1. HAND PARESTHESIAS IN
DRIVERS FOND OF
MOTORCYCLES
• º

2. HAVS (HAND ARM VIBRATION SYNDROME)
SD. DE RAYNAUD, ENTUMECIMIENTO, HORMIGUEO Y DÉFICIT NEUROSENSORIAL Y DISMINUCIÓN DE LA
FUERZA DE AGARRE.
EN CONJUNTO, ESTOS PROBLEMAS DE SALUD SE DENOMINAN HAVS Y PUEDE LLEGAR A SER
SIGNIFICATIVAMENTE INCAPACITANTE EN LOS CASOS MÁS SEVEROS.
EL TERMINO HAVS COMENZÓ A GENERALIZARSE COMO LA DESCRIPCIÓN DE UN CONJUNTO DE ALTERACIONES
DE TIPO VASCULAR, NEUROSENSORIAL, Y MÚSCULO-ESQUELÉTICOS ASOCIADOS CON LA EXPOSICIÓN
EXCESIVA A HTV.
HA HABIDO UNA SERIE DE INFORMES QUE TRATAN LA POSIBLE BASE FISIOPATOLÓGICA DE LOS ELEMENTOS
DE HAVS. SIN EMBARGO, LA RELACIÓN EXACTA ENTRE LA DOSIS Y CUALQUIERA DE LOS ELEMENTOS
VASCULARES O NEUROSENSORIAL DE HAVS NO ESTA DEL TODO ACLARADO.
WHITE FINGER, NUMBNESS AND TINGLING, NEUROSENSORY DEFICIT IN THE HANDS, AND LOSS OF GRIP
STRENGTH.
COLLECTIVELY THESE HEALTH PROBLEMS ARE TERMED HAVS AND CAN BECOME SIGNIFICANTLY DISABLING IN
SEVERER CASES.
THE TERM HAVS BEGAN TO HAVE WIDESPREAD COINAGE AS DESCRIBING THE RANGE OF VASCULAR,
NEUROSENSORY, AND MUSCULOSKELETAL PROBLEMS ASSOCIATED WITH EXCESSIVE EXPOSURE TO HAND
TRANSMITTED VIBRATION.HTV. THERE HAVE BEEN A NUMBER OF REPORTS THAT ADDRESS THE POSSIBLE
HAVS.

3. -OSCILLATION OF A BODY ABOUT A REFERENCE POSITION AND CAN BE
DESCRIBED IN TERMS OF AMPLITUDE AND FREQUENCY
VIBRATION

4. -VASCULAR.
-VIBRATION WHITE FINGER.VWF (14)
-VASCULAR INJURY (7)
-MUSCULAR
-FIBROSIS/NECROSIS/STRUCTURAL DISORGANIZATION (3, 18,14)
-MUSCLE WEAKNESS, PAIN.(23)
-NERVE
-SENSORINEURAL DISTURBANCES.(14)
-IMPAIRED BLOOD FLOW,INTRANEURAL EDEMA, CHEMICAL
IRRITABLITY(10),
-DEMIELINATION / RE-INNERVATION, FIBROSIS(3)
RESPONSETOVIBRATION

