Instrumental methods for diagnosing vibration disease.

Causes and mechanism of development of vibration disease

The etiology of the disease is based on the impact of industrial vibration on the body, as well as accompanying occupational factors such as cooling, noise, static muscle tension, and constant forced bending of the body. Under the influence of all these factors, vibration disease develops very quickly. Vibration with a frequency of 16-200 Hz causes the greatest harm to the body.

The danger of industrial vibration lies in its aggressive effect on body tissue. It causes the greatest harm:

• bone and nerve tissue;
• peripheral receptors, which are localized on the surface of the feet and the skin of the hands;
• receptors of the vestibular apparatus, which are located in the ear labyrinth;
• auditory receptors - vibration has a noise-canceling effect on them.

In workers who work in conditions of industrial vibration, the formation of destructive phenomena is observed in the Vater-Pacini corpuscles, neurons of the spinal cord, nerve fibers, ganglia of the vertebral and intervertebral columns. Subsequently, they experience a decrease in the perception of vibration sensitivity, as well as the appearance of pain. The more pronounced the changes in the autonomic apparatus are, the sooner dystrophic disorders occur in the skeletal system, skin and muscles. In this case, the receptors of the large joints of the shoulder girdle are predominantly affected.

Vibration disease appears in case of prolonged exposure to vibration on the body - about 3-5 years. In essence, the disease becomes the result of chronic microtraumatization of peripheral tissue formations, which leads to disruption of blood supply and tissue trophism.

S.A. Babanov, E.V. Vorobyova State Educational Institution of Higher Professional Education Samara State Medical University

Vibration disease is an occupational disease characterized by the polymorphism of clinical symptoms and the peculiarity of its course. Those working with hand-held power tools with impact or rotational action may be exposed to prolonged exposure to vibration. These include metal casting cutters, metal cutters, riveters, molders, drillers, stone cutters, grinders, polishers, sanders, sharpeners, and assemblers. The disease occurs among fellers and timber cross-cutters when working with motor and electric saws, among levelers working on dynamic peening machines, and among concrete planters when vibrating concrete (1-6). By its physical nature, vibration is a mechanical oscillatory movement that repeats itself after certain periods. The main parameters characterizing vibration are vibration frequency and vibration velocity. The vibration frequency is measured in hertz (Hz), vibration velocity is measured in meters per second (m/s). Vibration with a frequency of 8-16 Hz is low-frequency, 31.5-63 Hz is mid-frequency, and from 125 to 1000 Hz is high-frequency. The greatest risk of developing vibration disease occurs during vibration with a frequency of 16-200 Hz. Depending on the type of contact with the worker’s body, local and general vibration are conventionally distinguished. With local vibration, the body shakes by transmitting it through the upper limbs. This form of vibration is more often encountered by those working with hand-held mechanized impact or rotary tools. General vibration is transmitted through supporting surfaces to the body of a sitting or standing person (bench, floor, workpiece, platform or place where the worker is located) (1-2). Pathogenesis. The development of pathology is based on complex mechanisms of neurohumoral and neuro-reflex disorders. It has been proven that vibration has a general biological effect on any cells, tissues and organs. Being a strong irritant, it is perceived, apparently, by special nerve endings-receptors of vibration sensitivity. Vibration, causing biological effects of varying degrees of severity in the state of the receptor apparatus of almost all tissues, as well as peripheral nerves, can be considered as a specific irritant of the vibration analyzer. In parallel with the progressive decrease in vibration perception during vibration disease, pain, tactile and temperature sensitivity are impaired. Classification. In 1963, the classification of E.Ts. was proposed. Andreeva-Galanina and V.G. Artamonova. The authors considered vibration disease in the form of three forms of the disease:

• vibration disease from exposure to local vibration; • vibration disease from exposure to “combined” vibration – local and general; • vibration disease from general vibration.

In their classification, the authors tried to reflect the clinical symptoms of vibration pathology depending on the severity, form of manifestation and, most importantly, the spectral characteristics of the operating vibration and the place of its application. According to the severity of the pathological process, 4 stages of the disease were conventionally distinguished:

1. initial (mild symptoms); 2. moderately expressed; 3. pronounced; 4. generalized (extremely rare).

