Vibration disease and sensorineural hearing loss. Vibration disease

The group of occupational diseases includes diseases: a) developed in persons living near industrial enterprises that pollute the air, b) listed in the List of Occupational Diseases approved by the Ministry of Health and the Ministry of the Russian Federation, c) developed on the way to or from work. Choose the correct answer:

3. The category of actual occupational diseases includes: a) anthracosis; b) eczema; c) varicose veins of the lower extremities; d) vibration disease; d) chronic bronchitis. Choose the correct combination of answers:

4. On the basis of what documents (orders) are PMOs carried out and what determines the method of its implementation? a) order No. 700; b) order No. 83; c) specifics of production; d) from complaints from those being examined; e) on the specifics of damage to organs and systems. Choose the correct combination of answers:

The sanitary and hygienic characteristics of working conditions are:

enterprise administration

representative of the enterprise trade union committee

safety inspector

sanitary doctor for occupational health at the State Sanitary and Epidemiological Supervision Center

shop doctor

Examination of the working capacity of a patient with occupational bronchial asthma (atopic):

needs employment, transfer to a “fresh” stream, out of contact with the production factor

able to work in his profession under the dynamic supervision of an occupational pathologist

needs to determine the disability group

7. The document necessary to resolve the issue of the nature of the disease is:

accident report

sanitary characteristics of working conditions

all answers are correct

8. The functions of an occupational pathologist include:

consultative reception of patients with occupational diseases, disabled people due to occupational diseases and persons suspected of occupational diseases, hospitalization and supervision of patients in the departments of occupational pathology hospitals

diagnosis of occupational diseases, treatment and rehabilitation of patients with occupational diseases and disabled people due to occupational diseases

issuance of medical reports based on the results of consultation and recommendations for treatment by doctors according to place of residence, on the employment and management of these sick and disabled people, referral of sick and disabled people to MSE

clinical expert assessment of the quality of preliminary and periodic medical examinations working

all answers are correct

9. Factors causing occupational diseases include:

chemical and biological

industrial aerosols

physical

overwork, overstrain of individual organs and systems

all answers are correct

bronchial asthma

dermatitis

polyneuropathy

silicosis

sensorineural hearing loss

11. To resolve the issue of occupational etiology of bronchial asthma, the concentration of the industrial allergen:

is critical

not decisive

12. Necessary medical examinations of workers under medical supervision include everything except:

preliminary (upon applying for a job)

periodic (during work)

targeted (to identify diseases of a certain nosology)

after removal from the corresponding disability group

13. The purpose of the preliminary medical examination upon entry to work is:

determining the suitability (suitability) of workers and employees for the work assigned to them

prevention of common diseases

prevention of occupational diseases

all answers are correct

all answers are wrong

14. The forms of expert decisions in case of occupational diseases are:

certificate of temporary transfer to light work for a maximum period of 1 year

percentage of loss of professional ability to work

disability group

all answers are correct

15. The main objectives of the Center for Occupational Pathology are:

establishing a connection between diseases and profession

improvement of sick and disabled people due to occupational diseases

improving the health of people at risk

development and implementation of measures to prevent and reduce occupational morbidity and labor losses due to illness and disability

all answers are correct

16. The purpose of periodic medical examinations is:

dynamic monitoring of the health status of workers exposed to occupational hazards and unfavorable working conditions

timely identification of initial signs of occupational diseases and their prevention

identification of common diseases that prevent continued work in hazardous conditions

identification of diseases to prevent accidents and ensure occupational safety and public health protection

all answers are correct

17. DisabilityI

18. DisabilityIIgroups are established by the patient:

who, due to severe functional disorders, cannot care for themselves and need constant outside care or supervision

with significantly pronounced functional impairments, as well as with rapid progression of the disease and frequent severe exacerbations pathological process leading to the development of complete permanent or long-term disability

with chronic diseases or anatomical defects that significantly reduce the ability to work due to impaired body functions

19. DisabilityIIIgroups are established by the patient:

who, due to severe functional disorders, cannot care for themselves and need constant outside care or supervision

with significantly pronounced functional impairments, as well as with rapid progression of the disease and frequent severe exacerbations of the pathological process, leading to the development of complete permanent or long-term disability

with chronic diseases or anatomical defects that significantly reduce the ability to work due to impaired body functions

20. Acute occupational diseases are recorded:

in outpatient clinics and clinics of all types

in the clinics of occupational diseases of the research institute

Health care facilities that have the right to establish the connection between diseases and working conditions and determine their professional nature in occupational pathology centers.

Topic No. 2. Diseases due to exposure physical factors production environment

Lesson No. 1.Vibration disease

Appendix 1. Abstract (current state of the issue):

Epidemiology, etiology, pathogenesis and classification

vibration disease

Vibration disease – Occupational Illness, characterized by the polymorphism of clinical symptoms and the peculiarity of the course. The main etiological factor of this disease is industrial vibration; Associated occupational factors also play a significant role in its development: noise, cooling, significant static tension in the shoulder muscles and shoulder girdle, forced body position, which can contribute to a more rapid development of the pathological process and determine the characteristics of the clinical picture.

Vibration disease is more common among workers in the engineering, metallurgical, construction, aircraft and shipbuilding, mining industries, employed in agriculture, transport and other sectors of the national economy. 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, among concrete molders when vibrating concrete, etc.

By its physical nature, vibration is a mechanical oscillatory movement that repeats itself at certain periods.

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.

Mechanical vibrations (vibration) are perceived by all tissues of the body, but mainly by the nervous and bone tissues, the latter being a good conductor and resonator of vibration.

The nerve endings are most sensitive to the effects of vibration, primarily the receptors of the skin of the distal parts of the arms and the plantar surface of the feet. The vestibular apparatus takes part in the transmission of vibration stimuli. High frequency vibrations can affect hearing aid action close to the action of noise. The degree to which a person perceives mechanical vibrations occurring in different planes depends on the position of the body. Thus, in a standing position a person is more sensitive to vertical vibrations, and in a lying position - to horizontal ones. It has now been proven that the influence of high-frequency vibration on the body of workers causes a vasoconstrictor effect, and the most adverse effect (vasospasm) is observed at a frequency of 100-250 Hz. The frequency of vibration determines not only the nature of changes in vascular tone, but also the violation of vibration and pain sensitivity. The effect of vibration of low frequency and large amplitudes on the body is mainly associated with the displacement of the body and individual organs in space, as well as with irritation of the vestibular apparatus.

Vibration has a general biological effect on any cells, tissues and organs. Being a strong irritant, it is perceived by special nerve endings - vibration sensitivity receptors. Prolonged exposure to vibration on vibration sensitivity receptors creates conditions for an increase in the excitability of the corresponding overlying centers. Under the influence of afferent impulses, reflex reactions occur in the neurons of the spinal cord, sympathetic ganglia, and reticular formation of the brain stem, including at various levels of the autonomic-vascular centers. As a result of disruption of the regulatory influences of the central nervous system on vascular tone, in particular on the state of regional blood circulation, specific manifestations of vasospasm are observed. The more vibration sensitivity is changed, the more pronounced vascular spasm is. Direct mechanical damage and irritation of vascular smooth muscle cells cannot be ruled out, which contributes to their spasm or atony. Subsequently, dystrophic changes develop.

The pathological process generally has the character of angiotrophoneurosis, which at a certain stage tends to generalize. Subsequently, as the disease develops, from vibration centers that are in a state of stagnant excitation (parabiosis), irritation radiates to the vasomotor, pain and temperature centers.

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, etc.).

In industrial environments, a combination of local and general vibration may be observed (combined vibration). Thus, a combined effect with a predominance of local vibration is manifested when working with hand-held machines, when the transmission of vibrations throughout the body is carried out not only through the upper, but also through the lower limbs, chest, back and other parts of the body, depending on the working posture and design of the tool. In other cases, general vibration may predominate, for example, when forming reinforced concrete products on vibration platforms with simultaneous manual leveling of the concrete mass.

According to the severity of the pathological process, 4 stages of the disease were conventionally distinguished: I – initial (mild phenomena); II – moderately expressed; III – pronounced; IV – generalized (extremely rare).

In 1967 E.A. Drogichina and N.B. Metlina developed a classification that allows this disease to be considered in the form of 7 syndromes: angiodystonic, angiospastic, vegetative polyneuritis syndrome, neurotic, vegetomyofasciitis, diencephalic and vestibular. The identification of individual syndromes was due to the fact that the influence of additional production factors (cooling, microtraumatization, forced posture, physical stress), along with vibration, created the opportunity for the formation of a certain clinical orientation of certain deviations from the general symptomatology of the disease.

In recent years, the clinical course of vibration disease has changed significantly (nonspecific symptoms are often noted). At the Research Institute of Occupational Medicine of the Russian Academy of Medical Sciences, classifications of its various forms were created.

Classification of vibration disease from exposure to local vibration.

Initial manifestations (Idegree)

Peripheral angiodystonic syndrome of the upper extremities, including rare angiospasms of the fingers

Syndrome of sensory (vegetative-sensory) polyneuropathy of the upper extremities

IIdegree)

Peripheral angiodystonic syndrome of the upper extremities with frequent vasospasms of the fingers

Syndrome of autonomic-sensory polyneuropathy of the upper extremities:

with frequent angiospasms of the fingers;

with persistent vegetative-trophic disorders on the hands;

with dystrophic disorders of the musculoskeletal system of the arms and shoulder girdle (myopathosis, myo-fibrosis, periarthrosis, arthrosis);

with cervicobrachial plexopathy;

with cerebral angiodystonic syndrome

Pronounced manifestations (IIIdegree)

Upper extremity sensorimotor polyneuropathy syndrome

Encephalopathy syndrome

Polyneuropathy syndrome with generalized acroangiospasms.

Classification of vibration disease from exposure to general vibration.