5. EPIDEMIOLOGICAL STUDY OF VIBRATION SYNDROME IN RESPONSE TO TOTAL
HAND-TOOL OPERATING TIME.TOT.(14)(0-2000-5000-8000 HOURS IN CHAIN SAW
WORKERS)KMIYASHITA,SSHIOMI,NITOH,TKASAMATSU,ANDHIWATA
-RAYNAUD'S PHENOMENON INCREASED IN FREQUENCY AND SEVERITY
-ABNORMAL FINDINGS IN CIRCULATORY FUNCTION
-LOSS OF PAIN SENSE, AND VIBRATORY SENSE.
-MUSCLE ATROPHY, OBSERVED IN THE DORSAL INTEROSSEOUS MUSCLES,
-WITH UNDER 2000 HOURS EXPOSURE, "LATENT INTERVARL "OF THE HAVS
HAND MUSCLE PATHOLOGY AFTER LONG-TERM VIBRATION EXPOSURE.(3)
(ABDUCTOR POLLICIS BREVIS MUSCLE IN PATIENTS SUFFERING HAVS)
LARSE.NECKING,GO.RANLUNDBORG,RONNIELUNDSTRO.M,LARS-ERICTHORNELLandJANFRIDE!N
-DIRECT MUSCLE DAMAGE (NECROSIS, FIBROSIS AND STRUCTURAL
DISORGANIZATION)
-MUSCLE DENERVATION AND RE-INNERVATION.
STRUCTURAL NERVE CHANGES AT WRIST LEVEL IN WORKERS EXPOSED TO
VIBRATION.(18) (BIOPSIES OF THE DORSAL INTEROSSEOUS NERVE)
Trygve Stromberg, Lars B Dahlin, Arne Brun, Goran Lundborg
-BREAKDOWN OF MYELIN AND BY INTERSTITIAL AND PERINEURIAL FIBROSIS.
RESPONSETOVIBRATION

6. INTRANEURAL EDEMA FOLLOWING EXPOSURE TO VIBRATION.(10)
(RAT-TAIL 82HZ, 4 H/ 5 DAYS)by G6ran l.undborq.l-' Lars B Dahlin," Nils Danielsen,2 Hans A Hansson," Lars E Neckinq,' IImari Pyykk64
- EPINEURIAL EDEMA.
RESPONSETOVIBRATION

7. -PATHOPHYSIOLOGY OF NERVE COMPRESSION SYNDROMES:
RESPONSE OF PERIPHERAL NERVES TO LOADING.(13)
BY DAVID REMPEL, M.D., M.P.H.†, SAN FRANCISCO, CALIFORNIA, LARS DAHLIN, M.D., PH.D.‡, AND GÖRAN LUNDBORG, M.D., PH.D.‡, MALMÖ, SWEDEN
THE JOURNAL OF BONE AND JOINT SURGERY VOL. 81-A, NO. 11, NOVEMBER 1999
-PATHOPHYSIOLOGY OF NERVE COMPRESSION.(29)
S.E. Mackinnon / Hand Clin 18 (2002) 231–241
-NERVE COMPRESSION INJURY AND INCREASED ENDONEURIAL
FLUID PRESSURE: A "MINIATURE COMPARTMENT SYNDROME"(4)
GORAN LUNDBORG, ROBERT MYERS, HENRY POWELL
RESPONSETO PRESSION

8. 20 MM/HG -↓ EPINEURAL FLOW
30 MM/HG -ENDONEURIAL EDEMA
-IMPAIRMENT AXONAL TRANSPORT
-PERINEURIAL/EPINEURIAL THICKENING
50 MM/HG - ESTRUCTURAL ALTERATIONS IN MYELIN.
80 MM/HG -STOP BLOOD FLOW
-WALLERIAN DEGENERATION.
RESPONSE TO PRESSION.

9. Mackinnon SE, Dellon AL. Surgery of the peripheral nerve.

10. The cascade of the biological response to
compression includes endoneurial edema,
demyelination, inflammation, distal axonal
degeneration, fibrosis, growth of new axons,
remyelination, and thickening of the perineurium
and endothelium. The degree of axonal
degeneration is associated with the amount of
endoneurial edema.
Pathophysiology of Nerve Compression Syndromes: Response of Peripheral Nerves to Loading(13)
DAVID REMPEL, LARS DAHLIN, GÖRAN LUNDBORG.

