Vibration disease is a disease based on pathological changes in the receptor apparatus and various parts of the central nervous system that occur with prolonged exposure to local and / or general vibration. The clinical picture may include polyneuropathic, angiospastic, angiodistonic, asthenic, vegetative-vestibular, polyradicular syndromes, functional disorders in the gastrointestinal tract and hearing loss. Disease is diagnosed by a comprehensive examination of the patient with thermometry, capillaroscopy, electromyography, ECG, cold test. The choice of therapeutic tactics is based on the syndromes prevailing in the clinical picture of the disease.
ICD 10
T75.2 Exposure to vibration
General information
Vibration sickness is of a professional nature. It develops in workers of manual mechanized labor associated with the use of percussion or rotational tools. Vibration disease is most often found among workers in the mining, construction, metallurgical, ship and aircraft construction, transport industries, as well as in agriculture. Professions that are at risk for the development include: drillers, polishers, stone cutters, grinders, asphalt pavers, stumpers, tram drivers, etc. The clinical symptoms that manifest depend on the frequency of vibration, its nature (general or local) and related factors (noise, forced body position, cooling, etc.).
Causes and mechanism
The main cause is the impact on the body of mechanical vibrations — vibrations. Vibration with a frequency of 16-200 Hz has the most adverse effect. Vibration disease develops faster when combined with the effects of vibration and other adverse working conditions. The latter include: the need to maintain an uncomfortable body position, noise, working in the cold, static muscle strain, etc.
Vibration affects all tissues of the human body, but nerve and bone tissue are most susceptible to it. First of all, vibration affects the peripheral receptors located in the skin of the hands and the plantar surface of the feet. Also, mechanical vibrations act on the receptors of the vestibular analyzer located in the ear labyrinth. High-frequency vibration has a noise-like effect on the auditory receptors. It stimulates the secretion of norepinephrine, an excess of which leads to a narrowing of the vascular lumen. Mechanical vibrations of low frequency (up to 16 Hz) cause motion sickness, which is observed among workers of various modes of transport.
Vibration disease develops as a result of the constant irritation of mechanoreceptors arising under the influence of vibration and deformation of the Vater–Pacini bodies, which leads to overexpression of the higher located nerve centers (sympathetic ganglia, spinal cord, reticular formation) and disruption of their functioning. Disorders of the central nervous system in vibration disease are primarily expressed in a disorder of vascular tone regulation with the development of angiospasm and arterial hypertension. As a result of angiospasm, trophic processes are disrupted mainly in the tissues of the musculoskeletal and neuromuscular apparatus. Thus, vibration disease has the character of angiotrophoneurosis, which can acquire a generalized character.
Classification
Clinical neurology uses a classification according to which vibration disease is divided into three forms: vibration disease when exposed to local vibration; vibration disease that occurs when exposed to general vibration; vibration disease when exposed to combined (local and general) vibration. There are also 4 degrees of severity of vibration disease: initial, moderate, pronounced and generalized. Generalized vibration disease is observed in extremely rare cases.
Symptoms
Vibration sickness from local vibration is observed mainly in workers dealing with hand tools. It is manifested by pulling, aching pains in the extremities that occur during the rest period and at night. Characteristic is the disappearance of pain in the hands after 10-15 minutes from the start of work with a vibrating instrument. Vibration sickness from local vibration is accompanied by paresthesia, which accompanies the pain syndrome and can be expressed in a feeling of crawling goosebumps on the skin, tingling or numbness. There is an increased chilliness of the hands or feet, paroxysmal whiteness of the fingers, especially in cold weather or in contact with cold water. In the case of woodcutters, woodcutters and workers of similar professions, whiteness of the fingers is observed on the left hand, and in sanders, polishers, etc. – on the fingers of both hands.
Vascular disorders are one of the leading ones in the clinic of this pathology. They are manifested by angiodistonic syndrome, peripheral angiospasm, hemodynamic disorders in the form of changes in systolic and minute volume of blood circulation, a drop or rise in blood pressure, vascular tone disorders and peripheral resistance. Often, vibration disease occurs with the clinic of neurocirculatory dystonia. In some cases, patients have latent hyperhidrosis.
Another leading syndrome, which is characterized by vibration disease from local vibration, is polyneuropathy. In the early stages of the disease, it can manifest itself in the form of increased sensitivity (hyperesthesia), then in the form of its decrease (hypesthesia). Moreover, depending on the severity of the vibration disease, sensitivity disorders affect only the fingers or extend further to the hands or feet according to the type of “gloves” and “golfs”. They are accompanied by trophic disorders in the form of hyperkeratosis, thickening and deformation of nails, less often — atrophy of small muscles of the hand.
