Vibration disease
Doc. R.Bodnar
Vibration disease
Vibration disease is a professional
disease, the main etiological factor of which
is industrial vibration. The favourable
background for the development of the
disease there are the following concomitant
occupational factors of risk: noise, super
cooling, significant muscle tension of
shoulder, forced position of body.
VIBRATION
Usually vibration disease is met among
the
workers
of
machine
building,
metallurgical, aircraft, shipbuilding, mineral
resource industries, and also in transport
and agriculture. Mainly among those
workers, whose character of work is related
with the long influence of vibration during
the use of hand mechanic tools of percussion
action.

Use of a vibrating tool
for road breaking
The vibration
The vibration is the mechanic
oscillations that repeat periodically
and
are
characterized
by
the
frequency measured in hertz (Hz),
vibrovelocity (m/s) and amplitude
(cm).

Types of vibration




low-frequency (8 – 15 Hz),
medium-frequency (16 – 64 Hz),
high-frequency (more than 64 Hz).
Dangerous for the development of
disease is the vibration with the
frequency 16 – 250 Hz.
Vibration is usually measured in three
orthogonal directions at the interfaces
between the body and the vibrating surface
According to the character of
influence on the organism there is
-
local,
 - general,
 combined vibration.
Local vibration
During the local vibration the
transmission of mechanic oscillations
to the body is realized through the
arms. Most often this etiologic factor
we can be among the face-workers,
chasers, drillers, tunnellers, polishers,
grinders, wood-cutters.

Hand Arm Vibration
Syndrome
The sources of the general
vibration are
the
vibroplatform, the table vibrator,
the forming and concrete-laying
machines, the floor of weaving-mills,
agricultural
machines
(tractors,
combines),
excavators,
vehicles
(airplanes, helicopters, sea and river
ships).
Combined vibration
The
combined vibration is a combination of local
and general. For its turn, it can be with the
advantage of local influence during the work with
hand tools, when the transmission of vibration on
the worker’s body is realized not only through the
arms, but also through the legs, thorax, back and
other parts of body, depending on the posture
during the work and the construction of instrument.
In other cases the general influence can prevail, for
example, during the work on vibroplatforms with
simultaneous floating of concrete mix.
Pathogenesis of vibration disease.
Complexity
of
vibration
disease’s
pathogenesis is explained by the polymorphy
of clinic manifestations of the affection of
cardiovascular
and
nervous
systems,
articular and motor apparatus and also
metabolic process, in the foundation of
development of which lay the complicated
mechanisms
of
neurocirculatory,
neurohumoral,
reflex
and
regulatory
disorders.

Classification of vibration
disease:
 1.
From influence of local vibration.
 2.
From influence of “combined”
vibration
 3.
From influence of general
vibration
According to the intensity’s degree of
pathologic process symbolically mark
out 4 stages of disease:
 I – initial;
 II – moderately expressed (dystrophic
disorders);
 III – expressed (irreversible organic
changes);
 IV – generalized
Clinical syndromes:







1) angiodistonic
2) angiospastic
3) syndrome of vegetative polyneuritis;
4) syndrome of vegetative myofascitis
5) syndrome of somatic neuritis
(cubital, median), plexitis, radiculitis;
6) diencephalic with neurocirculatory
disturbance;
7) vestibular
Sensory decrement by the
peripheral type
Clinical picture
I stage – initial manifestations. This
stage is characterized by the appearance of
the peripheral angiodistonic syndrome or
sensory neuropathy of hands. Patients
complaint to a transient pain and
paresthesia. Disturbance of sensibility
mostly is observed in the area of distal
phalanxes. Trophic disturbances appear.
Sometimes can be acrospasm of fingers
that passes quickly. This stage is functional
and difficult for diagnostics. Capacity for
work is not disturbed.

Clinical picture
II stage – moderately expressed
manifestations. Characterized by more stable

pain syndromes, paresthesias and vascular
disturbances. A complaint is increasing. Pains and
paresthesias are longer. It is observed a change of
tone as of the great vessels as of capillaries.
Disturbance of sensibility is more expressed, the
trophic disturbances are increasing, and syndrome
of vegetative-sensory polyneuritis declares itself
together with the dystrophic disturbances of
locomotor system. It becomes difficult for patient
to fulfil his job.
Clinical picture

III stage – expressed manifestations.
Often attacks of angiospasm. Disorders of
sensibility not only of polyneurotic character.
Sudden reduction, and sometimes complete fallout
of
vibration
sensibility,
expressed
trophic
disturbances. The disease is accompanied by the
development
of
sensomotor
polyneuropathy,
encefalopolyneuropathy
with
generalized
acrospasm that changes by paresis of capillaries,
cyanosis of hands. Complications are possible. Ill
persons are disabled.
Clinical picture
 IV stage – generalized. Can be met
seldom, appear during the long progressing of
disease. Pathologic process is characterized by the
generalization of vascular disturbances as a result
of central nervous system’s affection, namely of
those sectors that regulate the activity of vascular
system. Such patients have vascular disorders not
only on hands, but also expressed on legs.
Vibration induced gangrene
Clinical picture of vibration
disease from local influence of
vibration
The vibration disease conditioned by the local
vibration more frequent meets among the
workers with the hand mechanized instruments.
The disease develops gradually, mainly at
workers with large experience of work (10 - 15
years).
 A clinical
picture is conditioned by
vegetative-vascular, neuromuscular, sensible
and trophic disturbances.