Initial manifestations(Idegree)

Angiodystonic syndrome (cerebral or peripheral)

Vegetative-vestibular syndrome

Syndrome of sensory (vegetative-sensory) polyneuropathy of the lower extremities

Moderately pronounced manifestations (IIdegree)

Cerebro-peripheral angiodystonic syndrome

Sensory (vegetative-sensory) polyneuropathy syndrome in combination:

with polyradicular disorders (polyradiculoneuropathy syndrome);

with secondary lumbosacral radicular syndrome (due to osteochondrosis of the lumbar spine);

with functional disorders of the nervous system (neurasthenia syndrome).

Expressed manifestations(IIIdegree)

Sensorimotor polyneuropathy syndrome

Disculatory encephalopathy syndrome in combination with peripheral polyneuropathy (encephalopoly-neuropathy syndrome)

The proposed classifications provide grounds not only for establishing the severity of the pathological process, but also for resolving questions about the choice of treatment and the patient’s ability to work. However, they are also conditional.

Clinic, diagnosis of vibration disease.

Differential diagnosis

The main complaints in the local 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, disturbing more 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.

First (initial) degree The disease is asymptomatic. The state of the body is compensated. The process is completely reversible. Patients complain about not sharp pains in the hands, a feeling of numbness, 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. Sometimes mild functional disorders of the nervous system can be noted. This stage is the most difficult to diagnose and is characterized as functional.

Second degree– moderately expressed 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 are observed as large vessels, and capillaries. 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 is more clearly manifested. When carrying out treatment and preventive measures, the process is reversible. The disease is difficult and slow to treat, and there is a tendency to progress and recur.

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. There is a tendency to progress. Complications are possible. There is significant disability.

The “abortive” form of vibration disease has a relatively benign course. The only manifestation of the disease is a tendency to attacks of vascular spasm in the extremities. Outside of such an attack, there is no pain, skin sensitivity is not changed, and there are no trophic disorders. Typically, this form of the disease is observed in individuals with a well-developed muscular system and stable autonomic regulation.

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. The clinical picture caused by prolonged exposure to low-frequency vibration is manifested primarily by early peripheral and cerebral autonomic-vascular disorders, which are mainly of a nonspecific functional nature, which causes diagnostic difficulties. 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.

One of the main signs of this pathology is vegetative-vestibular syndrome, which manifests itself in the form of unsystematized dizziness, rapid motion sickness, and nausea. Most patients have decreased excitability of the vestibular analyzer with the presence of positive labyrinth tests (otolith reaction of degrees II and III, etc.). However, these disorders are usually mildly expressed. In addition to dysfunction of the vestibular analyzer, changes in the auditory and visual analyzers. Often this form of vibration disease is observed in combination with cerebral angiodystonia. Sometimes dysfunction of the digestive glands occurs, and disturbances in the motor and secretory functions of the stomach may be associated with disorders of their regulation, prolapse of the abdominal organs, and irritation of the celiac (solar) plexus, which developed as a result of jerky vibration.

When examining workers exposed to constant exposure to rough, jerky vibration, degenerative changes in the spine are often revealed (osteochondrosis, deforming osteoarthritis of the lumbosacral, less commonly cervicothoracic region spinal column). When examining tractor drivers and heavy-duty transport drivers, most of them were found to have osteochondrosis of the lumbosacral region of the spine. This, as a rule, is accompanied by the occurrence of secondary radicular, pain and reflex syndromes, which causes a decrease in working capacity. Functional disorders caused by exposure to general vibration usually remain compensated for a long time and, as a rule, do not lead to disability.

Consequently, vibration disease, caused by exposure to general vibration, can manifest itself in the following syndromes: cerebral-peripheral angiodystonic, vegetative-vestibular, vegetative-sensory polyneuropathy. With moderately pronounced signs of the disease (grade II), the syndrome of autonomic-sensory polyneuropathy can be observed in combination with polyradicular disorders and functional changes in the central nervous system. With more pronounced manifestations of the disease, the development of sensorimotor polyneuropathy with signs of discirculatory encephalopathy or diencephalic pathology is possible.

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 in identifying the earliest stages of the disease, functionally compensated, “abortive” forms, and in determining 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 frequency.

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, etc. These methods are well known in clinical practice.

Vibration disease for a long time may not manifest itself, progress slowly. During this period, patients do not seek medical help and the question of assessing their ability to work does not arise until the initial signs pathological process.

There are three general approaches to conducting a work ability examination for vibration disease:

• 1) adequate treatment (outpatient or inpatient) with subsequent return to previous work, subject to dynamic medical supervision;
• 2) active therapy followed by a temporary transition (for the period of follow-up treatment) to lighter work not associated with vibration. In this case, additional payment is made for a period of up to 2 months, and a professional bulletin is issued;
• 3) in severe cases establish the percentage of disability or disability group. With loss of ability to work in a previous profession, the patient is provided with work without contact with vibration.

It should be noted that with vibration disease of degrees I and II the prognosis is favorable, but with pronounced manifestations it is doubtful.

Persons with vibration disease of the first degree are temporarily (for 1 month) transferred to work not related to the influence of vibration, and are issued a certificate of professional incapacity for work in case of a decrease in earnings. Active therapy is carried out on an outpatient basis without interruption from work. In this case, outpatient treatment and adherence to individual prevention measures give a positive result and the patient’s ability to work is not impaired. Subsequently, dynamic monitoring of the employee’s health status is carried out.

Treatment of patients with stage II of the disease is carried out in a hospital with subsequent transfer to consolidate the result of treatment for a period of up to 2 months to a job that is not associated with the influence of vibration; they are issued a certificate of professional incapacity for work in case of a decrease in earnings. In this case, sanatorium-resort treatment is strongly recommended, as well as dynamic observation of the patient with subsequent decision-making on his professional suitability.

If timely and rational therapy for vibration disease of the I and II degrees, as well as a complex of other treatment and preventive measures, did not give the proper effect and the patient has persistent pathological disorders, he should be considered disabled in a profession associated with the influence of 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 another job, taking into account the indicated restrictions. If rational employment has led to a decrease in qualifications, the patient should be sent to MSEC to determine the percentage of disability. Patients with vibration disease III degree, as a rule, are of limited ability to work; they are determined by the percentage of loss of professional ability to work or the group of disability due to an occupational disease. vibration disease nerve blood flow

Occupational diseases of workers. Part 1. Vibration disease

The study of occupational diseases has a long history. In ancient times, even before new era, the attention of individual philosophers and doctors was drawn to the high mortality rate of miners. In ancient Greek and Roman literature (VI-IV centuries BC), in the works of Aristotle and Lucretius, cases of severe illness in silver mine workers are given. Ovid and Plutarch, in their writings, presented a picture of hard work leading to early deaths among metallurgists and tanners.

The study of occupational diseases has a long history. In ancient times, even before the new era, the attention of individual philosophers and doctors was drawn to the high mortality rate of miners. In ancient Greek and Roman literature (VI-IV centuries BC), in the works of Aristotle and Lucretius, cases of severe illness in silver mine workers are given. Ovid and Plutarch, in their writings, presented a picture of hard work leading to early deaths among metallurgists and tanners. Hippocrates (460-377 BC) drew attention to the high mortality rate of miners. He was the first to point out the harmfulness of lead dust, even compiled a list of “lead” professions of that time and described the clinic of “lead colic.” However, all these descriptions were isolated and fragmentary.

INTRODUCTION TO PROFESSIONAL MEDICINE. HISTORICAL ASPECT

Only with the development of industry in the 16th century. Special works on occupational diseases began to appear. In 1556, Agricola, a German doctor and metallurgist, described severe occupational diseases of miners in his work “On Mining and Metallurgy.” Later, a book was published by the Renaissance physician and chemist Paracelsus, “On Mountain Consumption and Other mountain sickness”, which gives a clinical picture of the miners’ illness, accompanied by fever, shortness of breath, cough, and weight loss. Paracelsus drew attention to the short life span of miners as a result of harsh working conditions and frequent illnesses. Early death Many historians associate Paracelsus himself with his work at mining and metallurgical enterprises in Tyrol.

In the 17th century Martin Pane published a paper on the diseases of miners and metal smelters and described cases of lead poisoning. A significant contribution to the doctrine of occupational diseases was made by the Italian physician, professor of practical medicine Bernardino Ramazzini. His book “On the diseases of artisans. Discourses,” published in 1700, was the first systematic work of that period, which quite widely described various occupational diseases of workers in various professions. He described diseases of miners, gilders, chemists, plasterers, blacksmiths and other artisans.

Development of large industry in the second half of the 19th century. and at the beginning of the 20th century. accompanied by the emergence of new professions and new occupational hazards. This contributed to a wider study of various forms of occupational diseases, the description of which was presented in the works of L. Teleki, A. Lehman, T. Oliver, A. Hill, V. Bradford, Devoto, A. Hamilton, K. Drinker and others.

Brutal exploitation of workers and poor working conditions lead to an increase and worsening of occupational diseases. Mortality among workers in mines and other industries is rising. There is a need to open specialized medical institutions to treat such patients. In 1910, Devoto founded a clinic for occupational diseases in Milan. Soon, institutes of industrial medicine with clinics for occupational diseases (or without them) were created in Finland, Japan, Spain, and the USA.

Selected information about harmful influence production factors on the health of workers can be found in M. V. Lomonosov’s treatise “The First Foundations of Metallurgy or Mining,” written in 1763. The first Russian book “Diseases of Workers with Indications of Preventive Measures,” which is devoted to the description of occupational diseases, was written by a well-educated St. Petersburg by doctor N. Nikitin, published in 1847. He also published a number of articles in the journal “Friend of Health” on measures to prevent diseases in various fields.

