Hand Paresthesias in Drivers Fond of Motorcycles - Cés

HAND PARESTHESIAS IN DRIVERS FOND OF

MOTORCYCLES

• º

HAVS (HAND ARM VIBRATION SYNDROME)

SD. DE RAYNAUD, ENTUMECIMIENTO, HORMIGUEO Y DÉFICIT NEUROSENSORIAL Y DISMINUCIÓN DE LA FUERZA DE AGARRE.

EN CONJUNTO, ESTOS PROBLEMAS DE SALUD SE DENOMINAN HAVS Y PUEDE LLEGAR A SER SIGNIFICATIVAMENTE INCAPACITANTE EN LOS CASOS MÁS SEVEROS.

EL TERMINO HAVS COMENZÓ A GENERALIZARSE COMO LA DESCRIPCIÓN DE UN CONJUNTO DE ALTERACIONES DE TIPO VASCULAR, NEUROSENSORIAL, Y MÚSCULO-ESQUELÉTICOS ASOCIADOS CON LA EXPOSICIÓN

EXCESIVA A HTV. HA HABIDO UNA SERIE DE INFORMES QUE TRATAN LA POSIBLE BASE FISIOPATOLÓGICA DE LOS ELEMENTOS

DE HAVS. SIN EMBARGO, LA RELACIÓN EXACTA ENTRE LA DOSIS Y CUALQUIERA DE LOS ELEMENTOS VASCULARES O NEUROSENSORIAL DE HAVS NO ESTA DEL TODO ACLARADO.

WHITE FINGER, NUMBNESS AND TINGLING, NEUROSENSORY DEFICIT IN THE HANDS, AND LOSS OF GRIP STRENGTH.

COLLECTIVELY THESE HEALTH PROBLEMS ARE TERMED HAVS AND CAN BECOME SIGNIFICANTLY DISABLING IN SEVERER CASES.

THE TERM HAVS BEGAN TO HAVE WIDESPREAD COINAGE AS DESCRIBING THE RANGE OF VASCULAR, NEUROSENSORY, AND MUSCULOSKELETAL PROBLEMS ASSOCIATED WITH EXCESSIVE EXPOSURE TO HAND TRANSMITTED VIBRATION.HTV. THERE HAVE BEEN A NUMBER OF REPORTS THAT ADDRESS THE POSSIBLE

HAVS.

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

VIBRATION

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

RESPONSE TO VIBRATION

EPIDEMIOLOGICAL STUDY OF VIBRATION SYNDROME IN RESPONSE TO TOTAL HAND-TOOL OPERATING TIME.TOT.(14)(0-2000-5000-8000 HOURS IN CHAIN SAW WORKERS)KMIYASHITA,SSHIOMI,NITOH,TKASAMATSU,ANDHIWATA

-RAYNAUD'S PHENOMENON INCREASED IN FREQUENCY AND SEVERITY-ABNORMAL FINDINGS IN CIRCULATORY FUNCTION-LOSS OF PAIN SENSE, AND VIBRATORY SENSE.-MUSCLE ATROPHY, OBSERVED IN THE DORSAL INTEROSSEOUS MUSCLES,-WITH UNDER 2000 HOURS EXPOSURE, "LATENT INTERVARL "OF THE HAVS

HAND MUSCLE PATHOLOGY AFTER LONG-TERM VIBRATION EXPOSURE.(3) (ABDUCTOR POLLICIS BREVIS MUSCLE IN PATIENTS SUFFERING HAVS) LARSE.NECKING,GO.RANLUNDBORG,RONNIELUNDSTRO.M,LARS-ERICTHORNELLandJANFRIDE!N

-DIRECT MUSCLE DAMAGE (NECROSIS, FIBROSIS AND STRUCTURAL DISORGANIZATION)-MUSCLE DENERVATION AND RE-INNERVATION.

STRUCTURAL NERVE CHANGES AT WRIST LEVEL IN WORKERS EXPOSED TO VIBRATION.(18) (BIOPSIES OF THE DORSAL INTEROSSEOUS NERVE)Trygve Stromberg, Lars B Dahlin, Arne Brun, Goran Lundborg

-BREAKDOWN OF MYELIN AND BY INTERSTITIAL AND PERINEURIAL FIBROSIS.

RESPONSE TO VIBRATION

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

- EPINEURIAL EDEMA.

RESPONSE TO VIBRATION

-PATHOPHYSIOLOGY OF NERVE COMPRESSION SYNDROMES: RESPONSE OF PERIPHERAL NERVES TO LOADING.(13)BY DAVID REMPEL, M.D., M.P.H.†, SAN FRANCISCO, CALIFORNIA, LARS DAHLIN, M.D., PH.D.‡, AND GÖRAN LUNDBORG, M.D., PH.D.‡, MALMÖ, SWEDENTHE JOURNAL OF BONE AND JOINT SURGERY VOL. 81-A, NO. 11, NOVEMBER 1999

-PATHOPHYSIOLOGY OF NERVE COMPRESSION.(29)S.E. Mackinnon / Hand Clin 18 (2002) 231–241

-NERVE COMPRESSION INJURY AND INCREASED ENDONEURIAL FLUID PRESSURE: A "MINIATURE COMPARTMENT SYNDROME"(4)GORAN LUNDBORG, ROBERT MYERS, HENRY POWELL

RESPONSE TO PRESSION

20 MM/HG -↓ EPINEURAL FLOW

30 MM/HG -ENDONEURIAL EDEMA -IMPAIRMENT AXONAL TRANSPORT -PERINEURIAL/EPINEURIAL THICKENING

50 MM/HG - ESTRUCTURAL ALTERATIONS IN MYELIN.

80 MM/HG -STOP BLOOD FLOW -WALLERIAN DEGENERATION.

RESPONSE TO PRESSION.