12. MINI-SINDROME COMPARTIMENTAL
AFECTACIÓN FLUJO ENDONEURAL
↓
EDEMA ENDONEURAL
↓
PERINEURO INTACTO
↓
MINIATURE COMPARTMENT SYNDROME
RESPONSETO PRESSION

13. Multiple and double crush syndrome
-Upton and McComas; who stated that a proximal level of nerve
compression could cause more distal sites to be susceptible to compression
Alterations of axoplasmic flow

14. TREATMET
1.- DRIVER POSITION & SETTING
2.- DRIVING TECHNIQUES
3.- DOWN MOTORCYCLE VIBRATION

15. ! PRESSION.
CARPAL TUNNEL PRESSURE 3 TO 5 MM/HG WITH THE WRIST IN A NEUTRAL
POSITION.
PLACING THE HAND ON A COMPUTER MOUSE ↑ P 16 TO 21 MM/HG.
USING THE MOUSE TO POINT AND CLICK ↑ P 28-33 MM/HG.
WRIST EXTENSION 40º+ MP 0º 63MM/HG.
DRIVER POSITION.
WRIST EXTENSION AND ULNAR DEVIATION, FLEXION MP, EXTENSION PIP.
PERMANENT/CONTINUOUS MUSCLE ACTION. (LUMBRICAL,
INTEROSEOUS,FDS,FCU,PRONATOR TERES....)

18. HTTP://CYCLE-ERGO.COM/

19. ! VIBRATION
! ARM POSITION
! GLOVES
HANDLE-BARS
BAR-ENDS
1.- DRIVER POSITION & SETTING

20. que podemos hacer....

22. 1.-AUTOTREATMENT
- 2 TIME A DAY
- NEURODINAMICS(N.D) GLINDING EXERCICES
-IMPROVING INTRANEURAL CIRCULATION, AXOPLASMIC FLOW, NEURAL
CONNECTIVE TISSUE VISCOELASTICITY, AND BY REDUCING MECANSENSITIVITY
(BUTLER, 2000; SHACKLOCK, 2005).
-NERVE GLIDING EXERCISES MAY ALSO LIMIT FIBROBLASTIC ACTIVITY AND
MINIMISE SCAR FORMATION VIA NORMAL AND EARLY USE OF MESONEURIAL
GLIDING TISSUES (MILLESI ET AL., 1995)
2.-OUR TREATEMENT
-SOFT-TISSUE WORK
-INHIBITIÓN TENSIONS (PRONADOR TERES, FCU, HYPOTHENAR MUSCLES)
-STRETCHING (INTEROSEOUS ≢, FDS,FCU, ABD+OPP V..)
-N.D.
TREATMENT

26. -Epidemiological study of vibration syndrome in response to total hand-tool operating time.
(14)
KMIYASHITA,SSHIOMI,NITOH,TKASAMATSU,ANDHIWATA
BrtishJournalofIndustrialMedicine 1983;40:92-98
-Hand muscle pathology after long-term vibration exposure.(3)
LARSE.NECKING,GO.RANLUNDBORG,RONNIELUNDSTRO.M,LARS-ERICTHORNELLandJANFRIDE!N
Journal of Hand Surgery (British and European Volume, 2004) 29B: 5: 431–437
-Structural nerve changes at wrist level in workers exposed to vibration.(18)
Trygve Stromberg, Lars B Dahlin, Arne Brun, Goran Lundborg
OccupationalandEnvironmentalMedicine 1997;54:307-311
-Intraneural edema following exposure to vibration.(10)
by G6ran l.undborq.l-' Lars B Dahlin," Nils Danielsen,2 Hans A Hansson," Lars E Neckinq,' IImari Pyykk64
Scand J Work Environ Health 13 (1987) 326 -329
-VIBRATION CAUSES ACUTE VASCULAR INJURY IN A TWO-STEP PROCESS:
VASOCONSTRICTION AND VACUOLE DISRUPTION.(7)
SANDYA R. GOVINDARAJU1, JAMES LW. BAIN1, THOMAS J. EDDINGER2, DANNY A. RILEY1,
THE ANATOMICAL RECORD: ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY
VOLUME 291, ISSUE 8, PAGES 999–1006, AUGUST 2008-
RESPONSETOVIBRATION