Leading doctors of that time F.F. Erisman, A.V. Pogozhaev, V.V. Svetlovsky repeatedly drew the attention of the tsarist government to the hopelessness of the workers’ lives, their high mortality rate from backbreaking and harmful work. V.I. Lenin, who deeply knew the needs of the working people, wrote about the situation of the working class in tsarist Russia: “Thousands and tens of thousands of people, who work all their lives to create other people’s wealth, die from hunger strikes and from constant malnutrition, die prematurely from diseases caused by disgusting working conditions, squalid living conditions, lack of rest.” During this difficult period for the working class, the first original domestic manual on occupational hygiene by F. F. Erisman appeared, “Professional hygiene or hygiene of mental and physical labor" The manual provides data on the impact of working conditions on health and physical development workers.

The book by E. M. Dementyev “The Factory, What It Gives to the Population and What It Takes from It” shows the impact of harsh working conditions on the health of workers. The widespread nature and severity of occupational diseases among workers during the period of capitalism attracted the attention of public health doctors. Thus, the sanitary doctor of the Podolsk district of the Moscow province V. A. Levitsky was the first to describe severe mercury poisoning of workers and members of their families involved in the production of felt.

The main tasks of the work of health authorities and authorities social protection population for the prevention of occupational diseases are:

• determination of professional suitability for work associated with possible exposure to harmful and hazardous factors working environment (preliminary medical examinations);
• diagnosis of occupational diseases and justification for assessing the patient’s ability to work (conducting regular periodic medical examinations);
• establishment and substantiation of recommendations for the rational employment of patients, allowing them to participate in socially useful work without harm to health (medical advisory commission);
• substantiation and establishment of recommendations for the rational organization of labor, for safe working conditions (sanitary and epidemiological surveillance);
• monitoring the health status of workers (conducting regular periodic medical examinations);
• identification and elimination of the causes contributing to the decrease or loss of ability to work (sanitary and epidemiological surveillance).

CRITERIA FOR LOSS OF WORK CAPACITY

Temporary loss of ability to work is observed mainly in cases of severe and moderate intoxication, for example, carbon monoxide, carbon tetrachloride, benzene, etc. Often, complete temporary loss of ability to work can also occur as a result of exacerbation of a chronic occupational disease: toxic or dust bronchitis, occupational bronchial asthma, etc. .

Partial temporary disability in patients with occupational diseases is observed in cases where, due to the nature of the disease, they are temporarily unable to perform their usual work, but can be used in other jobs without harm to their health. Patients are considered temporarily partially incapacitated light forms occupational intoxications and diseases in which, after cessation of contact with the relevant unfavorable factors of the working environment and treatment, complete recovery is possible.

When temporarily transferred to another job due to an occupational disease, by decision of the VKK, the patient is issued a so-called labor (“additional paid”) sick leave, according to which an additional payment is made up to the previous average earnings. A work sick leave certificate is issued at a time for no more than 10 days, and the maximum extension period should not exceed 2 months. in a calendar year. If a patient with partial loss of ability to work can be rationally employed not only without harm to health, but also without reducing qualifications, there is no need to issue a sick leave certificate. Therefore, when deciding whether to issue a sick leave certificate, the patient’s profession and position should be taken into account. So, for example, if mild lead intoxication is detected in a lead smelter, who, due to the nature of his work, is forced to have contact with him, then when transferred to another job, due to a decrease in his qualifications, he needs to receive a sick leave certificate for the period of temporary employment. An electrician in a lead production foundry who has mild lead intoxication can be rationally employed without contact with lead without changing his profession; therefore, there is no need to issue him a sick leave certificate.

Issues of long-term and permanent disability are dealt with by medical and labor expert commissions, which belong to the social protection bodies of the population. Disability should be understood as a persistent disability in which the patient cannot perform his work or is incapacitated for a period of time. long period or constantly.

VTEK determines the disability and the percentage of disability of the patient in the direction of the VKK. In case of occupational diseases (and intoxications), patients who cannot perform their work for a long period due to health reasons are subject to referral, and their transfer to another job without contact with the corresponding unfavorable factors of the working environment is associated with a decrease in qualifications. Patients who have complete permanent loss of ability to work are also referred to VTEC.

Most common reasons that cause disability due to occupational diseases and intoxications are:

• complications and residual effects that occur during acute (especially severe forms) of intoxication;
• chronic diseases characterized by a progressive course and frequent exacerbations;
• acute and chronic diseases and intoxications, the treatment of which requires a long period of time (more than 2 months), and the patient’s employment during the period of treatment is associated with a decrease in qualifications.

Some forms of chronic occupational diseases and intoxications in the initial stages can be completely curable (for example, stage I vibration disease, chronic intoxications with lead, mercury, benzene). Therefore, loss of ability to work in such patients may be temporary and partial. In cases where chronic diseases and intoxications are not completely curable (for example, pneumoconiosis, chronic manganese intoxication, etc.), the loss of ability to work in such patients, regardless of the severity of the clinical picture, is permanent, so they need rational employment from the very beginning of the disease.

The degree of disability of patients depends on the form and severity of the disease, the severity of functional disorders, clinical and work prognosis. Therefore, there are three disability groups - I, II and III. In addition, when determining the state of ability to work and establishing a disability group, one should take into account the patient’s age, profession, general educational and professional training, as well as work experience and specific working conditions.

Group I disability is established for patients who, due to pronounced functional disorders, cannot care for themselves and require constant outside care or supervision. Such patients are completely disabled. Disabled people of group I may include patients with occupational, bronchial asthma, pneumoconiosis, chronic dust bronchitis with decompensation of respiratory function. Group II disability is established for patients with significant functional impairment, as the disease progresses, but they do not require constant care or supervision. Group III disability is determined by patients with a chronic disease or anatomical defect that significantly reduces their ability to work. In this case, it is necessary to transfer to another, less qualified job, and change working conditions.

VIBRATION OCCUPATIONAL PATHOLOGY

With technological progress, modern production is increasingly using various mechanisms and new technological processes. This, in turn, causes the body of workers to be exposed to various unfavorable physical factors, such as vibration, noise, electromagnetic waves radio frequency and optical range. Occupational diseases caused by exposure to physical factors of the working environment can occur in various sectors of the national economy: in mechanical engineering, shipbuilding and aircraft construction, electronic and radio engineering, construction and mining industries, agriculture, etc. All diseases caused by exposure to one or another physical factors, are distinguished by the originality of the pathological symptom complex, polysyndromic nature with the presence of specific and more often nonspecific symptoms, which creates certain diagnostic difficulties. At the same time the implementation early diagnosis, timely treatment, rational solution of issues of medical labor examination and rehabilitation - necessary condition for successful implementation of treatment and preventive measures.

Vibration disease - an occupational disease characterized by a variety of clinical symptoms and specific course. Main etiological factor is industrial vibration. Associated occupational factors also play a significant role in the development of the disease: noise, cooling, significant static tension in the muscles of the shoulder and shoulder girdle, forced situation body, etc. They can contribute to a more rapid development of the pathological process and determine some features of the clinical picture.

STATISTICS OF OCCUPATIONAL DISEASES CAUSED BY VIBRATION EXPOSURE

Vibration disease occupies a leading place among all occupational diseases and is more common among workers in the engineering, metallurgical, aircraft, shipbuilding, and mining industries, employed in agriculture, transport and other sectors of the national economy.

DISTRIBUTION BY HARMFUL PRODUCTION FACTORS OF WORKERS,
EMPLOYED IN WORK WITH HARMFUL AND (OR) DANGEROUS WORKING CONDITIONS (%)

Source of statistics: Federal Center hygiene and epidemiology of Rospotrebnadzor

ETIOLOGY OF VIBRATION OCCUPATIONAL PATHOLOGY

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 crosscutters when working with motor and electric saws, among levelers working on dynamic peening machines, among concrete molders when vibrating concrete, and so on.

By its physical nature, vibration is a mechanical oscillatory movement that is repeated after certain periods of time. The main parameters characterizing vibration are vibration frequency and vibration velocity. The oscillation frequency is estimated in hertz (hertz or Hz - one oscillation per second), vibration velocity - in meters per second (m/s).

The strength of the impact of vibration on the body depends on the amount of absorbed energy, the most adequate expression of which is vibration velocity. Vibration with a frequency of 8-16 Hz is low-frequency, 16-64 Hz is mid-frequency, and from 64 to 1000 Hz is high-frequency. Regarding the risk of developing vibration disease highest value has vibration with a frequency of 16-250 Hz.

Depending on the type of contact with the worker’s body, a distinction is made between local (local) and general vibration (vibration of workplaces). With local (local) vibration, the body is shaken by transmitting it through the limbs. This form of vibration is more often encountered by those working with hand-held mechanized impact or rotary tools.

Vibration of the workplace (bench, floor, workpiece, platform or place where the worker is, etc.) is defined as general. This form is found during vibration compaction of concrete in reinforced concrete and construction industries, in the textile industry, as well as in the maintenance of transport and agricultural machinery. General vibration becomes especially complex when working on rolling stock of railway transport, on tractors, etc.

Under these conditions, vibration is most often of a jerky nature. In industrial environments, a combination of local and general vibration may occur. Thus, a combined effect with a predominance of local vibration occurs when a series of manual machines, when the transmission of vibrations throughout the body is carried out not only through the upper, but also through the lower limbs, chest, back and other parts of the body, depending on the working posture and design of the tool. In other cases, general vibration may predominate, for example, when forming reinforced concrete products on vibration platforms with simultaneous manual leveling of the concrete mass.

Mechanical vibrations (vibrations) are perceived by all tissues of the body, but mainly by the nervous and bone tissues, the latter being a good conductor and resonator of vibration. The most sensitive to the effects of vibration are the nerve endings and, above all, the receptors of the skin of the distal parts of the arms and the plantar surface of the foot. The vestibular apparatus also takes part in the transmission of vibration stimuli. High-frequency vibrations can have an effect on the hearing aid that is similar to that of noise. A potentiation of the biological effect under the combined action of vibration and noise was revealed.