Low Vibration Tools
The most characteristic complaints are:
-sudden
appearance of attacks of albication of fingers
on the hands which arise up at local or general cooling
(symptom of dead fingers),
-dull aching of arms which disturbs patient at night
and in rest,
 -often pains are accompanied by paresthesias in the
form of numbness, feeling of formication,
general weakness, headache without clear
localization, dizziness, bad sleep, promoted irritability,
there can be complaints for the pain in the area of
heart.
Vascular disorders. More frequent they
show up violations of peripheral circulation of
blood, change of capillaries’ tone, violations of
general hemodynamics.

There is violation of sensibility by the
polyneurotic type. At the initial stages of
disease the decline of pain sensitiveness turns
out only on the ends of fingers, with progress of
illness there is the considerable decline of pain,
temperature and vibration sensitiveness as a
"jacket" or "semi jacket".

Trophic disorders show up hyperkeratosis
on the palms and lateral surfaces of fingers.
Quite often is observed an erasing of picture on
the skin, especially on distal phalanxes. Nails
are thickened, turbid, deformed or polished as
“watch crystals”.

Atrophy of muscles during
vibration diseases
Roentgenograms
can
reveal
ossific
formations and centers of osteosclerosis. In a
spinal column, the changes in intervertebral
disks and joints prevail, mainly of degenerativedystrophic character.

Main syndromes of vibration disease:
1. Angiodistonic - it is observed at influence
of high-frequency vibration in initial one and
moderately marked stages. Basic complaints on
pains in hands at night, paresthesias.
Objectively there are insignificant vegetative
vascular disorders (chilling and cyanosis of
hands, hyperesthesia on separate phalanxes.

Main syndromes of vibration disease:
2. Angiospastic syndrome - meets at I, ІІ and ІІІ
stage of vibration disease at influence of highfrequency and medium-frequency vibration. For this
syndrome the marked paresthesias and moderate arm
aches are typical, attacks of angiospasm of the type of
"white fingers". Objectively we find the reduction of
skin temperature on hands, the increase of the threshold
of vibration sensibility, disturbance of all types of
sensitiveness of the type of "gloves", spasm of
capillaries. The angiospastic reactions depending on
severity of disease can spread on lower extremities,
vessels of heart, cerebrum.

Main syndromes of vibration disease:
3. The syndrome of vegetative-sensory
polyneuritis arises up at influence of vibration of
different frequencies, meets at moderate and marked
VD. The syndrome is characterized by the intensive
pains and paresthesias in extremities, disturbance of
superficial sensitiveness after a polyneurotic type,
reduction of skin temperature, more expressed
vegetative disorders (chilling, hyperhidrosis, cyanosis
of hands)

Main syndromes of vibration disease:
4. Syndrome of vegetative myofascitis is
characterized by the combination of vegetative-sensory
polyneuritis with the dystrophic changes in the muscles
of shoulder (fasciculitis, myositis, fibromyositis) and
tendinous apparatus. A syndrome is characterized by
the presence of expressed pains and paresthesias in
hands, by the diminution of strength, by the dystrophic
changes in muscles and other tissues of locomotor
system, by the disorder of sensitiveness after a
polyneurotic and segmental types.

Main syndromes of vibration disease:
5. Syndrome of somatic nerves’ lesion
(neuritis, plexitis, radiculitis). Neuritis and
plexitis in pure form at influence of vibration
meet rarely; it is possible to speak about its
combination with other symptoms, typical for
VD, vegetative-sensory polyneuritis, vegetative
myofascitis.

Main syndromes of vibration disease:
6.
Diencephalic with neurocirculatory
disturbances. Cerebral symptoms develop on a
background of peripheral vegetative-vascular
and sensible disturbances, characteristic for VD
of long duration. Cerebral symptoms are
characterized by cerebral vasomotor and
vestibular disturbances, which are developed as
vegetative-vascular crises.
Main syndromes of vibration disease:
7. Vestibular syndrome - develops at
influence of general vibration. It is characterized
by dizziness, nystagmus, ataxy, vestibular
crises.

Vibration disease from
the influence of general vibration
Syndromes of vibration disease conditioned
by general vibration:
- cerebral-peripheral,
- angiodistonic,
- vegetative-vestibular,
vegetative-sensory polyneuropathy.
Diagnostics of vibration disease
The diagnosis of vibration disease is proposed
on the basis of the collected complaints,
anamnesis of disease and life, study of
professional route, sanitary and hygienic
description work conditions.