In addition to the stages, it is proposed to note the most typical syndromes of the disease depending on the operating vibration factor. This may be angiodystonic syndrome, more often when exposed to high-frequency vibration, or polyneuropathy from exposure to vibration with a predominance of low frequencies in the spectrum.

Classification of vibration disease from exposure to local vibration Initial manifestations (1st degree):

1. Peripheral angiodystonic syndrome of the upper extremities, including with rare vasospasms of the fingers. 2. Syndrome of sensory (vegetative-sensory) polyneuropathy of the upper extremities.

Moderate manifestations (grade 2):

1. Peripheral angiodystonic syndrome of the upper extremities with partial angiospasms 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 (myopathosis, myofibrosis, periarthrosis, arthrosis); d) with cervicobrachial plexopathy; e) with cerebral angiodystonic syndrome.

Severe manifestations (grade 3):

1. Syndrome of sensory-motor polyneuropathy of the upper extremities. 2. Encephalopathy syndrome. 3. Polyneuropathy syndrome with generalized acroangiospasms.

In the classification of vibration disease from general vibration, 3 degrees of its severity are distinguished: initial, moderately severe and severe. With the 1st degree of severity of vibration disease, it was emphasized that motor functions do not suffer, angiodystonic syndrome is based on predominantly perivascular disorders, and the disease is functionally reversible. Angiodystonic syndrome can be cerebral or peripheral. With the 2nd degree of severity of vibration disease from exposure to general vibration, there is a decrease in the body’s adaptive capabilities, more clear symptoms of cerebral-peripheral angiodystonic and vegetative-sensory polyneuritis (polyneuropathy) with possible polyradicular disorders. With a severe form of the disease of the 3rd degree (observed extremely rarely), symptoms of discirculatory encephalopathy are distinguished, most often in the form of encephalopolyneuropathy syndrome.

Classification of vibration disease from exposure to general vibration Initial manifestations (1st degree):

1. Angiodystonic syndrome (cerebral or peripheral). 2. Vegetative-vestibular syndrome. 3. Syndrome of sensory (vegetative-sensory) polyneuropathy of the lower extremities.

Moderate manifestations (grade 2):

1. Cerebro-peripheral angiodystonic 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).

Severe manifestations (grade 3):

1. Sensorimotor polyneuropathy syndrome. 2. Disculatory encephalopathy syndrome in combination with peripheral polyneuropathy (encephalopolyneuropathy syndrome).

Vibration disease from exposure to local vibration This form of the disease is more common among those who work with hand-held power tools. The main complaints with this form of vibration disease:

• sudden attacks of whitening of the fingers on the left hand (chopping, hewing, etc.) or on both hands (polishing, sanding, etc.). Attacks of whitening of fingers are more often observed when washing hands with cold water or during general cooling of the body; • aching, aching, nagging pain in the limbs, more disturbing at night or during rest. Often the pain is accompanied by paresthesia (especially in the form of an unpleasant sensation of crawling), increased chilliness of the hands; • general malaise, headaches without precise localization, dizziness, poor sleep, increased irritability. Complaints of squeezing pain in the heart area, palpitations, and pain in the stomach are possible.