The degree of human sensitivity to the perception of mechanical vibrations occurring in different planes depends on the position of the body. Thus, in a standing position a person is more sensitive to vertical vibrations, and in a lying position - to horizontal ones. Research by E. Ts. Andreeva-Galanina and her students has established a certain dependence of the biological effect of vibration on its physical characteristics. It has now been proven that the influence of high-frequency vibration on the body of workers causes a vasoconstrictor effect, and the most adverse effect(vasospasm) is observed at a frequency of 60-250 Hz. The frequency of vibration determines not only the nature of changes in vascular tone, but also the disturbance of vibration and pain sensitivity. The effect of vibration of low frequency and large amplitudes on the body is mainly associated with the displacement of the body and its individual organs in space, as well as with irritation of the vestibular apparatus.

A certain role in the body's response to the influence of mechanical vibrations is played by the resonant frequency biologically inherent in the body as a whole and in individual organs and tissues. Thus, it has been established that for the body it is on average about 6 Hz, for the head and stomach - 8 Hz.

Already by the middle of the twentieth century. there is a need for a differentiated assessment of the biological effect of vibration depending on its spectrum
and place of application, in connection with which in 1963 the classification of E. Ts. Andreeva-Galanina and V. G. Artamonova was proposed. The authors considered vibration disease in the form of three forms of the disease:

1. Vibration disease from exposure to local vibration.
2. Vibration disease from exposure to “combined” vibration - local and general.
3. Vibration disease from general vibration.

In their classification, the authors tried to reflect clinical symptoms 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, four stages of the disease are distinguished: I - initial (mild phenomena); II - moderately expressed; III - pronounced; IV - 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 angiospastic syndrome, more often when exposed to high-frequency vibration, or polyneuritic from exposure to vibration with a predominance of low frequencies in the spectrum.

This classification is conditional, but it helps to resolve issues of assessing work capacity and choosing a therapeutic agent.

In 1967, the classification of E. A. Droginina appeared, which allows us to consider this disease in the form of seven syndromes: angiodystonic, angiospastic, vegetative polyneuritis, neuritic, vegetomyofasciitis, diencephalic and vestibular. The identification of individual syndromes was due to the fact that the influence of additional production factors (cooling, microtraumatization, forced posture, physical stress) along with vibration created the opportunity for the formation of a certain clinical orientation of certain deviations from the general symptomatology of the disease.

Vibration disease from local vibration. This form of the disease is more common in those who work with hand-held power tools. Vibration disease, caused by exposure to local vibration, usually occurs gradually and develops gradually. The leading place is occupied by vascular syndrome, accompanied by phenomena of vascular spasm of the extremities. Often the disease is latent and can only be detected during preventive medical examinations.

The main complaints with this form of vibration disease are:

• 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 the 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, disturbing more at night or during rest. Often the pain is accompanied by paresthesia (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 compressive pain in the heart area, palpitations, pain are possible in the area of ​​the stomach.

The nature of the pain in the arms is noteworthy. The pain often occurs spontaneously and is more disturbing in the morning, at night or after work. According to patients, 10-15 minutes after starting to work with pneumatic tools, the pain in the hands, as a rule, disappears, the state of health improves, but in the evening or at night the pain in the hands resumes. The intensity of pain in the arms, which often disturbs sleep, varies (from mild to severe) and depends on the severity of the disease. One of the main symptoms of vibration disease is vascular disorders. Most often they consist of impaired peripheral circulation, changes in capillary tone, and impaired general circulation. Clinically, this manifests itself in the form of angiodystonic syndrome with symptoms of peripheral vascular spasm. Hemodynamic disorders are detected in the form of changes blood pressure, minute and systolic volumes of blood circulation, elastic-viscous properties vascular walls and peripheral resistance. There is often a decrease in the rate of spread pulse wave through vessels of muscular and elastic types. However, such changes are more common when working with heavy air tools.

Indicators of vascular disorders are also asymmetry of blood pressure, the white spot phenomenon, changes in capillary tone - spasm or spastic-atonic state. Noteworthy is the change in the color of the skin of the hands: in some it is purple-cyanotic, while in others it is pale. Most patients have swollen hands, with deformation of the terminal phalanges or interphalangeal joints. Often the fingers of the hands look like drumsticks. Secretory disorders manifest themselves in increased sweating hands, less often
in dryness.

There is a decrease in skin temperature, mainly in the distal parts of the hands. In some patients, phenomena of latent sweating of the palms can be noted, which are observed after painful irritation with a needle. In severe cases of the disease, vascular disorders may fade into the background. In this case, the sensitive area is affected. One of the constant indicators of the presence of vibration disease is sensitivity disorder. Vibration, pain and temperature sensitivity suffers most sharply, tactile sensitivity suffers less. Muscular-articular sensation is disturbed only in rare cases.

Vibration sensitivity is especially often and early disrupted, and the nature of its changes fully corresponds to the form and severity of vibration disease. Changes in vibration sensitivity can be detected using a tuning fork (the perception of vibration is significantly shortened - up to 5-7 s) or an aesthesiometer - a special device that allows you to determine the threshold of vibration sensitivity, adaptation to vibration load, and the speed of sensitivity recovery after vibration load.

Depending on the severity of vibration disease, pain sensitivity disorders in the form hypersensitivity(in the early stages) and decreased sensitivity can spread not only to the fingers, but also to the hand or to capture the lower third of the forearm like a long glove. When exposed to vibration on the legs or in the generalization stage of the process, a decrease in sensitivity is noted on both the feet and legs, like socks, and the degree of disorder increases from the periphery (distal) according to the polyneuritic type. The described disorders in the severe form of vibration disease are accompanied by sensitivity disorders of the segmental type, most often affecting the zones of innervation of the segments.

TROPHIC DISORDERS

The most noticeable phenomena of increased keratinization are: both on the palmar surface of the hands and on the lateral surfaces of the fingers. Sometimes it is defined as round, pale, smooth formations on the back of the interphalangeal joints. Often there may be abrasion of the skin pattern, especially on the terminal phalanges. Nails are usually thickened, cloudy, deformed or thinned and polished like watch glasses. There are many cracks on the fingers.

Trophic disorders can spread to deeper tissues: subcutaneous tissue, tissue of interphalangeal joints, muscle tendons. In those working with heavy pneumatic tools, due to significant overstrain of the upper limbs, myofasciculitis, myositis of the muscles of the shoulder girdle, and tendomyositis of the forearm are often observed. Degenerative-dystrophic processes in the bone area are often detected. X-rays reveal foci of organic osteosclerosis. There are also changes in the spine, mainly in intervertebral discs and joints, mostly degenerative.

Choppers and miners sometimes experience aseptic necrosis lunate bone, less often the scaphoid, which certainly aggravates the disease. The most significant dysfunction of the upper extremities is with necrosis of the head of the humerus. In most cases, radiological data do not coincide with subjective disorders: the latter are either absent or expressed so insignificantly that workers do not pay attention to them. Lesions appear only with active X-ray examination.

Thus, these symptoms of the disease fit into the picture of vegetative polyneuritis of the extremities, occurring with peculiar vascular and trophic disorders. In rare cases, damage to peripheral motor fibers may also occur, which is accompanied by mild atrophy of the small muscles of the hands. All these changes, as a rule, occur against the background of functional disorders of the central nervous system, which clinically manifest themselves mainly in the form vegetative dystonia and asthenia. In most cases, due to the combined effect of vibration and noise, workers experience neuritis of the auditory nerves. In the initial stages of the disease, there is only a slight decrease in air conduction of sounds (to high tones 4,096-8,192 Hz), shortening bone conduction. However, in workers with extensive experience and in advanced stages of the disease, there is a decrease in hearing not only for high tones, but also for low tones (64-128 Hz), as well as hearing impairment and whispered speech. Acoustic neuritis is usually bilateral; They are best diagnosed by audiometry.

Of the general clinical symptoms, functional disorders of the digestive glands attract attention: gastritis, intestinal dyskinesia, metabolic disorders - carbohydrate, protein, phosphorus-vitamin (B6, C), etc. Of course, changes in the internal organs are not specific and can be attributed to the effects of vibration only in the case when they develop against the background of vibration disease. Thus, the clinical picture of the described vibration disease is complex, not always specific and difficult to diagnose. This makes it difficult to resolve complex issues of assessing work capacity.

There are four stages during vibration disease.

First (initial) stage 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.

Upon examination, mild sensitivity disorders on the terminal phalanges and mild changes in capillary tone are revealed. Attacks of whitening of the fingers appear extremely rarely and only after sudden cooling. Sometimes mild functional disorders of the nervous system can be noted. This stage is the most difficult to diagnose and is characterized as functional.

Second - stage of moderately expressed phenomena. By its nature it can be classified as functional, but the number of complaints with it increases.

Painful phenomena become more persistent. Changes in the tone of both large vessels and capillaries are observed. Sensitivity disorders, especially vibration sensitivity, are more pronounced; Autonomic dysfunction and asthenia phenomena are determined. The process is reversible, subject to active implementation of treatment and preventive measures.

Third - stage of pronounced vasomotor and trophic disorders. Attacks of vasospasms become frequent. Significant sensory disorders, which can be segmental in nature. A sharp decrease, and sometimes complete loss of vibration sensitivity. The disease at this stage is difficult and slow to treat, and there is a tendency to progress and recur.

Fourth - stage of generalized organic lesions. It is extremely rare. Vascular, trophic and sensory disorders are pronounced. Microfocal symptoms, lesions of the central nervous system, diencephalic crises, and often pronounced muscle atrophy and joint dysfunction may be observed. Vascular crises cover not only the peripheral vessels of the extremities, but also the area of ​​the coronary and cerebral vessels. In rare cases, gangrene of the fingers may develop. This stage of organic lesions tends to progress. Complications are possible. There is significant disability.

E.A. Drogichina identified an “abortive” form of vibration disease, which has a relatively benign course. The only manifestation of the disease is a tendency to attacks of vasospasm of the limbs. Outside of such an attack, there is no pain, skin sensitivity is not changed, and there are no trophic disorders. Working capacity has been preserved. Typically, this form of the disease is observed in individuals with well-developed muscular systemic and stable autonomic regulation.

