Vibration Disease caused by Physical agents

Occupational diseases caused byOccupational diseases caused by
physical agentsphysical agents

Occupational diseases caused by physical agentsOccupational diseases caused by physical agents
PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved
Plan
• Vibration disease
• Occupational deafness
• Altitude sickness and caisson disease

Vibration disease ⇒ Definition
Vibration disease (T 72.2) – absolutely
specific occupational disease caused by prolonged
influence of vibration and characterized by
polymorphous clinical manifestation with obligatory
affection of nervous system and microcirculation (+
locomotor system)

Vibration disease ⇒ Synonyms
Vibration disease
Syndrome of “dead fingers”
Vibration white finger
Hand Arm Vibrations Syndrome (HAVS)
Vibration (secondary) Raynaud Phenomenon
Vibration induced vasospastic disease
Grinders cramp
Spastic anaemia

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Vibration disease ⇒ Pathogenesis
• nervous - reflectory disorders;
• disorders in microcirculation;
• disorders of rheological properties of blood;
• disorders in obtaining and utilization of oxygen;
• disorders in hypothalamic-pituitary-adrenal system;
• functional activity of sympathoadrenal system due to
activation of adaptation mechanisms;
• overexcitation of peripheral vegetative formations.

Vibration disease ⇒ Pathogenesis
orthopedic disorders neurovascular disorders
high frequencylow frequency
++
- overcooling
- microtraumatization
- physical overloads
associated factors
VIBRATION
==
• neurovascular disorders
• changes in microcirculation & metabolism
• affection of neuromuscular, locomotor apparatus

Vibration disease ⇒ Industries
• metal-working
• machine-building
• metallurgical
• building
• mineral resource
• agriculture
• transport

Vibration disease ⇒ Occupations
• polishers
• grinders
• cleaners
high-frequency
local vibration

• croppers
• riveters
• tree breakers
low-frequency
local vibration

• drivers of heavy machines
• concrete workers
low-frequency
general vibration

• polishers
• grinders
• cleaners
• croppers
• riveters
• tree breakers
• drivers of heavy machines
• concrete workers
high-frequency
local vibration
high-frequency
local vibration
low-frequency
general vibration

Vibration disease ⇒ Classification
• Vibrational disease caused by local vibration
• Vibrational disease caused by general vibration
• Vibrational disease caused by mixed vibration

Vibration disease ⇒ Clinical manifestation
• angiodystonic
• angiospastic
• syndrome of vegetative polyneuritis
• vegetomyofascitis
• myositis
• osteoarthrosis
• osteochondrosis
• vestibular
• encephalopathy (diencephal with neurocirculatory disorders)
MAIN SYNDROMES

Vibration disease ⇒ Clinical manifestation (LOCAL)
1st
DEGREE – initial manifestations:
1) peripheral angiodystonia of upper extremities, rare acrospasms;
2) sensory (vegetosensory) polyneuropathy of upper extremities.
Complaints:
- transient paresthesia (numbness, tingling, creepyness),
- dull pain in distal parts of hands, chilliness of fingers,
- rare whitening of fingers on cooling
Physical examination:
- cyanosis or mottled skin & hypothermia of hands
- hyperhidrosis or dryness of hands
- hyperesthesia  hypoesthesia for vibration
- hyperkeratosis

Vibration disease ⇒ Clinical manifestation (acrospasm)

2nd
DEGREE – moderate manifestations:
1) peripheral angiodystonia of upper extremities, often acrospasm;
2) vegetative-sensory polyneuropathy of upper extremities:
a) with often angiospasms of fingers;
b) with stable vegetative-trophic disorders of hands;
c) with dystrophic disorders of locomotor system;
d) with cervicobrachial plexopathy;
e) with cerebral angiodystonic syndrome.

Vibration disease ⇒ Clinical manifestation (Ligamentosis)

3rd
DEGREE – marked manifestations:
1) syndrome of sensomotor polyneuropathy of upper extremities;
2) syndrome of encephalopolyneuropathy;
3) syndrome of angiopathy with generalized acroangiospasms

(GENERAL)
1st
DEGREE – initial manifestations:
1) angiodystonic syndrome (cerebral or peripheral);
2) vegetative-vestibular syndrome;
3) sensor (vegetative-sensor) polyneuropathy of lower extremities.

