of professions, except for vibrational ones. Returning to your previous job is not advisable, especially at the age of 45 and older, because. they may have an early development of vibrational pathology.
According to Order No. 90 of the Ministry of Health and the RF Ministry of Health, periodic medical examinations for persons working in contact with local vibration are carried out once a year and once every 2 years when the maximum general vibration limit according to the “Sanitary Standards ...” is exceeded. The frequency of examinations in the center of occupational pathology is 1 time in 3 years (local vibration), 1 time in 5 years (general vibration).
Additional medical contraindications for work in contact with local and general vibration:
Obliterating diseases of the arteries, peripheral angiospasm,
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 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 oscillations with a wide frequency range. The nature of its impact 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 region from 8 to 1000 Hz. According to the prevailing energy, low-frequency (8-16 Hz), mid-frequency (16-64 Hz) and high-frequency (64-1000 Hz) regions can be distinguished.
vibration sickness- complex pathological changes observed in persons systematically exposed to vibration. In this case, there is a combination of a direct irritating and damaging effect of vibration on nerve endings and perivascular plexuses with reflex influences (sensitive-vegetative reflexes) and parabiosis phenomena that develop in the central nervous system at its various levels.
Clinical picture
The clinical picture of vibration disease is determined not only by the frequency characteristic of vibration, but also by the place of its application, the characteristics of the profession, the presence of concomitant 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 place 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 action of low-frequency vibration and shocks.
Vibration disease from the "local" action of vibration is observed in people working with various manual vibrators of shock and rotational action at frequencies from 8 to 150 Hz and higher (in the metalworking industry - choppers, chasers, riveters, locksmiths working with grinders, moulders; in the mining industry - drillers, sinkers, as well as a number of other professions).
The clinical picture consists of symptoms of vegetative polyneuritis and angiodystonia phenomena with a predominant tendency to spasm of peripheral vessels and desolation of capillaries.
Vibration of low frequencies (8-20 Hz) causes mainly the phenomena of vegetative polyneuritis and lesions of bones and joints, vibration of higher frequencies - angiospastic syndrome (attacks of whitening of the fingers). However, most often there is a combination of those and other symptoms.
Symptoms
Typical complaints: attacks of whitening of the fingers (mainly during cooling), night pains and paresthesias in the hands (feeling of numbness, "goosebumps" in the fingers).
Objective symptoms: cyanosis and hypothermia of the hands, slight swelling of the fingertips, excessive sweating palms and fingers. Positive "symptom" white spot". White spots that form on the palm and fingers after a strong clenching of the latter into a fist (within 5 s), after straightening them, they last longer than 10 s. Positive Pal's symptom (disappearance or asymmetry of pulsation radial arteries when the patient's hands are quickly lifted up). Bogolepov's positive 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 the fingers, solid or spots, after lowering the patient's hands into water at 10-12°C for 3 minutes).
With capillaroscopy of the nail bed, there is a violation of capillary tone, as well as changes in vascular permeability.
The data of plethysmography, oscillography and rheovasography indicate a violation of the regulation of the tone of large vessels in the shoulder and forearm, which is expressed in the asymmetry of their indicators and impaired blood flow velocity.
Disorders of sensitivity occupy a significant place in the clinical picture.
Vibration sensitivity suffers especially, a decrease in which is already observed in early stages diseases.
Pain sensitivity is most severely disturbed, to a lesser extent - temperature, and even less - tactile. Musculo-articular feeling, 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 the 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 violations of skin trophism and subcutaneous tissue brushes, nails, interphalangeal joints. X-rays reveal violations of bone trophism. The disease usually occurs against the background of general autonomic dysfunction or neurasthenic syndrome. In rare cases, an organic lesion may develop spinal cord tina syringomyelia or lateral sclerosis.
Vibration, or shaking, is an oscillatory movement that repeats itself after a certain period of time. The main quantities that characterize vibration are the frequency of oscillations per second (hertz), the amplitude of oscillations and the energy of vibration, measured in kilogrammeters. Vibration is perceived by a person through contact. The most sensitive to vibration are the fingertips and the arch of the foot. A person perceives mechanical vibrations as vibration at their frequency from 25 to 8192 Hz, vibrations with frequencies less than 25 Hz are perceived as shocks.