VIBRATION DISEASE UNDER EXPOSURE TO GENERAL AND LOCAL VIBRATION

This form of vibration disease occurs most often in people exposed to workplace vibration, in particular during vibration compaction of concrete. This form is characterized by significant changes in the central nervous system, occurring as a neurosis with an increase in the excitatory process and a sharp weakening of the inhibitory process. This gave A. S. Melkumova the basis to call it “cerebral”. However frequent syndrome This form of vibration disease also remains polyneuritic, more pronounced on the lower extremities.

The disease can develop gradually. There are complaints of headaches localized in the frontotemporal areas, dizziness, increased irritability, general malaise, fatigue, aching pain in the lower extremities, numbness, paresthesia. Sometimes there are attacks of whitening of the toes. In more severe cases, the nature of the complaints may change. Headaches become constant, attacks of “lightheadedness” appear, excitability and tearfulness increase. Sometimes against this background “vegetative crises” arise. In such cases, a “feeling state” periodically occurs, accompanied by nausea, short-term memory loss, dizziness and general sweating. As a rule, the skin becomes pale, a sparkle appears in the eyes, the pupils are dilated, the muscles are tense, and the body temperature rises to 38°C or more. The attack ends with sweating, after which a state of prostration sets in. In the later stages of the disease, irritable weakness, memory loss, and sleep disturbances develop. In the future, the formation of diencephalic syndrome, expressed in weight loss, lack of appetite, severe asthenia, increased thirst, as well as in the appearance of symptoms of damage to the brainstem and hypothalamic region. From the outside cardiovascular systems there is a change in heart rate, arterial hypertension. Sometimes there is asymmetry or even absence of pulse in the dorsal arteries of the feet.

According to the degree of severity, four stages are distinguished.

First stage (initial) manifests itself in the form of a neurasthenic syndrome with symptoms of autonomic dysfunction. Symptoms of pain in the lower extremities with corresponding disorders of vibration and pain sensitivity are quite common. The disease is compensated in nature, and after cessation of contact with vibration, working capacity is completely restored.

The second is functional - characterized by the appearance of attacks of “lightheadedness”, instability of the cardiovascular system, pain in the limbs. Sleep is disturbed, most women experience ovarian restructuring menstrual cycle, in men, sexual dysfunction is possible. Asthenic syndrome is observed.

The third is transitional. It is possible to develop diencephalic syndrome. Headaches are constant, pre-syncope is more common, and crises that occur with short-term loss of consciousness are not uncommon. Vegetative polyneuritis of the extremities develops. The disease tends to progress.

Fourth - organic - is extremely rare. Diencephalic syndrome is pronounced, occurring with metabolic and endocrine disorders.

VIBRATION DISEASE WHEN EXPOSED TO GENERAL VIBRATION AND SHOCKS

One of the main syndromes is a disorder of the vestibular apparatus, manifested in the form of headaches and unsystematized dizziness. Most patients have increased excitability vestibular analyzer. However, these disorders are not clearly expressed
and pass quickly. In addition to dysfunction of the vestibular analyzer, changes in the auditory and visual analyzers are possible. Dysfunction of the digestive glands often occurs, and disturbances in the motor and secretory functions of the stomach can be associated with prolapse of the abdominal organs as a result of exposure to jerky vibration, often leading to inflammation of the solar plexus.

More persistent are disorders in the spine, manifested in the form of deforming osteoarthritis of the lumbar and lumbosacral region or discosis. When examining tractor drivers, most of them were found to have osteochondrosis in the lumbosacral spine. This, as a rule, is accompanied by the occurrence of secondary radicular disorders, quickly leading to disability.

General and jerky vibrations also have a negative impact on the female genital area, which is expressed by menstrual cycle disorders, and there is an exacerbation of inflammatory processes in the female genital organs. Some changes can also be observed in the central nervous system in the form of vegetative dysfunction against a neurasthenic background. This form of vibration disease is compensated and, as a rule, does not lead to disability.

Vibration disease rarely occurs in conditions associated solely with exposure to vibration. Workers are exposed to simultaneous exposure to dust, noise, and cooling. All of these are aggravating factors that significantly affect not only the timing of the development of changes caused by exposure to vibration, but also the severity of the disease.

To be continued.

Owners of patent RU 2471468:

The invention relates to medicine, physiotherapy. The method includes drug treatment, mud applications on the limbs, exposure to ultrasound and electrophoresis, hydrokinesitherapy, and hydrogen sulfide baths. Peripheral relaxants, vasoactive agents, B vitamins, chondroprotectors, and painkillers are used. At the first stage, sulfide silt mud applications are carried out using the gloves type, at a temperature of 30-40°C, for 10 minutes, every other day, five procedures. The collar area is treated daily with ultrasound with hydrocortisone, 0.4 W/cm2, for 10 minutes, for a total of five procedures. Hydrokinesitherapy is carried out at a water temperature of 38°C. At the second stage, calcium electrophoresis is carried out daily for five days on the collar area, applying 5-6 mA for 20 minutes. Carry out a set of exercises for osteoporosis. At the third stage, every day for five days a sauna is carried out for 20 minutes and a hydromassage in water at a temperature of 38°C for 10 minutes. Then perform exercises to relax and stretch muscle groups. At the fourth stage, hydrogen sulfide baths are carried out for five days at a temperature of 37°C for 10 minutes. Then perform a set of dynamic exercises and exercises for the hands. The method reduces the degree of functional disorders of the central nervous system, restores mobility in joints, increases mineral density and bone strength. 2 ave., 3 tab.

The invention relates to the field of medicine and can be used in the rehabilitation of patients with vibration disease in sanatorium conditions.

The leading place in the structure of occupational diseases in Russia is occupied by diseases caused by exposure to physical factors in the working environment and, above all, vibration disease.

Local vibration is one of the extreme factors of the working environment, and vibration disease (VD) occupies a leading position among individual nosological forms of occupational chronic diseases (Balan G.M., 1990; Suvorov G.A., 2000). Vibration disease reduces the ability to work in young and middle-aged people, and therefore there is a need for long-term treatment and rehabilitation of patients, their professional retraining and compensation payments, which has not only medical, but also socio-economic significance (Artamonova V.G., 1993 ; Izmerov N.F., 1998).

In the cold climatic conditions In Kuzbass, systematic cooling aggravates the adverse effects of vibration on the body of workers, which causes more rapid development and progression of vibration pathology.

Considering that the annual damage caused by occupational diseases in connection with various payments to victims ranges from 4 to 8% of the country's gross domestic product and for only one case of disease on average ranges from 100,000 to 500,000 rubles.

The problem of rehabilitation of patients with vibration disease (VD) is extremely relevant and socially significant. VD is characterized by progression of vascular manifestations even after cessation of contact with the industrial factor.

With prolonged contact with vibrating tools, the main load falls on the hands. Occupational changes usually begin to spread from the upper extremities: the intensity of blood flow decreases, peripheral nerve endings are damaged, pain sensitivity decreases, changes occur in the skeletal system, strength, static endurance, and joint mobility decrease. Radiographs of the hands often reveal brush-like radiolucencies, small islands of consolidation, or osteoporosis. The main symptom of the disease is vascular disorders. There is an asymmetry of blood pressure, a violation of peripheral circulation such as neurocirculatory dystonia.

In this regard, it is important to develop a program rehabilitation treatment patients with vibration disease at the sanatorium stage.

There is a well-known method of rehabilitation of patients with vibration disease: “Therapeutic physical education and massage in patients with vibration disease” (Krasnogor N.I. Therapeutic physical education and massage. 2006. No. 3. P.46-48). In therapeutic gymnastics, dynamic exercises with the largest possible range of motion are used. Dynamic exercises not only contribute to the development of the muscular system, but also affect the respiratory and circulatory organs (eliminate congestion). Strength exercises are used to strengthen and develop the muscular system. In classes, the main load falls on muscle groups that have not worked much. Complex proposed therapeutic exercises: 1. Pressing the spread fingers of one hand onto the fingers of the other. 2. Bending the hands back. 3. Bending back each finger individually. 4. Squeezing a tennis ball (sponge, washer, spring shock absorber, etc.). 5. Circular rotations with hands, forearms, shoulders (with dumbbells). The exercises must be performed with effort that does not cause pain.

The main attention is paid to massage; exercise therapy methods are represented by a small number of exercises.

Methodology “Therapeutic exercise for occupational diseases” - Dubrovsky V.I. Therapeutic physical education (kinesitherapy): Textbook. for students institutions of higher education. - 2nd ed., erased. - M.: Humanite. ed. VLADOS center, 2001. - pp. 421-430. IN complex treatment include general massage for 15-20 minutes followed by oxygen therapy (inhalation of humidified oxygen or taking oxygen cocktail). Vibration massage with needle vibratodes of paravertebral areas for 5-8 minutes. A course of 15-20 procedures. Exercise therapy (general developmental exercises, breathing and stretching), sauna (bath), diet therapy, vitaminization. There are 15-20 procedures per course. 2-3 courses per year. Massage in water (manual and with brushes) and hydromassage are shown.

Treatment is fragmented and not interconnected.

The closest is the method of rehabilitation of patients in sanatorium conditions, including drug treatment, mud applications on the limbs, exposure to ultrasound and electrophoresis, hydrokinesitherapy by performing exercises for the upper limbs, by active and passive flexion and extension of the injured arm, sitting in a bath in warm water, performing exercises for osteoporosis, conducting hydrogen sulfide baths. (Zaitsev N.M., T.S. Avdonchenko. Organization of rehabilitation treatment of patients with vibration disease in a sanatorium. J. Physical therapy and sports medicine, 2010, No. 4, pp. 37-38).

In this method, the exercise therapy program and its connection with the physiotherapy program are not sufficiently developed, due to which it is possible to increase the effectiveness of treatment.

The objective of the invention is to effectively help patients with vibration disease in the form of a comprehensive program of physical therapy in combination with physiotherapeutic treatment in a sanatorium.