In the clinical course of vibration disease, 3 degrees of severity are distinguished from the effects of local vibration. The first (initial) degree of the disease is asymptomatic. The state of the body is compensated. The process is completely reversible. Patients complain of mild pain in the arms, a feeling of numbness, and paresthesia. An objective examination reveals mild sensitivity disorders on the distal phalanges (hyper- or hypalgesia), mild changes in capillary tone. Attacks of whitening of the fingers occur extremely rarely and only after sudden cooling. The second degree is of moderate manifestations. The number of complaints with it increases. The frequency and duration of acroangiospasms increase. Painful phenomena and paresthesia become more persistent. Changes in vascular tone of both large vessels and capillaries are observed. Sensitivity disorders are more pronounced, which can also be segmental in nature; Autonomic dysfunction and signs of asthenia are determined. The syndrome of vegetative-sensory polyneuropathy in combination with dystrophic disorders of the musculoskeletal system manifests itself more clearly. Third degree – pronounced manifestations. Attacks of vasospasms become frequent. Sensitivity disturbances are significant. There is a sharp decrease, and sometimes a complete loss of vibration sensitivity. Vascular, trophic and sensory disorders are pronounced. Microfocal symptoms of central nervous system damage, diencephalic crises, and often pronounced muscle atrophy and contractures may be observed. Angiodystonic crises cover not only the peripheral vessels of the extremities, but also the area of ​​the coronary and cerebral vessels. The clinical picture of vibration disease from exposure to general vibration is determined by the nature of the affecting vibration and depends on the location of the latter. Usually the disease develops gradually after 5-7 years of working on machines, and more often begins with nonspecific manifestations: short-term headaches, increased irritability, sweating, pain in the limbs. In the clinical picture of vibration disease, especially in the initial stages, the leading one is angiodystonic syndrome, which usually occurs with sensory polyneuropathy of the lower extremities. Functional changes in the central nervous system occur very early. When examining tractor drivers and heavy-duty transport drivers, most of them were found to have osteochondrosis of the lumbosacral spine. This, as a rule, is accompanied by the occurrence of secondary radicular, pain and reflex syndromes, which causes a decrease in working capacity. When diagnosing vibration disease, in addition to clarifying the medical history, sanitary and hygienic characteristics of working conditions, a thorough objective examination of the patient using clinical and physiological methods is necessary. This is especially important both when identifying the earliest stages of the disease, functionally compensated, “abortive” forms, and to determine the functional capabilities of the body. First of all, when interviewing the patient, it is necessary to find out the nature of the complaints and their connection with work. When complaining of bouts of whitening of the fingers, it is necessary to establish their location, duration and purity. When examining a patient, pay attention to the color of the skin of the hands, movements in the fingers, hands and limbs in general. It is advisable to measure skin temperature. Particular attention should be paid to the state of vibration and pain sensitivity, as well as the osteoarticular apparatus, muscular and cardiovascular systems. Therefore, it is necessary to carry out pallesthesiometry, algesimetry, cold test, test with reactive hyperemia, capillaroscopy, and thermometry. Usually, after measuring the skin temperature, the brushes are immersed in water (water temperature 8-10 ° C) for 5 minutes. When whitening of the fingers appears, the cold test is considered positive. Then the skin temperature is measured again and the time for its recovery to the original values ​​is determined. In healthy individuals, the skin temperature on the fingers is usually 27-31°C, and the recovery time is no more than 20 minutes. To assess the state of the neuromuscular system, electromyotonometry and electromyography should be used; cardiovascular - electro-, poly- and mechanocardiography, oscillography. Vibration disease must be differentiated from other diseases of non-occupational etiology: Raynaud's disease, syringomyelia, autonomic polyneuropathy, myositis. Thus, syringomyelia is accompanied by severe motor impairment, early loss of tendon reflexes along with “pyramidal symptoms”, severe muscle atrophy, the development of arthropathy and bulbar disorders. Attacks of "white fingers" or vasospasm, with Raynaud's disease, are usually observed in women; Vascular disorders usually extend to all extremities and are not combined with segmental sensitivity disorders. It is also necessary to differentiate vibration disease from diseases such as neuritis and plexitis of other etiologies.