Who gets vibration sickness?
The national economy is currently widely used tools, machine tools and machines, the work of which is accompanied by vibration. Vibrations are mainly exposed to persons working with pneumatic and power tools (riveters, chippers, drillers, polishers, grinders, etc.). Vibration encountered in production is conventionally divided into general and local (local).
The changes that occur in workers exposed to the so-called local vibration have been studied in the most detail. When working with pneumatic tools (jackhammers, perforators, etc.) and when processing parts on rotating mechanisms, it is mainly the upper limbs that are subjected to shock. However, in the course of some work, for example, when vibrocompacting concrete, workers in some cases have to be on vibrating platforms and, therefore, be subjected to general vibration. General vibration is also experienced by many motor transport workers. It must be borne in mind that even in professions where workers are exposed to local vibration, concussions occur not only in the working limb, but also in other parts of the body.
The effect of vibration on the body
Vibration frequencies and amplitudes are of the greatest biological importance. With a high frequency and low amplitude, vibration affects mainly the nerve endings in the tissues. Vibration of low frequency and large amplitude mainly causes irritation vestibular apparatus and body displacement.
A certain relationship between physical characteristic vibrations and biological action. Vibration disease is caused by vibrations with frequencies above 35 Hz, and the higher the frequency of vibration and the greater the amplitude, the faster the disease develops. The normalization of the vibration factor in production conditions is carried out primarily taking into account these values.
Vibration, which is an irritant of the nervous system, can, under certain conditions, also have some positive influence on the body due to the functional shifts that 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 therapeutically.
However, with prolonged exposure certain types vibration on the body in adverse conditions, a vibration disease can develop, which is expressed in serious violations from the side the most important organs and systems (nervous system, circulatory apparatus, etc.).
The changes resulting from the impact of local vibration on the body were first described in 1911 by the Italian Loriga, who found in stonemasons working with pneumatic tools pronounced changes in the form of an angiospastic syndrome mainly in the “working” hand: “the phenomenon of dead fingers”.
Vibration disease symptoms
With vibration disease caused by exposure to local vibration, clinical phenomena usually develop gradually and are observed predominantly in workers with significant work experience associated with vibration. Patients complain of stupid, aching pain in the hands, more pronounced in the working hand, forearm, sometimes in the interscapular region, to a feeling of numbness and stiffness in the hands, fatigue of the hands during work.
Pain, as a rule, occurs outside of work, most often at night, and subsides after the start of work. There is a significant decrease in the sensitivity of the hands, as a result of which the patient is deprived of the opportunity to feel small items and do fine work. The hands become chilly, a tendency to spasm of the vessels of the extremities develops, which is most often detected when exposed to cold, as well as other irritants. Patients often indicate whitening of the fingers from the cold, more often from general cooling.
Along with the above disorders, patients complain of headaches, fatigue, irritability, bad dream.
Differential diagnosis of vibration disease
During the examination, swelling of the fingers, often swelling of the hand, cyanosis attracts attention. skin, hypothermia and sweating of the hands, limited mobility, thickening and deformity of the interphalangeal joints, abrasion of the finger pattern, hyperkeratosis, nail changes. Capillaroscopy at high frequencies of vibration marks a tendency to spasm, at low frequencies spastic-atonic phenomena predominate. Sometimes there is a decrease in muscle strength, hand tremor, lethargy of tendon reflexes.
A decrease in pain, vibration, temperature and tactile sensitivity is very characteristic.
In the skeletal system, it is determined: osteoporosis, sclerosis of the bones of the hand and wrist, 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 due to developing dystrophic processes. In a severe form 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 limbs.
In addition to the changes described above on the part of the working hand, which in the literature are called angioedema of the upper extremities, or vegetative 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 apparatus and gastrointestinal tract. Patients have autonomic dysfunction with angiodystonic phenomena, arterial hypotension, bradycardia and the phenomena of myocardial dystrophy.
On the electrocardiogram, there is 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 with vibration disease are expressed in violation of the motor and secretory function of the stomach (decrease in acidity gastric juice and peristalsis of the stomach). In advanced stages of the disease, 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 proceed in phases: at first, spastic phenomena predominate, then paretic ones. Paleness and necrosis of the fingers - spasm of peripheral vessels - are the most important, but not the only symptom of this disease. As the vibration frequency increases, the vasoconstrictor action it, however, after vibration with a frequency of 250-300 Hz, angiospasm rarely appears. Therefore, with autonomic vibrational neuritis, angiospasm may be absent.