The goal is achieved by a method of rehabilitation of patients with vibration disease in sanatorium conditions, including drug treatment, mud applications on the limbs, exposure to ultrasound and electrophoresis. During hydrokinesitherapy, exercises are performed for the upper limbs by actively and passively flexing and extending the injured arm while sitting in a bathtub in warm water. They perform exercises for osteoporosis and conduct hydrogen sulfide baths.

At drug treatment use peripheral relaxants, vasoactive agents, B vitamins, chondroprotectors, painkillers. In this case, at the first stage, mud therapy is carried out by carrying out sulfide silt mud applications using gloves, at a temperature of 30-40°C, for 10 minutes, every other day, for a total of five procedures. The collar zone is treated daily with ultrasound with hydrocortisone, 0.4 W/cm2, for 10 minutes, a total of five procedures, then hydrokinesitherapy is carried out at a water temperature of 38°C.

At the second stage, daily, for five days, calcium electrophoresis is carried out on the collar area, influencing 5-6 mA, for 20 minutes and a set of exercises for osteoporosis is carried out.

At the third stage, every day, for five days before performing myofascial stretching, a sauna is performed for 20 minutes and a hydromassage in water at a temperature of 38°C for 10 minutes, then exercises are performed to relax and stretch the muscle groups.

At the fourth stage, hydrogen sulfide baths are carried out for five days at a temperature of 37°C for 10 minutes, followed by a set of dynamic exercises and exercises for the hands.

Novelty of the invention:

For drug treatment, peripheral relaxants, vasoactive agents, B vitamins, chondroprotectors, and painkillers are used.

At the first stage, mud therapy is carried out by carrying out sulfide silt mud applications using gloves, at a temperature of 30-40°C, for 10 minutes, every other day, for a total of five procedures. The collar zone is treated daily with ultrasound with hydrocortisone, 0.4 W/cm2, for 10 minutes, a total of five procedures, then hydrokinesitherapy is carried out at a water temperature of 38°C. Under the influence of mud, pain subsides, joint mobility increases, muscle elasticity increases, and skin elasticity improves. One of the constant indicators of the presence of vibration disease is sensitivity disorder. Vibration, pain and temperature sensitivity suffers most sharply, tactile sensitivity suffers less. Mud therapy gives excellent results in the treatment of vibration disease. Neurovascular regulation improves, pain and numbness in the hands disappear, and sleep improves. Doing exercises in water accelerates the restoration of normal range of motion in joints, promotes relaxation of tense muscles and strengthens weakened muscles. Gymnastics in water - hydrokinesitherapy has an intense, versatile effect on the body. Being in water significantly increases heat transfer and metabolism, activates hemodynamics and the activity of the respiratory and cardiovascular systems. Exercises in water have a multifaceted effect on the musculoskeletal system.Use physical exercise in water for various diseases is based on the hydrostatic effect on the body, the influence of the thermal factor, and the positive effect on the emotional environment (the psyche of the victim). Warm water makes exercise easier and accelerates the restoration of normal range of motion in joints with reduced muscle strength.

At the second stage, daily, for five days, calcium electrophoresis is carried out on the collar area, influencing 5-6 mA, for 20 minutes and a set of exercises for osteoporosis is carried out. It promotes recovery functional indicators skeletal system. As is known, physical exercises help improve blood circulation, tissue trophism, strengthen the muscular and osseous-ligamentous apparatus, have a therapeutic effect, toning the patient’s body, improving its general condition, restoring functions impaired by the disease.

At the third stage, every day, for five days before performing myofascial stretching, a sauna is performed for 20 minutes and hydromassage in water at a temperature of 38 ° C for 10 minutes, then exercises are performed to relax and stretch muscle groups. Myofascial stretching is very powerful technique, which allows you to treat soft tissue dysfunctions, restore the elasticity of muscles and ligaments. The sauna is used to: relax working muscles; rapid removal of metabolic products from them and from the blood. The sauna has a stimulating effect on the central and autonomic nervous systems, causing a high level of metabolism in the body. The sauna helps the body relax, as the heat reduces the tone of muscles and tendons and has a positive psychological effect. Hydromassage, which is carried out with water jets, relieves pain, improves blood circulation, and promotes complete relaxation.

At the fourth stage, hydrogen sulfide baths are carried out for five days at a temperature of 37°C for 10 minutes, followed by a set of dynamic exercises and exercises for the hands. The proposed complex helps restore mobility in joints, improve blood circulation and trophism of the hands, and improve the functional state of the neuromuscular system. The variety of effects of active dynamic exercises causes a continuous change in the processes of excitation and inhibition in the central nervous system and creates favorable conditions for longer-term performance of nerve centers. Dynamic exercises not only contribute to the development of the muscular system, they are contrasted with the static conditions that prevail in labor. After using the baths, the phenomena of paresthesia disappear, peripheral blood circulation improves, pain decreases, and attacks of whitening of the fingers become less frequent.

Our proposed method of restorative treatment of patients with vibration disease has significant differences from analogues and the prototype, because it provides for the implementation of exercise therapy techniques in combination with other sanatorium-resort treatment procedures in the form of a comprehensive program for the entire course of stay in the sanatorium, helps to improve clinical symptoms: relieves pain syndrome in muscles and joints and muscle spasm, increases muscle strength and blood circulation at the level of microcirculation in the tissues of the diseased limb, reduces the degree of functional disorders of the central nervous system, restores mobility in the joints, increases mineral density and bone strength.

We believe that the proposed method of treatment at the sanatorium stage will not only improve clinical symptoms, but also improve the parameters of social effectiveness.

The entire process of rehabilitation treatment is carried out under the control of anthropometry (measurement of hand muscle strength - dynamometry); changes in joint pain and muscle soreness, electrophysiological research methods.

The method is carried out as follows.

Treatment is carried out in the Prokopyevsky sanatorium. Patients take daily walks at a slow pace, stopping to explore the surrounding area and the lake during the warmer months physical therapy carried out outdoors. When stopping, they suggest listening to the sounds of nature, silence, enjoying the smells of wet earth, forest, and freshness. At the same time, it is recommended to feel that the body is healing, the state of health is improving, calmness comes, and the mood improves.

Patients undergoing treatment in a sanatorium are prescribed medication: peripheral relaxants - mydocalm;

vasoactive: a nicotinic acid, trental;

neurovitamins: B vitamins (B1 and B12);

chondroprotectors - alflutop, chondrolep;

painkillers - baralgin, indomethacin.

Stage 1 - 5 days

Patients are given sulfide silt mud applications - gloves at a temperature of 30-40°C for 10 minutes every other day 5 times, i.e. 3 times in this five-day period, and ultrasound with hydrocortisone on the collar area 0.4 W/cm2 10 minutes daily for 5 days, after in which patients perform a set of physical exercises in warm water at 38°C for 5 days (Table 1).

Stage II - 5 days

Before performing a set of exercises for osteoporosis, patients continue to take mud applications - gloves at a temperature of 30-40 ° C for 10 minutes every other day, the remaining 2 times, and take calcium electrophoresis on the collar zone 5-6 mA for 20 minutes daily for 5 days. After these procedures, patients perform a set of exercises for osteoporosis for 5 days.

A set of exercises for osteoporosis:

I.P. Lying on your back:

1. Take hands and feet (bend), hold for 5 seconds and relax (8-10 times).

2. Squeeze the fingers and toes half-strength and unclench them, press the palm of your hand onto the couch with full force (8-10 times).

3. Hands to the shoulders, lower your arms along the body and press on the couch (8-10 times).

4. Circular movements with hands and feet towards you (5 times).

6. Legs bent at the knees, swaying left and right (5-6 times).

7. Try to separate the bent knees with tension (6-8 times), then connect the knees with tension (6-8 times).

8. Press into the couch: with the back of your head, shoulder blades and arms (5-6 times); then with the lower back (5-6 times); then with the legs: heels, buttocks, knees (5-6 times).

9. Press your whole body into the couch (8-10 times).

10. Raise your head, stretch your chin to your stomach (5-6 times).

11. Legs bent at the knees, hands on the hips, trying to bend the legs, and resisting with the hand - one at a time (8-10 times).

12. Legs bent at the knees, right knee clasp your hands and pull to the stomach, then the left knee (8-10 times).

13. Legs bent at the knees, raise the pelvis - inhale, lower - exhale (8-10 times).

14. Legs straight, raise the right leg 10 cm - 10 seconds, hold and lower, do the same with the left leg (10 times).

16. Stretch your arms forward, raise your body 45°, feet towards you, hold for 3 seconds and lower (6 times).

I.P. Lying on your side

17. Mahi right foot(6 times). Circular movements, leg bent at the knee (6 times), then with the other leg.

18. Raise and lower two legs, then one leg at a time: lift the right one, attach the left one for 3 seconds, hold it and lower it (5 times).

I.P. Lying on your stomach:

19. Tighten your buttocks, place your hands under your chin (6-8 times).

20. Hands on the belt, pull the elbows back, chin to the chest, connect the shoulder blades for 5 seconds, hold and relax (5-6 times).

21. Arms to the sides, hands into fists, lift the body up, connect the shoulder blades with the muscles for 5 seconds. (5-6 times).

22. Raise two straight legs for 5 seconds, hold and relax (5-6 times).

I.P. Lying on your back:

23. Hands up, stretch, feet towards you (3-4 times).

24. Hands along the body (on the couch), mentally lift up, without moving (6-8 times).

25. We try to spread our arms to the sides, but without moving, we just strain the muscles (6-8 times).

26. Feet towards you, mentally spread straight legs (5-6 times).

27. In combination with movements No. 30 and No. 31, do 5-6 times.

28. Arms to the sides, inhale, clasp your torso with your hands and exhale (3 times).

29. One hand on the chest, the other on the stomach. Pull in your stomach - inhale, relax your stomach - exhale (3 times).