Treatment. The choice of therapeutic measures must be approached differentially, depending on the form and severity of the disease. Treatment should begin in the early stages. The main principles of treatment of vibration disease are etiological, pathogenetic and symptomatic. The most striking effect is observed when using substances with chalinolytic action, which influence various parts of a pathogenetically closed arc, capable of changing the regulatory processes of the body in the right direction and thereby influencing the condition, trophism and function of many organs and systems of the patient. In case of vibration disease caused by the influence of local vibration, occurring with predominant neurovascular disorders, in the event of pain, the combined use of ganglion-blocking substances (pachycarpine, difacil, hexametone) with small doses of central anticholinergics (aminazine, amizil) and vasodilators (nicotinic acid, but spa, novocaine). Difacil is prescribed as a 1% solution, 10 ml intramuscularly every other day; for a course of 4-5 injections with a break of 2-3 days. A total of 2-3 courses of treatment are recommended. Alternation of difacil with novocaine (0.5% solution) in the form of intravenous injections in a dose of 5 to 10 ml every other day for 10 days is indicated. Novocaine can also be prescribed intramuscularly, 5 ml in the form of a 2% solution every other day, for a total of 10 injections. Aminosine is indicated at 0.025 g - 1 tablet 1 time per day after meals, preferably at night, for 10 days. Amizil is prescribed orally in powders of 0.001 g 1 time per day after meals, preferably at night, also for 10-12 days. Trental is taken 2 tablets (0.2 g) 3 times a day after meals. Halidor is successfully used - 2 tablets (200 mg) 3 times a day, course 16 days; no-spa (0.02 g) – 2 tablets 3 times a day, course 16-20 days. Among the antiadrenergic substances, methyldopa (dopegit) is recommended, 0.25 g 2 times a day, a course of 15-20 days under blood pressure control. Of the physical methods of treatment, the most pronounced effect is provided by the use of electrophoresis of various medicinal substances. Both factors - electrical and pharmacological, acting on the body simultaneously, cause not only a general, but also a response specific to each drug substance. In this regard, electrophoresis with a 5% novocaine solution or a 2% benzohexonium solution is most often used on the hands or on the collar area. For severe vascular disorders, ionic collars (novocaine, calcium, bromide) are recommended. A good therapeutic result is observed when using balneological measures: hydrogen sulfide, radon, oxygen, nitrogen-thermal baths at a temperature not exceeding 37 ° C and lasting no more than 10-15 minutes. When implementing complex therapy, great importance is attached to therapeutic exercises, massage of the arms and collar area, daily hydro procedures with self-massage, climatic therapy (aerotherapy, air baths, heliotherapy).

Work ability examination. When conducting an examination, the effect of the treatment and preventive measures used in each case is taken into account. If there are signs of vibration disease, in particular in the first stage of the disease, when all processes are still easily reversible, there are no serious trophic disorders or sensitivity disorders, and vasomotor phenomena are not pronounced, it is necessary to carry out active therapy without interruption from work. If timely and rational therapy, as well as a set of therapeutic and preventive measures, did not give the desired effect, and the patient has persistent pathological phenomena, he should be considered disabled in a profession associated with exposure to vibration, noise, adverse meteorological factors, as well as significant stress on the upper and lower extremities. Such a patient needs rational employment, that is, transfer to work taking into account the specified restrictions.

Literature 1. Artamonova V.G., Mukhin N.A. Occupational diseases. M.: Medicine. 2004; 432. 2. Vasitskaya N.N., Izmailov D.V., Zhestkov A.V. Babanov S.A. Immunological changes in elderly highly experienced workers in vibration-hazardous professions. Materials of the scientific and practical conference dedicated to the 40th anniversary of the Samara Regional Hospital No. 2. 138-139. 3. Verbovoy A.F. Scientific basis of the pathogenesis of osteopenic syndrome in various forms of industrial osteopathies. Author's abstract. diss…. Doctor of Medical Sciences - St. Petersburg: 2002; 32. 4. Verbovoy A.F. Babanov S.A. Sharonova L.A. Determination of the rate of biological aging in vibration disease // Hygiene and Sanitation. 2004; 3: 39-40. 5. Occupational diseases. Guide for doctors / Ed. N.F. Izmerova. M.: Medicine. 1996; 1-2. 6. Shustov V.Ya., Korolev V.V., Olkhovskaya A.G. Occupational diseases. Saratov. 1991; 205.

Classification of vibration disease

In clinical neurology, it is customary to distinguish three forms of vibration disease. The classification criterion is the extent to which the human body is exposed to vibration: whether vibration affects the body as a whole or only its individual parts.

• The first form of the disease is called local vibration disease. It occurs due to local exposure to a negative production factor.
• The second form of pathology involves general exposure to vibration.
• The third combines the features of the first two forms.

There are also several stages of vibration disease, depending on the degree of its severity. According to this factor, there are initial, pronounced, moderate and generalized stages.