(GENERAL)
2nd
DEGREE – moderate manifestations:
1) cerebral & peripheral angiodystonic syndrome;
2) syndrome of sensor (vegetative-sensor) polyneuropathy
a) with syndrome of polyradiculopathy;
b) with secondary lumbosacral plexus syndrome;
c) with functional disorders of nervous system.

(GENERAL)
3rd
DEGREE – marked manifestations:
1) syndrome of sensomotor polyneuropathy of lower extremities;
2) syndrome of encephalopolyneuropathy;
3) syndrome of angiopathy with generalized acroangiospasms

Vibration disease ⇒ Diagnosis
Set of “vibration tests”:
• Nailfold capillaroscopy
• Thermometry, thermography
• Cooling rest
• Hand aesthesiometry (palesthesiometry)

Vibration disease ⇒ Capillaroscopy

Vibration disease ⇒ Capillaroscopy
norm
1st
degree
2nd
degree

Vibration disease ⇒ Cooling test

Vibration disease ⇒ Thermography

Vibration disease ⇒ Pallesthesiometry

Vibration disease ⇒ Dynamometry

Vibration disease ⇒ Diagnosis
Differential diagnosis with:
• Raynaud's syndrome
• syringomyelia
• vegetative polyneuritis
• myositis

Vibration disease ⇒ Treatment
• reasonable employment
• physiotherapy
• vitaminotherapy (C, PP, B-complex)
• cholinolytics (spasmolytin, amyzil)
• ganglioblockers (pachycarpin, benzohexonium)
• vasodilatators (papaverinum, nicotinate)
• calcium antagonists (cordafen, corinfar)

Vibration disease ⇒ Expertise of workability
• 1st
DEGREE – temporary (for 1 month) employment
without contact with vibration
• 2nd
DEGREE – treatment in hospital (in-patient) and
further temporary (for 1-2 month) employment without
contact with vibration
• 3rd
DEGREE – limited working capacity, possible 3rd
(or
even 2nd
) invalidity group

Vibration disease ⇒ Prophylaxis
• technical measures
• water procedures (bathes for hands)
• gymnastics
• periodical medical checkups

Occupational deafness ⇒ Definition
Occupational deafness (H 90.3) –
occupational disease caused by prolonged
influence of noise and characterized by
perceptive symmetric decrease of hearing

Occupational deafness ⇒ Etiology
MPL = 80 dB
high
frequency
low
frequency
20000 Hz20 Hz
middle
frequency
300 Hz 800 Hz

Occupational deafness ⇒ Pathogenesis
intensity
tonality
periodicity
character & degree
of
biological effect
specific
(affection of
acoustic analyzer)
non-specific
(influence on nervous,
cardiovascular systems)

Occupational deafness ⇒ Pathogenesis
Specific effects
• affection of villae of lower cochlea
of helix;
• affection of support cells;
• affection of spiral ganglion;
• affection of vestibulocochlear
nerve & plexus;
perceptive type of deafness
+
disturbances of
microcirculation & trophism

Occupational deafness ⇒ Industries
• metal-working
• machine-building
• metallurgical
• building
• mineral resource
• agriculture
• transport

Occupational deafness ⇒ Occupations
• fettlers
• drillers
• chippermen
• riveters
• polishers
• grinders

Occupational deafness ⇒ Diagnosis
ComplaintsComplaints::
• neuritis – feeling of “noise”, “ringing” in ears;
• neurasthenia – increased irritability, bad sleep, headache;
• vestibular syndrome – dizziness;
• neurosis – pain in heart region;
• deafness – decrease of hearing in both ears.
Physical examinationPhysical examination::
• vegetative disorders – stable red dermographism;
• instability in Romberg position, tremor of arms;
• decrease of perception of high frequencies (4-6 kHz);
• reduction of bone conduction;
• normal perception of usual speech;
• normal otoscopy data;