I.P. Sitting on a chair:

30. Hands up, stretch your hands to the ceiling - inhale, hands down - exhale (5-8 times).

31. Hands back, bend over, connect the shoulder blades - inhale, starting position - exhale (5-8 times).

32. Hands behind your back, in a lock: raise your hands up and down the spine (5-8 times).

33. Sit freely, arms down. Raise your shoulders up, squeeze your shoulder blades together: bend over. Relaxing your shoulders, lower them forward. Bring your shoulder blades together - inhale, lower them - exhale (5-8 times).

I.P. Lying on your back:

34. Take hands and feet (bend), hold for 5 seconds and relax (8-10 times).

35. Squeeze the fingers and toes half-strength and unclench them, press the palm of your hand onto the couch with full force (8-10 times).

I.P. Lying on your stomach:

37. Hands on the belt, pull the elbows back, chin to the chest, connect the shoulder blades for 5 seconds, hold and relax (5-6 times).

38. Arms to the sides, hands into fists, lift the body up, connect the shoulder blades with the muscles for 5 seconds. (5-6 times).

I.P. Sitting on a chair:

39. Hands up, stretch your hands to the ceiling - inhale, hands down - exhale (5-8 times).

40. Hands back, bend over, connect the shoulder blades - inhale, starting position - exhale (5-8 times).

41. Hands behind your back, in a lock: raise your hands up and down the spine (5-8 times).

42. Hands on your waist, tilt your torso to the left, straighten to the right. Tilt - exhale, starting position - inhale (5-8 times).

43. Sit freely, arms down. Raise your shoulders up, squeeze your shoulder blades together: bend over. Relaxing your shoulders, lower them forward. Bring your shoulder blades together - inhale, lower them - exhale (5-8 times).

44. Lean tightly against the back of the chair. Raise your chin up, stretch - inhale, lower - down (5-8 times).

Stage III - 5 days

Before performing myofascial stretching, patients take a sauna for 20 minutes and hydromassage in water at a temperature of 38°C for 10 minutes every day for 5 days, then perform a set of exercises.

Exercises to relax and stretch muscle groups (myofascial stretching)

1. I.P. The methodologist stands to the side of the patient. The patient's forearm should be relaxed. The methodologist clasps the patient's hand with a gentle movement: with one hand, grasping the convexity of the hypothenar, and with the other, the convexity of the thenar, clasping the palm completely and gently straightening it, and then gives the palm its usual concave shape. During an arm stretch, the therapist pulls the interosseous muscles and palmar fascia while stretching the entire upper quarter of the fascia for 10 seconds. Do it 3 times.

2. I.P. The methodologist stands to the side of the patient. The patient's forearm should be relaxed. The methodologist gently clasps the patient's forearm with his hands and stretches the fascia of the forearm, and, in particular, the fascia of the pronator teres muscle for 10 seconds. Do it 3 times.

3. I.P. The methodologist stands on the side of the patient and clasps the forearm with one hand and the shoulder area with the other and stretches the myofascial structure in the area of ​​the elbow joint for 5 seconds.

4. I.P. The patient lies on his back, the methodologist grasps the patient's hand on both sides, then pulls the arm with force until the soft tissues relax. Once they relax, the therapist applies another force, again waiting until the tissues relax, and continues to stretch until he feels the stretch limit.

The effect of myofascial relaxation was also achieved by stretching the soft tissues, but without preliminary tension.

Stage IV - 5 days

Before performing a set of dynamic exercises and exercises for the hands, patients take hydrogen sulfide baths at a temperature of 37°C for 10 minutes every day for 5 days.

Then patients perform a set of active dynamic exercises.

A. A set of active exercises and exercises with a gymnastic stick for the upper limb

1. I.P. Standing, arms down.

1-2. Raise your hands

up - inhale. 3-4. I.P. - exhale. 4-6 times

2. I.P. Same.

1-4 circular movements in shoulder joints forward, 1-4 the same back. 4-6 times in each direction.

3. I.P. Same.

Flexion and extension of arms in elbow joints 6-8 times

4. I.P. Same.

Alternately bending the arms at the elbow joints from behind, trying to touch the opposite shoulder blade with each hand 4-6 times with each hand

5. I.P. Same.

Alternately flexion and extension of the arms at the elbow joints, with each hand, trying to reach the forehead 4-6 times with each hand.

6. I.P. hands behind in the “lock”.

Bend the injured arm from behind at the elbow joint with the help of the healthy one. 4-6 times.

Exercises with a gymnastic stick

7. I.P. - standing, hands with a stick down.

Circular movements of the arms back and forth. 4-6 times in each direction.

8. I.P. - standing, arms down behind you.

Flexion and extension of the arms at the elbow joints. 4-6 times.

I.P. - standing, stick on the floor, injured arm on top.

Circular movements in one direction and the other 4-6 times.

9. I.P. - standing, arms down.

Put the stick behind your head, return to I.P. 4-6 times.

10. I.P. - standing, hands behind.

Pull your arms straight back and lower them into IP. 6 times.

The following were used as objective criteria when assessing the effectiveness of the ongoing rehabilitation treatment before starting the course of treatment and at the end:

1. Anthropometry: hand muscle strength (dynamometry)

2. Pain in the joints (according to subjective sensations)

4. Muscle soreness - studied on a 4-point scale:

No pain - 4 points;

On palpation, the patient notes mild pain - 3 points;

There is severe pain on palpation - 2 points;

There is sharp pain on palpation -1 point;

5. Electrophysiological research methods:

Blood flow studies were carried out using rheovasography and Doppler ultrasound methods:

A. Rheovasography

Rheovasograms of the upper extremities were recorded and analyzed. Of the many quantitative indicators, we used the rheovasographic index (I), which reflects the intensity of blood supply to the area under study.

An increase in this indicator was regarded as a sign of an increase in the volume of blood supply in the study area as a result of a course of restorative treatment using physical education.

6. Doppler ultrasound (USDG)

The studies were carried out at rest, with the patient lying on his back while recording a Dopplerogram of the radial artery in centimeters per 1 second.

Statistical processing of the results was carried out using the Statistica for Windows software package (6.0). Variation statistics methods were used for calculations: the arithmetic mean (M) and the error of the mean value (m) were calculated. Assessment of the significance of changes in the arithmetic mean values ​​of the compared groups was carried out using the Student's t-test with the Bonferroni correction (Glantz S., 1999).

An analysis of the rehabilitation treatment of 46 men with vibration disease was carried out, of which severity I was diagnosed in 19 patients, II in 27 patients, whose average age was 48.5±4.1 years, sent for rehabilitation treatment to the Prokopyevsky sanatorium. The average work experience was 15.4±4.9 years, and average duration diseases - 12.4±2.1 years. The main group consisted of 24 patients who were treated according to a new rehabilitation program, and the control group - 22 people who were treated according to the same program with the exception of physical therapy.

The results obtained showed that the systematic application of the proposed method has a pronounced positive effect:

1. Joint pain was not reported by 50% of patients in the main group (8 people) and 35% in the control group (4 people).

2. The strength of the hand muscles increased in patients of the main group by 10 kg, in the control group - by 6 kg.

3. Cyanosis persists in 8 people of the main group, at the beginning of treatment there were 14 such patients, in the control group - in 12 people, at the beginning of treatment their number was 16 people.

4. Muscle soreness in patients of the main group decreased by 2 times, in the control group - by 1.3 times.

5. According to the results of rheovasography, blood filling in the upper extremities in patients of the main group increased by 1±0.4 cm/sec, in the control group - by 0.6±0.12 cm/sec.

6. The results of the study using Doppler ultrasound showed acceleration of blood flow in the radial artery in patients of the main group by 9±0.1 cm/sec, in the control group by 5±0.05 cm/sec.

7. Evaluation of the effectiveness of rehabilitation treatment showed that significant improvement was achieved in 75% of patients in the main group and in 45% in the control group.

8. The results obtained confirm the effectiveness of the program and give grounds to recommend it for the treatment of this

EXAMPLE No. 1.

Patient B. Diagnosis upon admission to the sanatorium: vibration disease of the 1st degree: GRZ has been working in underground work for 8 years. He considers himself sick for 6 years.

At the beginning of the course of treatment, he notes sharp pain in the joints of the upper extremities, cyanosis of the extremities, dynamometry of the right upper extremity is 7.1 kg, left 8.2 kg, severe pain in the muscles of the upper extremities, the rheovasographic index is 1.7 cm/sec, the blood flow velocity in the radial artery of the upper extremities is the average is 18.1 cm/sec, drug treatment aimed at improving the system. The patient was prescribed medication: mydocalm No. 10, nicotinic acid No. 10, vitamins B1, B12 to No. 10, alflutop No. 5, baralgin No. 5.

After the course of treatment, the patient does not notice pain in the joints of the upper extremities, cyanosis appears slightly, dynamometry right hand equal to 17 kg, left - 16.5 kg, rheovasographic index increased by 8 cm/sec, blood flow velocity in the radial artery according to the results of Doppler ultrasound is 24.7 cm/sec.

EXAMPLE No. 2

Patient G. Diagnosis upon admission to the sanatorium: vibration disease, stage I: Works as a miner in underground work for 16 years. He considers himself sick for 8 years.

At the beginning of the course of treatment, he notes sharp pain in the joints of the upper extremities, cyanosis of the extremities, dynamometry of the right upper extremity is 5.1 kg, left 6.0 kg, severe pain in the muscles of the upper extremities, the rheovasographic index is 1.2 cm/sec, the blood flow velocity in the radial artery of the upper extremities is on average equal to 1.1 cm/sec. The patient was prescribed medication: mydocalm No. 10, trental No. 10, vitamins B1 and B12, chondrolep No. 5, indomethacin No. 10.

A course of treatment was carried out according to the proposed method.

After the course of treatment, the patient notes minor pain in the joints of the upper extremities, cyanosis manifests itself to a lesser extent, the dynamometry of the right hand is 10.0 kg, the left - 12.5 kg, the rheovasographic index increased by 5.8 cm/sec, the blood flow velocity in the radial artery according to the results of ultrasound scanning is 15.4 cm/sec.