Preventive measures

In order not to look for ways to treat vibration disease, doctors advise following the rules of prevention:

• Properly organize your work and your working time;
• Comply with all hygiene standards;
• Observe the vibration level. It should not exceed permissible limits;
• When using special tools, it is necessary to take a 5-10 minute break at least once an hour and you are allowed to work with them no more than 60-70% of the working time;
• After work associated with constant shaking, self-massage and warm baths for hands and feet are necessary.
• It is recommended to undergo a course of professional therapeutic massage once a year;
• It is advisable to take a course of ultraviolet irradiation in a hospital setting at least 2 times a year;
• Every year it is necessary to go for health purposes to the sea, to a sanatorium, forest, mountains and other recreational places;
• When hiring for a job that involves constant shaking, you need to know what its contraindications are, for example, polyneuropathy, Rhine syndrome, etc.;
• Once a year, it is necessary to do a full examination of the body with all the necessary tests in order to identify hidden pathological processes at the very beginning.

Vibration disease can be successfully treated in the early stages and leaves no consequences. If the course of therapy has not been completed and the pathology develops further, then it is no longer so easy to eradicate it, and it can leave its traces that will seriously harm a person’s health. In especially severe cases, people with this disease remain disabled, so when working with vibration you need to know what preventive measures exist.

Symptoms of vibration disease from local vibration

1. At the initial stage of vibration disease, which was caused by local exposure to a negative production factor, patients experience pain in the fingers, as well as numbness.
2. At the second stage, the pain worsens, becomes stable, various changes in vascular tone appear, as well as noticeable sensory disorders. Asthenia and autonomic dysfunction may occur.
3. The third stage is characterized by the fact that trophic and vasomotor disorders become pronounced and come to the fore in the clinical picture. Patients also complain of frequent attacks of numbness, pain, paresthesia, whitening of the fingers and sensory disorders. This stage of the disease will be characterized by suppression of tendon reflexes and loss of vibration sensitivity. Patients complain of gastrointestinal disorders.
4. The fourth stage of local vibration is characterized by more serious clinical manifestations: pain in the fingers begins to become stable, and microfocal symptoms arise.

Symptoms

There are three types of vibration disease:

• from exposure to local vibration;
• from the effects of general vibration;
• from exposure to both types of vibration.

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

• initial, with minimal manifestations of the disease, which are functional and reversible;
• moderate;
• expressed;
• generalized: has been rare lately, as people change their profession and stop contact with vibration.

In addition, the clinical picture includes the following syndromes (which can be observed to varying degrees in one or another type of vibration disease):

• angiospastic;
• angiodystonic;
• polyneuropathic;
• polyradicular;
• asthenic;
• vegetative-vestibular;
• diencephalic;
• nonspecific changes in internal organs (for example, intestinal dyskinesia).

Vibration disease from local vibration

This form of the disease occurs among people who work with hand-powered tools. Patients complain of aching and nagging pain in the hands, mainly at night and during rest. The pain may be accompanied by the appearance of paresthesia: a feeling of crawling, tingling, numbness. Chilliness of the extremities is characteristic. The pain stops when you resume working with the vibrating tool after 10-15 minutes. Periodically there are attacks of whitening of the fingers. There is a characteristic feature: hewers (cutters) have white fingers on their left hand, and sanders, polishers and similar workers have white fingers on both. Attacks of whitening can occur either independently or when exposed to cold (washing hands with cold water, general hypothermia).

CM. SEE ALSO: Raynaud's syndrome: symptoms and treatment

There is a deterioration in health. There is general malaise, headaches without clear localization, poor sleep, dizziness, palpitations, and increased irritability. Vascular disorders are clinically manifested in changes in skin color (pale or purple-cyanotic hands) and changes in blood circulation parameters. Capillary tone is disrupted, hemodynamic indicators indicate changes in blood pressure and minute volume of blood flow. Vascular disorders can masquerade as neurocirculatory dystonia.

Over time, the fingers become swollen and take on the appearance of “drumsticks” - with thickenings at the ends; joints are deformed, the range of movements in them decreases. Trophic disorders are manifested by hyperkeratosis, the pattern on the distal phalanges is smoothed out, the nails thicken and become cloudy. Multiple cracks on the palms are often observed. When the process is far advanced, trophic disorders also affect deeper tissues: subcutaneous fat, muscles and tendons, which manifests itself in the form of myositis, tendonitis, and tendomyositis. X-rays reveal foci of osteoporosis and cyst-like formations in the bones. Degenerative-dystrophic changes are found in the spine (mainly in the intervertebral discs) and in the joints.