In addition to local symptoms, vibration sickness from local vibration is accompanied by general malaise, increased irritability, sleep disturbance, dizziness, diffuse headache. Possible heart pain, tachycardia, epigastric pain. Functional disorders of the central nervous system, with which vibration disease occurs, are manifested mainly by asthenia, neurasthenia and vegetative-vascular dystonia. Cerebral angiospasm may occur. With the combined effects of vibration and noise, cochlear neuritis develops, leading to varying degrees of hearing loss.
Symptoms
Vibration sickness from general vibration develops in drivers, as well as in those working on various machine installations. As a rule, the onset of the disease occurs in the 5th-7th year of such work activity. Vibration disease from general vibration is characterized by a gradual onset with nonspecific vegetative-vascular disorders of a cerebral and peripheral nature. There are short-term headache, excessive sweating, pain in the extremities. In the initial period, there is an angiodistonic syndrome and a sensory type of polyneuropathy of the lower extremities. Already in the early stages, disturbances in the work of the central nervous system occur. They are manifested by increased irritability, sleep disorders, fatigue and general malaise. There may be dizziness, tremor of the eyelids, trembling of the fingers of outstretched hands, sometimes anisoreflexia (difference in tendon reflexes on the right and left sides).
Vibration disease differs from general vibration in the predominance of vegetative-vestibular syndrome, manifested by nausea, motion sickness and non-systemic dizziness. Moderate vibration disease is often characterized by a combination of vegetative-sensory type polyneuropathy with polyradicular syndrome. In severe vibration disease, polyneuropathy is sensorimotor in nature and is accompanied by dyscirculatory encephalopathy, less often diencephalic disorders. In some cases, vibration disease is accompanied by a disorder of the secretory and motor functions of the stomach, a violation of the digestive glands. In women, vibration disease from general vibration can occur with menstrual cycle disorders in the form of menorrhagia and algomenorrhea, exacerbation of existing inflammatory diseases (adnexitis, colpitis, endometritis, salpingoophoritis).
Diagnostics
Vibration disease is diagnosed by the joint efforts of a neurologist and a therapist. Additional consultations of a cardiologist, vascular surgeon, gastroenterologist, otolaryngologist are often required. During the examination, attention is paid to the skin color of the distal extremities, vibration and pain sensitivity are carefully studied, the state of the muscular, bone and joint apparatus and the cardiovascular system are analyzed. Thermography, electromyography, electrocardiography, capillaroscopy are used. A cold test is carried out, which consists in immersing the hands in cold water. When the fingers are whitened, the test is considered positive, and the delay in restoring skin temperature for more than 20 minutes indicates violations in the regulation of vascular tone and a tendency to angiospasm.
According to the indications for vibration disease, examination of the gastrointestinal tract is carried out: gastric probing, gastroscopy, liver ultrasound, as well as hearing examination: audiometry, threshold audiometry, electrocochleography, acoustic impedance measurement.
Due to the variety of clinical manifestations, vibration disease has to be differentiated from many other diseases. For example, with vegetative polyneuropathy, Raynaud’s disease, polymyositis, syringomyelia, neuritis, radiculitis. In the presence of diencephalic disorders, it is necessary to exclude infectious lesions of the central nervous system: encephalitis, neurosyphilis, Creutzfeld-Jakob disease, etc.
Treatment
It is important to start therapy of vibration disease as early as possible. The fundamental point is the exclusion of the effects of vibration on the body. In addition, patients with vibration disease should avoid hypothermia and excessive physical exertion. The selection of therapy is carried out individually, depending on the dominant symptoms.
If the vibration disease occurs with sensorineural disorders, then combined treatment with ganglioblockers (diphenyltropine, pachycarpine, hexamethonium), vasodilators (drotaverine, nicotinic acid, vinpocetine) and central cholinolytics (benaktisin, chlorpromazine) is used. Pentoxifylline is indicated to improve microcirculation. If the vibration disease occurs with vegetative paroxysms, then pyrroxane is recommended. In asthenoneurotic syndrome, sedatives and biogenic stimulants (glutamic acid, aloe) are included in the treatment of vibration disease. If vibration disease is accompanied by cardiovascular syndrome, then papaverine, bendazole, and other cardiovascular drugs are recommended.
The complex treatment of vibration disease includes restorative therapy: the introduction of 40% glucose, calcium gluconate, B vitamins (B1, B6, B12). Physiotherapeutic treatment gives a good effect: electrophoresis of novocaine and benzohexonium on the collar zone or brush, UHF, reflexotherapy. Massage and hydro procedures are carried out: hand and foot baths, 4-chamber bath, shared baths (hydrogen sulfide, radon, nitrogen, oxygen).
Forecast
Vibration disease has a favorable prognosis provided it is detected early and the issue of employment of the patient is resolved with the exception of the effects of vibration and cooling. In the case of a late start of treatment or therapy in the conditions of continued exposure to vibration on the body, disease passes into a pronounced stage and can lead to disability.