The typical additional
signs of vascular disorders
1.
Symptom of "white spot". You ask a patient to clench
firmly the fist of hand and through 5 sec quickly unclench it. In a
norm the white spots which appeared have to vanish in 5 sec. If
spots do not disappear quickly – the test is positive.
 2.
Pile’s symptom. A pulse is found on both radial arteries,
and then by rapid motion lift up the hands of patient. Thus a pulse
can vanish on a few seconds. Such test is positive.
 3.
Test on reactive hyperemia. You impose a cuff on a
shoulder and pump a pressure 180 - 200 mm of column of
mercury. Then ask to lift hands up, in 2 min. to put hands down,
take cuff off and write down time of hand’s reddening. In a norm
the reddening begins in 1,5 - 2 sec. and passes in 15 sec.
Lengthening of this time testifies to the spasm of vessels, and
shortening - about their atony.

The typical additional
signs of vascular disorders
4.
Test of Boholyepov. A patient stretches both hands with the
unbended fingers ahead. At that you pay attention on colouring of
skin, state of veins and capillary net of nail bed of fingers. Then a
patient lifts a right hand up, and put down a left on 30 sec. After it,
returns hands in previous position. We look after the change of
vein and capillary circulation of blood. Normally, the changes of
blood filling are normalized in 30 sec. At insufficiency of
circulation of blood, pallor or cyanosis, which arose up disappear
slower, than the more expressed is a disorder of peripheral
circulation of blood.

The typical additional
signs of vascular disorders
5.
Cold test. The hands of explored are dipped into a
cold water (+10°С) on 5 min. At albication of fingers
the test is considered positive. Pay attention on
prevalence and intensity of the process, mark the time
of renewal of skin temperature after cooling. Normally
it does not exceed 20 min. At patients with vibration
disease there is an acute deceleration of renewal of skin
temperature.
Capillaroscope
Diagnostic of sensory during
vibration disease
Diagnostic of sensory during
vibration disease
Medical treatment
During
VD conditioned by the influence of local
vibration, which flows mainly with neurovascular
disorders and pangs, are recommended
the ganglionic blockers (Gexameton,
Benzogexoniy),
small doses of central anticholinergic drugs
(Difacil, Aminazin, Amizil),
 and vasorelaxants (Nicotinic acid, No-shpa,
Novocaine).
For
medical treatment of asthenoneurotic syndrome indicate
sedative (valerian, Novopasit) and tonics, and also biogenic
stimulators (aloe, glutamic acid, plazmol, ginseng tincture,
eleuterococ).
 For the removal of pain syndrome: Analgin, nonsteroid
antiphlogistics (Ibuprofen, Voltaren, Indometacin, Butadion).
For the improvement of circulation (peripheral, coronal and
cerebral) of blood indicate the medicines which extend coronal
vessels and improve the cerebral circulation of blood: Devincan,
Vincapan, Apresin, Papaverine hydrochloride, Aprofen,
Cinarizin, Piracetam, Cavinton.
For the increase of the tone of parasympathetic
nervous system, reduction of disturbances at
vegetative-sensory polyneuropathy prescribe: Prozerin,
Oxazil, Galantamin.

For the improvement of microcirculation are
indicated: ATF, Parmidin, Riboxin, anabolic hormones
- Retabolil, Nerabol.

With the purpose of improvement of protein
metabolism prescribe: Unitol, Penicilamid.

A
good effect has application of medicines which normalize
vein tone: Venoruton, vein vasodilators - nitrates (Nitrosorbid,
Nitroglycerine), arterial vasodilators - Apresin, antagonists of
calcium - Nifedipin, Corinfar, Adalat.
 From
tonics is effective introduction of 40% s-n of glucose,
calcium gluconate, calcium chloride, preparations of bromine,
coffeine.
 Vitamins
B1, B12, B6, PP.
 Physiotherapy.
Prophylaxis
The contra-indications to the employment on
the work related with influence of vibration are the
chronic diseases of the peripheral nervous system,
obliterating endarteritis, Raynaud's disease, disease of
locomotor system, marked asthenic states, expressed
vegetative dysfunction, vagopaties with susceptibility
to angiospasms, stenocardia, arterial hypertension of ІІ
-III stages, disease of endocrine glands with stable
disturbance (saccharine diabetes), stomach and
duodenal ulcer, neuritis, polyneuritis, stable hearing
loss of any aetiology, otosclerosis, chronic diseases of
female breeding organs.

Periodic medical examinations are realized
not rarer once in 12 months with participation of
internist, neurologist, otolaryngologist. At the
inspection it is necessary to realize
capillaroscopy, measuring of skin temperature,
cold test, to explore a vibration, pain
sensitiveness, if necessary radiography of hands,
spine.