There is a feeling of coldness in the extremities to the touch; dry skin of the hands or increased sweating are possible.

All these are manifestations of angiospastic and angiodystonic syndromes.

Polyneuropathic syndrome consists of the development of sensitivity disorders. Suffering mainly from pain, temperature and vibration sensitivity. Initially, hyperesthesia (increased sensitivity to irritants) is possible, which over time is replaced by hypoesthesia (accordingly, a decrease in this sensitivity). Gradually, the higher located areas are also involved in the process: from the hands, changes move to the forearms (on the legs - from the feet to the shins), like “gloves” and “socks”. The pronounced stage of vibration disease from local vibration is accompanied by loss of sensitivity according to the segmental type. Rarely, motor disorders are observed in the form of hypotrophy (atrophy) of the small muscles of the hand: thenar, hypothenar, interosseous muscles.

When the body is exposed to noise, in addition to vibration, cochlear neuritis develops, i.e. hearing loss, which can be detected during audiometry.

Vibration disease from exposure to general vibration

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

On examination, microsymptoms are revealed: tremor of the eyelids, fingers of outstretched arms, anisoreflexia (unequal reflexes on the right and left), instability while standing with eyes closed and arms outstretched, in the so-called Romberg position. Pain in the extremities, coldness and chilliness of the legs appear, which is associated with vascular spasm. Gradually, changes in biochemical processes in tissues, inflammation with compression of the nerve roots in the spinal cord are added to the manifestations of systemic damage to peripheral nerves. Muscle atrophy develops. In some cases, there is a disorder of the functions of internal organs, for example, a violation of the secretion of the glands of the digestive system. Pathological changes are also noticeable in the cardiovascular system: blood pressure rises, heart rhythm disturbances appear.

With prolonged exposure to general vibration on the body, vascular spasm becomes generalized, that is, it affects the vessels of the entire body. Patients complain of coronary-type pain in the heart area, signs of chronic cerebrovascular accident appear (usually dyscirculatory encephalopathy, but there may also be diencephalic manifestations). In women, due to impaired blood flow in the pelvic organs, menstrual irregularities occur, in men - problems with potency.

Vibration disease from exposure to both types of vibration

Clinical manifestations are the same as for the conditions described above. Only usually the disease manifests itself a little earlier and progresses a little faster, since the harmful effects of vibration on the body seem to double.

Symptoms of vibration disease from general vibration

This form of the disease is characterized by a combination of sensory impairment with a neurasthenic syndrome. The patient exhibits symptoms such as dizziness, headaches, irritability, increased sensitivity, numbness and aching pain in the lower extremities. As the disease worsens, these symptoms are joined by vegetative crises, which are characterized by tachycardia, thermoregulation disorders, fear of dying, a feeling of lightheadedness, and lack of air.

A more detailed study of the clinical picture of the pathology reveals symptoms such as attacks of pallor of the toes, weakening of memory, sleep disturbances, and tearfulness. At the beginning of the disease, the patient experiences disinhibition of tendon reflexes, and then their inhibition. Severe trophic disorders are also observed - muscle hypotonia and thinning of the skin on the toes.

Sometimes patients are diagnosed with a combined form of vibration disease, caused by both local and general exposure. Its most characteristic symptoms are severe headaches and non-systemic dizziness. Patients also complain of visual and hearing impairment, gastrointestinal dyskinesia, and severe abdominal pain.

Prevention

To prevent vibration disease, people whose work activities involve constant exposure to vibration need to:

• comply with labor protection measures;
• during work, use tools, equipment, special work clothes with devices that dampen vibration;
• undergo preventive medical examinations in a timely manner;
• after each shift, perform self-massage of the limbs;
• eat well, make sure that your diet contains sufficient quantities of foods containing vitamins B1 (bran, meat, liver, brewer's yeast, eggs, seeds) and C (rose hips, black currants, citrus fruits, bell peppers, tomatoes, onions, leafy greens).

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Diagnosis of vibration disease

Diagnosis of vibration disease is carried out by a therapist and a neurologist. However, in some situations they may also need to consult a gastroenterologist, vascular surgeon, cardiologist or otolaryngologist. The first stage of diagnosis involves examining the patient and collecting anamnesis. During the examination of the patient, the doctor pays special attention to the skin tone of the extremities, studies pain and vibration sensitivity in detail, and checks the condition of the cardiovascular system, osteoarticular and muscular systems.