Occupational deafness ⇒ Diagnosis
• audiometry – decrease of perception of high frequencies
• ECG – pulse lability & disturbance of conductivity;
• tendency to elevation of blood pressure.
Stage, degree
Tonal threshold audiometry
Whisper
teston 0.5; 1; 2 kHz on 4 kHz
1st
, initial changes < 10 dB 50± 20 dB 5± 1.0 m
2nd
, cochlear neuritis of
mild degree
11 – 20 60± 20 dB 4± 1.0 m
3rd
mean degree
21 – 30 65± 20 dB 2± 1.0 m
4th
severe degree
31 – 45 70± 20 dB 1± 0.5 m

Occupational deafness ⇒ Audiometry

Audiometry
Volum
Frequency, kHz
Stage, degree
Whisper
test
on 0.5; 1; 2 kHz on 4 kHz
1st
, initial changes < 10 dB 50± 20 dB 5± 1.0 m

Audiometry
Volume
Frequency, kHz
Stage, degree
Whisper
2nd
mild degree
11 – 20 60± 20 dB 4± 1.0 m

Audiometry
Volume
Frequency, kHz
Stage, degree
Whisper
3rd
mean degree
21 – 30 65± 20 dB 2± 1.0 m

Audiometry
Volume
Frequency, kHz
Stage, degree
Whisper
4th
severe degree
31 – 45 70± 20 dB 1± 0.5 m

Occupational deafness ⇒ Treatment
• reasonable employment
• general health-improving therapy
• vitamins C, PP, B-complex, glutamine acid and rutin
• sedatives
• physiotherapy

Occupational deafness ⇒ Workability expertise
1st
DEGREE – workability remains, dynamic medical follow-up
should be performed;
2nd
DEGREE – continue working under thorough medical follow-up
OR
transfer to another work not connected with noise;
3rd
– 4th
DEGREE – rational employment

Occupational deafness ⇒ Prophylaxis
• technical measures
• anti-noise bushes (“earplug”), earphones, helmets
• medical checkups

Altitude disease ⇒ Definition
Occupational altitude disease (H 70.2) –
occupational disease caused by sudden and
significant decrease of oxygen in air

Altitude disease ⇒ Occupations

Altitude disease ⇒ Pathogenesis
Acute decrease
of pO2 in air
Quick air
pressure fall
Acute increase
of pCO2 in blood
Irritation
of chemoreceptors
Reflectory
reactions:
↑ heart rate
↑ breathing rate
Acute decrease
of pO2 in blood
Hypoxia
Disturbances of
nervous system

Altitude disease ⇒ Clinical manifestation
Collaptoid formCollaptoid form
ComplaintsComplaints:
- general weakness
- feeling of “burning”
- vision disturbances
- dyspnea
- feeling of “noise in ears”
- dizziness & nausea
Physical examinationPhysical examination:
- excitement ⇒ sluggishness
- paleness
- sweating
- decrease of blood pressure
- usually no lose of consciousness
Unconscious formUnconscious form

Altitude disease ⇒ Treatment
• Oxygen therapy (+ 3 – 5 % of CO2)
• Stimulation of blood circulation
• Prophylaxis of complications
• Symptomatic therapy

Altitude disease ⇒ Expertise of workability
Transient collaptoid form – continue working after recovery
Prolonged collaptoid or transient unconscious form – free
from work for 1-2 weeks, no decrease of workability
Prolonged unconscious form with residual changes –
reasonable employment, decrease of workability

Altitude disease ⇒ Prophylaxis
• Use of oxygen equipment
• Training in altitude chamber, in high mountains
• Prophylactic medical checkups

Decompression disease ⇒ Definition
Decompression disease (H 70.3) (syn. caisson
disease) – occupational disease caused by sudden
and significant decrease of air pressure

Decompression disease ⇒ Technology

Decompression disease ⇒ Non-occupational

Decompression disease ⇒ Pathogenesis

Decompression disease ⇒ Clinics (ACUTE)

Decompression disease ⇒ X-ray (CHRONIC)

Decompression disease ⇒ Threatment

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Vibration Disease caused by Physical agents

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