Occupational Diseases Caused by Exposure to Physical Factors

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Vibration disease is caused by long-term (at least 3-5 years) exposure to vibration in production conditions. Vibrations are divided into local (from hand tools) and general (from machines, equipment, moving machines).

Pathogenesis: chronic microtraumatization of peripheral vegetative formations, perivascular plexuses with subsequent disruption of blood supply, microcirculation, biochemistry and tissue trophism.

The clinical picture is characterized by a combination of vegetative-vascular, sensory and trophic disorders. The most characteristic clinical syndromes: angiodystonic, angiospastic (Raynaud's syndrome), vegetosensory polyneuropathy.

The disease develops slowly, after 5-15 years from the start of work associated with vibration, with continued work the disease increases, after cessation there is a slow (3-10 years), sometimes incomplete recovery. Conventionally, there are 3 degrees of the disease: initial manifestations (I degree), moderately expressed (II degree) and pronounced (III degree) manifestations.

Typical complaints: pain, paresthesia, chilliness of the extremities, attacks of whitening or cyanosis of the fingers when cooling, decreased strength in the hands. As the disease worsens, headaches, fatigue, and sleep disturbances occur. When exposed to general vibration, complaints of pain and paresthesia in the legs, lower back, headaches, and dizziness predominate.

Objective signs: hypothermia, hyperhidrosis and swelling of the hands, cyanosis or pallor of the fingers, attacks of “white” fingers that occur during cooling, less often during work.

Vascular disorders are manifested by hypothermia of the hands and feet, spasm or atony of the capillaries of the nail bed, and a decrease in arterial blood flow to the hand. There may be cardialgia. It is mandatory to increase the thresholds of vibration, pain, temperature, and less often tactile sensitivity.

Sensory impairment is polyneuritic in nature. As the disease progresses, segmental hypalgesia and hypalgesia on the legs are revealed. There is soreness in the muscles of the limbs, thickening or flabbiness of certain areas.

Radiographs of the hands often reveal brush-like radiolucencies, small islands of consolidation, or osteoporosis. With long-term (15-25 years) exposure to general vibration, degenerative changes in the lumbar spine and complicated forms of lumbar osteochondrosis are often detected.

Characteristics of the main syndromes of vibration disease:

Peripheral angiodystonic syndrome (I degree); complaints of pain and paresthesia in the hands, chilliness of the fingers. Mildly expressed hypothermia, cyanosis and hyperhidrosis of the hands, spasms and atony of the capillaries of the nail bed, a moderate increase in the thresholds of vibration and pain sensitivity, a decrease in the skin temperature of the hands, and a slow recovery after a cold test. Strength and endurance of muscles are not changed.

Peripheral angiospastic syndrome - Raynaud's syndrome (I, II degree) is pathognomonic for exposure to vibration. I'm worried about bouts of whitening of the fingers and paresthesia. As the disease progresses, whitening spreads to the fingers of both hands.

The clinical picture outside of attacks of whitening of the fingers is close to angiodystoic syndrome. Capillary spasm predominates.

The syndrome of vegetosensory polyneuropathy (II degree) is characterized by diffuse pain and paresthesia in the arms, less often in the legs, and a decrease in pain sensitivity of the polypeuritic type. Vibration, temperature, tactile sensitivity is reduced. Reduced muscle strength and endurance. As the disease progresses, vegetative-vascular and sensory disorders are also detected on the legs.

Attacks of whitening of the fingers become more frequent and lengthen in time. Dystrophic disorders develop in the muscles of the arms and shoulder girdle. The structure of the EMG changes, the speed of excitation along the motor fibers of the ulnar nerve slows down