The changes described above various bodies and systems, caused by the influence of local vibration, give reason to attribute the described form of vibrational disease to the general suffering of the body.
Vibration sickness, caused by exposure to local vibration, can develop under adverse conditions as early as a few months after starting work. If you continue to work after the onset of symptoms of vibration disease and untimely implementation of therapeutic measures, the changes usually progress, which leads to pronounced and persistent disorders. Sometimes the effects of angiospasm, caused by exposure to local vibration, can persist and even progress after the cessation of work. Severe angiospasm can lead to gangrene. The rapid development of vibration disease in to a large extent depends on individual sensitivity. It is not necessary for all workers to get sick. Sometimes the manifestations 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 period of asymptomatic development of the disease refers to the first (initial) stage. At the same time, mild pains and mild sensitivity disorders (hyper- or hypesthesia) in the fingers can be observed periodically. 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 bouts of vasospasm and phenomena of "dead" fingers, the spasm is usually replaced by an atonic state of the capillaries and cyanosis of the fingers. With capillaroscopy, spastic-atonic phenomena are expressed. Disturbances of sensitivity are expressed also. They are often combined with changes in the muscles, the activity of the central nervous system (asthenic reactions), the cardiovascular and endocrine systems is disrupted. This stage of the disease can be observed in long-term workers who have been exposed to high-frequency vibration for a long time, more often in combination with exposure to significant recoil and other adverse 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 in the premorbid period from a certain insufficiency of the endocrine autonomic system.
Some cases of vibrational disease have to be differentiated from Raynaud's disease (in both cases, the main manifestation of the disease is bouts of whitening of the fingers).
The following signs speak in favor of vibration disease:
1) the development of the disease during the period of work in the "vibration" profession;
2) pain in the hands and paresthesia, not associated with bouts of whitening;
3) significant violations of sensitivity, especially vibration;
4) deformity of the fingers, hyperkeratosis, nail changes;
5) osteoarticular lesions, typical for vibration exposure;
6) muscular atrophy;
7) localization of the lesion, typical for this profession (earlier or more severe lesion of 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 superficial. With a vibrational disease, there is never a complete dissociation of sensitivity (partial - it can take place), the boundaries of sensitivity disorder are not sharp and do not exactly coincide with segmental zones. In addition, these boundaries can be unstable. Tendon reflexes are usually preserved. Attacks of whitening of the fingers for syringomyelia are completely uncharacteristic.
Under the influence of general vibration on the body, if health measures are not taken in a timely manner, serious changes can develop in various organs and systems, 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, and nausea. In patients, there is a decline in nutrition, increased muscle excitability, arterial hypotension, bradycardia, myocardial dystrophy, angiodystonic phenomena with a tendency to fainting 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 considerable intensity, diencephalic disorders come to the fore. In severe cases of the disease, attention is drawn to an increase in body temperature, asthenia, vestibular disorders, severe emaciation, baldness, increased gastric secretion, leukocytosis, a tendency to lymphocytosis, a violation of the basic, carbohydrate, fat and water metabolism.
Change in morphological and biochemical parameters blood, apparently associated with a violation of the central nervous regulation. In women suffering from vibration disease, hyperfunction is detected thyroid gland and menstrual irregularities. Young workers have cases of impotence.
In addition to functional disorders of the central nervous system (changes in the cortex and subcortical-diencephalic region), microsymptoms may occur, according to the available literature data. focal lesion hemispheres brain, brain stem and spinal cord.
Along with the described common phenomena local angioedema of the lower and upper extremities, changes in the peripheral nervous system and the musculoskeletal system can be observed.
Vibration disease in concrete workers, who are mainly exposed to general vibration, proceeds in a peculiar form. Compared with the usual form of vibrational disease, a much greater severity of general disorders is noteworthy.
The most characteristic is the general angiodistonic syndrome, against which vegetative crises are often observed. Often and outside of crises, individual diencephalic symptoms (sleep disturbance, impotence, subfebrile condition) are ascertained. In some cases, organic microsymptomatics are noted. From the side internal organs dystrophic changes in the heart muscle, disorders coronary circulation, secretory and motor function of the stomach and intestines, peptic ulcer.