The most effective diagnostic methods are:

• cold tests;
• thermometry;
• capillaroscopy;
• electropometry;
• polycardiography;
• electroencephalography.

Doctors can make a more accurate diagnosis after conducting examinations of the gastrointestinal tract such as gastroscopy, gastric intubation, and ultrasound of the liver. Hearing studies are also carried out using acoustic impedancemetry, electrocochleography and audiometry.

Diagnostics

The diagnosis is assumed on the basis of a characteristic clinical picture and anamnesis data, and the connection between complaints about well-being and working conditions is revealed.

Vibration disease occurs from the action of vibration (from the Latin vibratio - “trembling, oscillation”) or frequently repeated mechanical influences. Usually occurs as an occupational disease.

They also resort to a number of laboratory and instrumental methods. The following are required:

• general and biochemical blood test, general urine test;
• electrocardiography;
• X-ray of the chest organs, hands, feet, spine.

To confirm the diagnosis, special methods are used:

• cold test – assesses the state of the sympathetic nervous system;
• Pahl's test - the blood filling of the same-named vessels on different limbs is determined;
• white spot test - the time of occurrence of vascular spasm in the hands is assessed;
• test for reactive hyperemia - to restore vascular tone after compression;
• algesimetry – pain sensitivity of the forearm, lower leg, fingers and toes is established;
• pallesthesiometry – vibration sensitivity threshold is determined;
• skin thermometry – the severity of vascular changes in the hands is determined;
• capillaroscopy – changes are detected in the capillaries of the nail bed on the fourth finger of the right hand and the first finger;
• hand dynamometry - the strength of flexion of the fingers is determined;
• thermoesthesiometry – the ability to distinguish between temperature differences of up to 5 °C is established;
• hemodynamic test (Bogolepov test) - for blood filling of the hands when the position of body parts in space changes;
• Doppler ultrasound (USDG) – studies the arterial and venous blood flow of the extremities;
• rheovasography – pulse filling of the vessels of the hands and forearm with blood is determined.

Doppler ultrasound allows you to study the arterial and coronary blood flow of the extremities

There are other ways to study the effects of vibration sickness.

Drug treatment of vibration disease

If patients' clinical picture is dominated by neurosensory disorders, they are prescribed medications that have a ganglion-blocking effect (difacil, hexamethonium, pachycarpine). It is also considered advisable to prescribe vasodilating medications (Cavinton, drotaverine, nicotinic acid). It is possible to improve microcirculation processes by taking trental and pentoxifylline.

If vegetative paroxysms occur, the patient is advised to take pyrroxan. The disease is often accompanied by astheno-neurotic syndrome. To eliminate it, biogenic stimulants such as glutamic acid and aloe are included in the treatment regimen. Treatment of cardiovascular syndrome involves the use of cardiovascular drugs such as validol and papaverine.

Treatment

A patient diagnosed with vibration disease is contraindicated from working with vibration, i.e. re-employment is required. Work associated with hypothermia and significant physical stress and noise also becomes contraindicated.

Treatment of the disease must be comprehensive, including both medication and physiotherapeutic methods.

Medication methods

• blockade of impulses in the autonomic nervous system: benzohexonium, pachycarpine, hexamethonium, difacil, aminazine, amizil, pyrroxan;
• improving microcirculation and relieving vasospasm: trental (pentoxifylline), nicotinic acid, complamin, calcium channel blockers, cavinton;
• drugs that improve trophism and metabolism: vitamins B and C, ATP, phosphaden, aloe, glutamic acid, riboxin, calcium gluconate;
• antiplatelet agents (since the spasm is accompanied by a violation of the rheological properties of the blood): aspirin, cardiomagnyl;
• for cardiovascular symptoms: papaverine, dibazole, mildronate, β-blockers and other cardiovascular drugs;
• for astheno-vegetative syndrome: sedatives (drugs of bromine, valerian, motherwort, adaptol, tranquilar, etc.);
• for pain: non-steroidal anti-inflammatory drugs (ibuprofen, nimesulide, etc.).

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

Physiotherapeutic methods

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