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

The cascade of the biological response to compression includes endoneurial edema, demyelination, inflammation, distal axonal

degeneration, fibrosis, growth of new axons, remyelination, and thickening of the perineurium

and endothelium. The degree of axonal degeneration is associated with the amount of

endoneurial edema.

Pathophysiology of Nerve Compression Syndromes: Response of Peripheral Nerves to Loading(13) DAVID REMPEL, LARS DAHLIN, GÖRAN LUNDBORG.

MINI-SINDROME COMPARTIMENTAL

AFECTACIÓN FLUJO ENDONEURAL↓

EDEMA ENDONEURAL↓

PERINEURO INTACTO

↓MINIATURE COMPARTMENT SYNDROME

RESPONSE TO PRESSION

Multiple and double crush syndrome-Upton and McComas; who stated that a proximal level of nerve

compression could cause more distal sites to be susceptible to compression

Alterations of axoplasmic flow

TREATMET

1.- DRIVER POSITION & SETTING

2.- DRIVING TECHNIQUES

3.- DOWN MOTORCYCLE VIBRATION

! PRESSION. CARPAL TUNNEL PRESSURE 3 TO 5 MM/HG WITH THE WRIST IN A NEUTRAL POSITION. PLACING THE HAND ON A COMPUTER MOUSE ↑ P 16 TO 21 MM/HG. USING THE MOUSE TO POINT AND CLICK ↑ P 28-33 MM/HG. WRIST EXTENSION 40º+ MP 0º 63MM/HG.

DRIVER POSITION. WRIST EXTENSION AND ULNAR DEVIATION, FLEXION MP, EXTENSION PIP. PERMANENT/CONTINUOUS MUSCLE ACTION. (LUMBRICAL, INTEROSEOUS,FDS,FCU,PRONATOR TERES....)

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! VIBRATION! ARM POSITION! GLOVES HANDLE-BARS BAR-ENDS

1.- DRIVER POSITION & SETTING

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1.-AUTOTREATMENT - 2 TIME A DAY - NEURODINAMICS(N.D) GLINDING EXERCICES-IMPROVING INTRANEURAL CIRCULATION, AXOPLASMIC FLOW, NEURAL CONNECTIVE TISSUE VISCOELASTICITY, AND BY REDUCING MECANSENSITIVITY (BUTLER, 2000; SHACKLOCK, 2005).

-NERVE GLIDING EXERCISES MAY ALSO LIMIT FIBROBLASTIC ACTIVITY AND MINIMISE SCAR FORMATION VIA NORMAL AND EARLY USE OF MESONEURIAL GLIDING TISSUES (MILLESI ET AL., 1995)

2.-OUR TREATEMENT -SOFT-TISSUE WORK -INHIBITIÓN TENSIONS (PRONADOR TERES, FCU, HYPOTHENAR MUSCLES) -STRETCHING (INTEROSEOUS ≢, FDS,FCU, ABD+OPP V..) -N.D.

TREATMENT

-Epidemiological study of vibration syndrome in response to total hand-tool operating time.(14)KMIYASHITA,SSHIOMI,NITOH,TKASAMATSU,ANDHIWATABrtishJournalofIndustrialMedicine 1983;40:92-98

-Hand muscle pathology after long-term vibration exposure.(3)LARSE.NECKING,GO.RANLUNDBORG,RONNIELUNDSTRO.M,LARS-ERICTHORNELLandJANFRIDE!NJournal of Hand Surgery (British and European Volume, 2004) 29B: 5: 431–437

-Structural nerve changes at wrist level in workers exposed to vibration.(18)Trygve Stromberg, Lars B Dahlin, Arne Brun, Goran LundborgOccupationalandEnvironmentalMedicine 1997;54:307-311

-Intraneural edema following exposure to vibration.(10)by G6ran l.undborq.l-' Lars B Dahlin," Nils Danielsen,2 Hans A Hansson," Lars E Neckinq,' IImari Pyykk64Scand J Work Environ Health 13 (1987) 326 -329

-VIBRATION CAUSES ACUTE VASCULAR INJURY IN A TWO-STEP PROCESS: VASOCONSTRICTION AND VACUOLE DISRUPTION.(7)SANDYA R. GOVINDARAJU1, JAMES LW. BAIN1, THOMAS J. EDDINGER2, DANNY A. RILEY1,

THE ANATOMICAL RECORD: ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGYVOLUME 291, ISSUE 8, PAGES 999–1006, AUGUST 2008-

RESPONSE TO VIBRATION