Cholesterol metabolism is disturbed, in some cases the basal metabolism is significantly increased. 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 autonomic polyneuritis with a tendency to angiospasms, and in some cases damage to a motor peripheral neuron.
Vibration disease of concrete workers proceeds stubbornly, is difficult to treat, which significantly affects the working capacity of patients.
There are three stages of vibration disease of concrete workers:
The first stage is non-specific. There are complaints about headache, deterioration general well-being, moderate phenomena of autonomic dysfunction.
For the second stage, obvious angiodystonic phenomena of both peripheral and general, mild diencephalic syndromes, neurotic phenomena.
The third stage is characterized by clearly expressed diencephalic syndromes with impaired coronary circulation, severe asthenic condition with organic microsymptoms.
Under unfavorable conditions, the disease can develop during the first year of work. A previous infection can contribute to the occurrence of vibration disease.
Vibration disease pathogenesis
Some researchers explain the occurrence of angioedema by traumatizing the walls of capillaries, followed by the development of autonomic neuritis and local angiospasm.
However, as established by experiments and clinical and physiological observations, the mechanism of vibrational disease is very complex. Vibration disease caused by local vibration is a general disease of the body, in the development of which importance have, undoubtedly, reflex reactions, leading to the development of foci of congestive 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. Vibration-induced changes in the central and peripheral nervous system cause vascular and trophic disorders characteristic of vibration disease in the form of a peculiar trophoneurosis, which tends to generalize. Some authors believe that under the influence of vibration, irritations coming from the periphery into the central nervous system cause phenomena of parabiosis in it.
In the development of vibration disease at the present time, in addition to vibration, significant importance is attached to the influence of other factors that are associated with vibration work. These include recoil, static limb stress, noise, cooling, etc.
The changes observed as a result of the impact of general vibration on the body are also mainly associated with reflex developing vascular disorders (angiospasms). The impact of general vibration causes neurodynamic changes, leading to disruption of the interaction between the cortex and subcortex. Young people and women are more prone to vibration disease.
Vibration Disease Treatment
With vibration disease, which is a general disease of the body, it is necessary, first of all, to use restorative means, as well as methods that normalize the functional state of the central nervous system and contribute to the removal of the effects of angiospasm.
The courses of intravenous infusions of glucose with ascorbic acid, ingestion glutamic acid 0.5 g 3 times a day, the appointment of bromine with caffeine, glycerophosphates, small doses of sleeping pills at night, coniferous baths, physiotherapy.
Recommended for angiospasm 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 benefits can be provided by the use of ganglioblocking drugs (injections of 0.25% solution of novocaine 5-10 ml intravenously for 10-15 days, oral difacil 0.25 g 3 times a day for a month or the introduction of a 1% solution of difacil intramuscularly 10 ml with an interval of 2 days for 10 days). With local events good effect they also give massage of the extremities, warm baths, diathermy of the hands, paraffin, iontophoresis with sounded naftalan oil and other physiotherapeutic procedures. In severe cases of vibration disease, inpatient treatment is necessary. Complex therapy gives the greatest effect in case of vibration disease.
Spa treatment can be of great benefit. Reinforced is recommended rich in proteins, vitamins and carbohydrates food.
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 the VTEC to determine the group of occupational disability.
Prevention of vibration disease
In order to prevent vibration disease, workers must undergo a preliminary medical examination when hiring for work associated with exposure to vibration.
Persons suffering from a disease of the nervous and endocrine system, circulatory apparatus, peptic ulcer, vestibulopathy, hearing loss, who have suffered frostbite of the hands, polyneuritis, polyarthritis, should not be accepted for work associated with exposure to vibration. For the purpose of early diagnosis of the disease, all workers with pneumatic tools should be periodically subjected once a year to medical examination, which should be carried out with the participation of a therapist, a neuropathologist and an otolaryngologist, and, if necessary, a gynecologist and a radiologist with the necessary laboratory tests.
In order to prevent the development of a vibration disease, sanitary and technical measures should be taken to reduce the vibration (recoil) of pneumatic tools, prohibiting the stay of workers on vibrating installations, etc.