Thus, the proposed method allows:

1. Reduce pain (exercises in water).

2. Reduce the degree of functional disorders of the central nervous system (a set of exercises to relax and stretch muscle groups - myofascial stretching).

3. Restore mobility in joints, improve blood circulation and trophism of the hands, improve the functional state of the neuromuscular system (a set of active dynamic exercises - exercises for the upper limbs without an object and with a gymnastic stick and exercises for the hands).

4. Increase bone mineral density and strength (a set of exercises for osteoporosis).

The method increases tolerability physical activity after a course of rehabilitation treatment.

A method of rehabilitation of patients with vibration disease in sanatorium conditions, including drug treatment, mud applications on the limbs, exposure to ultrasound and electrophoresis, hydrokinesitherapy by performing exercises for the upper limbs by active and passive flexion and extension of the injured arm, sitting in a bath in warm water, performing exercises with osteoporosis, carrying out hydrogen sulfide baths, characterized in that during drug treatment they use peripheral relaxants, vasoactive agents, B vitamins, chondroprotectors, painkillers; in this case, at the first stage, mud therapy is carried out by carrying out sulfide silt mud applications like a glove, at a temperature of 30-40°C, for 10 minutes, every other day, for a total of five procedures; daily the collar zone is exposed to ultrasound with hydrocortisone, 0.4 W/cm2, for 10 minutes, a total of five procedures, then hydrokinesitherapy is carried out at a water temperature of 38°C; at the second stage, calcium electrophoresis is carried out daily for five days on the collar area, applying 5-6 mA, for 20 minutes and a set of exercises for osteoporosis is carried out; at the third stage, every day, for five days before performing myofascial stretching, a sauna is performed for 20 minutes and a hydromassage in water at a temperature of 38°C for 10 minutes, then exercises are performed to relax and stretch the muscle groups; at the fourth stage, hydrogen sulfide baths are carried out for five days at a temperature of 37°C for 10 minutes, followed by a set of dynamic exercises and exercises for the hands.

The invention relates to medicine and medical technology, namely to ultrasound devices used for the conservative treatment of chronic tonsillitis. .

The invention relates to medicine, physiotherapy

In accordance with unified classification vibration disease is included in the 3rd group of occupational diseases that arise under the influence of physical factors.

For the first time, people started talking about vibration disease at the end of the 19th century with the advent of instruments whose operating principle was related to vibration. Vibration is understood as a mechanical movement in which vibrations occur at a certain frequency.

The transmission method involves dividing vibration into local and general.

When working with hand tools, vibration is transmitted locally mainly to the hands. Timber fellers, metal cutters, molders, riveters, and polishers are susceptible to the negative effects of such vibration.

When affecting the entire body, general vibration is implied. Workers in textile factories, reinforced concrete production, construction workers, and transport workers fall under such negative influence.

Vibration disease, as an occupational disease, develops over a long period of time, causing irreversible changes in the body. The clinical picture is quite varied. The characteristics of a particular organism determine the damage to its various systems:

• nervous;
• cardiovascular;
• musculoskeletal;
• immune.

What triggers the development of the disease

The development of vibration disease is provoked by a number of factors. First of all, this is industrial vibration - local or general.

It has been proven that the most unfavorable vibration frequency for the body is 16 – 200 Hz. Factors that accompany the occurrence of the disease and aggravate it include:

• noise exceeding permissible limits;
• hypothermia;
• prolonged tension of the body muscles in a static position;
• long inclined position.

Under the influence of variable stimuli, the mechanisms of normal functioning of the nervous system are disrupted, as the most susceptible to vibration. Changes occur in the peripheral nervous system, in the nerve fibers of the spinal cord, and in the brain stem.

Under the influence of such a strong stimulus as high-frequency vibrations, the formation of norepinephrine increases, which large quantities enters the blood.

An imbalance in the functions of the nervous system causes a disorder in the regulation of vascular tone, which leads to the development of abnormal narrowing of the walls of blood vessels, changes in blood pressure, and disruption of the heart. Vasoconstriction causes disruption of the nutrition of the tissues of the limbs at the cellular level.

Varieties of manifestations

Polysyndromic and vague symptoms do not always specifically indicate vibration disease. The influence of factors of other origin causes a significant deviation from the general symptoms.

Vibration disease is classified according to the specifics of its manifestation and the degree of reflection of the clinical picture.

The place where vibration is applied gives the disease a certain shape:

• from exposure to local vibration;
• general vibration;
• combined effects.

4 stages show the degree of development of the disease with accompanying pathological processes:

• initial;
• moderate;
• expressed;
• generalized, observed very rarely.

At the initial stage, the disease is signaled by a few, not bright severe symptoms. These are moderate pain in the hands, the appearance of a feeling of numbness in them, paleness of the fingers after cooling.

A medical examination shows a slight change in capillary tone, a change in sensitivity on the terminal phalanges.

The second degree is a transition to more serious changes in organism. Pain in the limbs becomes frequent and more intense. The tone of capillaries and large vessels changes. As a result of defeat peripheral nerves Tendon reflexes decrease, sensitivity is impaired, and muscle weakness develops.

Cure occurs very slowly with frequent relapses of the disease.

The third degree of the disease is characterized by pronounced symptoms:

• significant sensitivity disorders;
• muscle atrophy;
• vascular and trophic deviations from the norm;
• frequent attacks of vasospasms, which involve not only peripheral vessels, but also coronary and cerebral vessels;
• a sharp decrease in working capacity.

The disease is difficult to treat at this stage, and the risk of complications is high.

Symptoms depending on exposure

Prolonged exposure to local vibration causes a number of unpleasant sensations:

1. Aching and nagging pain during rest they pass with the start of work after 15 minutes.
2. Arises feeling of crawling on the arms, numbness and tingling.
3. Increased chilliness of the limbs especially characteristic at low temperatures.
4. Fingers turn white, which is clearly manifested in cold weather or when interacting with water at low temperatures.
5. Vascular disorders manifested by vasospasms, sudden changes in blood pressure, disturbances in vascular tone, the appearance of pain in the heart, and tachycardia.
6. Signs appear. If on the most early stage sensitivity increases, then it gradually decreases, affecting the area of ​​the fingers, and then the hand or foot. In this case, trophic disorders are observed - thickening of the epidermis layer and nail plates.
7. Deterioration general condition, And.

From general vibration, the disease develops within 5-7 years. The initial symptoms are almost unnoticeable, but gradually they increase, causing numerous disorders in the body.

The first signs that indicate vegetative-vascular disorders:

• recurrent headaches;
• pain in the limbs;
• sweating

Disturbances in the central nervous system are indicated by:

Vibration disease from general vibration has specific characteristics; patients experience the following symptoms:

• nausea;
• non-systemic dizziness;
• motion sickness;
• disruption of important gastric functions.

Women exposed to general vibration report menstrual irregularities.

Differential diagnosis

The similarity of the clinical pictures of vascular and neurological pathologies with vibration disease makes it necessary to differentiate it from vibration disease and a number of other diseases.

With great variability in the symptoms of vibration disease, the main importance for establishing correct diagnosis has an analysis of the employee’s working conditions.

In order to establish the general picture of the disease, a number of diagnostic procedures are carried out:

1. Skin thermometry usually carried out with a cold test. It allows you to identify the degree of dysfunction of blood vessels. An electric thermometer measures the skin temperature on the fingers. In healthy people, the temperature is fixed within 27-31°. In those suffering from vibration disease it is lower – 18-20°. The cold test shows how long compensatory reactions are preserved.
2. Capillaroscopy gives an idea of ​​the degree of changes in small vessels.
3. Study of complex electrical resistance of skin provides reliable information about the stage of the disease.
4. Algesimetry– study of pain sensitivity using medical equipment. Special needles are immersed into the skin, determining the pain threshold, which is significantly exceeded in vibration disease.

The following methods are also used as necessary:

• radiography of joints;
• examination of the gastrointestinal tract.

Only an objective comprehensive examination with the involvement of doctors of various specializations will make it possible to make an accurate diagnosis and prescribe adequate effective treatment.

Principles and methods of therapy

The choice of treatment methods depends on the form of the disease and its severity. The earlier treatment for vibration disease is started, the higher its effectiveness.

The principles of treatment are based on a comprehensive approach to the problem or 3 principles:

• etiological the principle is a set of measures aimed at preventing the occurrence and development of the disease;
• pathogenetic the principle is based on preventing further development of the disease and its complications;
• symptomatic Therapy is aimed at eliminating symptoms that worsen the patient’s quality of life.

The treatment package includes medications and physiotherapeutic procedures.

The following medications are prescribed to the patient:

• chonolitics;
• vasodilators;
• ganglion blockers;
• antispasmodic;
• restoratives.

A good therapeutic effect is observed when using the following physiotherapeutic procedures:

• electrophoresis with a solution of novocaine or benzohexonium;
• radon, hydrogen sulfide, nitrogen-thermal baths;
• massage of the hands and collar area;
• hydro procedures;
• climate therapy.

At the earliest manifestations of the disease, adequate treatment started on time is effective. All painful processes at stage 1 can still be reversed. The person remains able to work, but work operations such as working with vibrating tools and lifting heavy objects should be excluded.

The disease at stage 2 is somewhat worse, but also treatable.

In the advanced stage of the disease, many diseases can develop from general vibration - from pressure disorders and metabolic processes before . In the long term development of the disease - disability.

Forewarned is forearmed

Vibration disease can be prevented by strictly observing labor organization standards.

Regular medical examinations help to identify deviations in the functioning of the body in a timely manner.

First of all, the patient should be oriented towards re-employment. Not only vibration is contraindicated for him, but also noise, hypothermia, and physical overexertion.

Industrial dispensaries, sanatoriums and resorts help reduce risk factors and ensure restoration of health.