Vibration disease Doc. R.Bodnar. Vibration disease Vibration disease is a professional disease, the main etiological factor of which is industrial vibration

Vibration diseaseVibration disease

Doc. R.Bodnar

Vibration diseaseVibration disease

Vibration disease Vibration disease is a professional is a professional disease, the main etiological factor of which disease, the main etiological factor of which is industrial vibration. The favourable is industrial vibration. The favourable background for the development of the background for the development of the disease there are the following concomitant disease there are the following concomitant occupational factors of risk: noise, super occupational factors of risk: noise, super cooling, significant muscle tension of cooling, significant muscle tension of shoulder, forced position of body.shoulder, forced position of body.

VIBRATION

Usually vibration disease is met among Usually vibration disease is met among the workers of machine building, the workers of machine building, metallurgical, aircraft, shipbuilding, mineral metallurgical, aircraft, shipbuilding, mineral resource industries, and also in transport and resource industries, and also in transport and agriculture. Mainly among those workers, agriculture. Mainly among those workers, whose character of work is related with the whose character of work is related with the long influence of vibration during the use of long influence of vibration during the use of hand mechanic tools of percussion action.hand mechanic tools of percussion action.

Use of a vibrating tool for road breaking

The vibrationThe vibrationThe vibration The vibration is the mechanic is the mechanic

oscillations that repeat periodically oscillations that repeat periodically and are characterized by the and are characterized by the frequency measured in hertz (Hz), frequency measured in hertz (Hz), vibrovelocity (m/s) and amplitude vibrovelocity (m/s) and amplitude (cm).(cm).

Types of vibrationTypes of vibration

-- low-frequency (8 – 15 Hz),low-frequency (8 – 15 Hz), -- medium-frequency (16 – 64 Hz), medium-frequency (16 – 64 Hz), -- high-frequency (more than 64 Hz). high-frequency (more than 64 Hz). Dangerous for the development of Dangerous for the development of

disease is the vibration with the disease is the vibration with the frequency 16 – 250 Hz. frequency 16 – 250 Hz.

Vibration is usually measured in three orthogonal directions at the interfaces

between the body and the vibrating surface

According to the character of According to the character of influence on the organism there isinfluence on the organism there is

-- local,local,-- general,general,combined vibration.combined vibration.

Local vibrationLocal vibration

During the local vibration the During the local vibration the transmission of mechanic oscillations transmission of mechanic oscillations to the body is realized through the to the body is realized through the arms. Most often this etiologic factor arms. Most often this etiologic factor we can be among the face-workers, we can be among the face-workers, chasers, drillers, tunnellers, polishers, chasers, drillers, tunnellers, polishers, grinders, wood-cutters.grinders, wood-cutters.

Hand Arm Vibration Syndrome

The sources of the general The sources of the general vibration arevibration are

the vibroplatform, the table vibrator, the vibroplatform, the table vibrator, the forming and concrete-laying the forming and concrete-laying machines, the floor of weaving-mills, machines, the floor of weaving-mills, agricultural machines (tractors, agricultural machines (tractors, combines), excavators, vehicles combines), excavators, vehicles (airplanes, helicopters, sea and river (airplanes, helicopters, sea and river ships).ships).

Combined vibrationCombined vibrationThe combined vibration is a combination of local The combined vibration is a combination of local and general. For its turn, it can be with the and general. For its turn, it can be with the advantage of local influence during the work with advantage of local influence during the work with hand tools, when the transmission of vibration on hand tools, when the transmission of vibration on the worker’s body is realized not only through the the worker’s body is realized not only through the arms, but also through the legs, thorax, back and arms, but also through the legs, thorax, back and other parts of body, depending on the posture other parts of body, depending on the posture during the work and the construction of instrument. during the work and the construction of instrument. In other cases the general influence can prevail, for In other cases the general influence can prevail, for example, during the work on vibroplatforms with example, during the work on vibroplatforms with simultaneous floating of concrete mix.simultaneous floating of concrete mix.

Pathogenesis of vibration disease.Pathogenesis of vibration disease.

Complexity of vibration disease’s Complexity of vibration disease’s pathogenesis is explained by the polymorphy of pathogenesis is explained by the polymorphy of clinic manifestations of the affection of clinic manifestations of the affection of cardiovascular and nervous systems, articular cardiovascular and nervous systems, articular and motor apparatus and also metabolic and motor apparatus and also metabolic process, in the foundation of development of process, in the foundation of development of which lay the complicated mechanisms of which lay the complicated mechanisms of neurocirculatory, neurohumoral, reflex and neurocirculatory, neurohumoral, reflex and regulatory disorders.regulatory disorders.

Classification of vibration Classification of vibration disease:disease:

1.1. From influence of local From influence of local vibration.vibration.

2.2. From influence of “combined” From influence of “combined” vibrationvibration

3.3. From influence of general From influence of general vibrationvibration

According to the intensity’s degree According to the intensity’s degree of pathologic process symbolically of pathologic process symbolically mark out 4 stages of disease:mark out 4 stages of disease:

I – initial;I – initial;II – moderately expressed (dystrophic II – moderately expressed (dystrophic

disorders);disorders);III – expressed (irreversible organic III – expressed (irreversible organic

changes);changes);IV – generalized IV – generalized

Clinical syndromes:Clinical syndromes: 1)1) angiodistonicangiodistonic 2)2) angiospasticangiospastic 3)3) syndrome of vegetative polyneuritis;syndrome of vegetative polyneuritis; 4)4) syndrome of vegetative myofascitissyndrome of vegetative myofascitis 5)5) syndrome of somatic neuritis (cubital, syndrome of somatic neuritis (cubital,

median), plexitis, radiculitis;median), plexitis, radiculitis; 6)6) diencephalic with neurocirculatory diencephalic with neurocirculatory

disturbance;disturbance; 7)7) vestibularvestibular

Sensory decrement by the peripheral type

Clinical pictureClinical picture I stage – initial manifestations.I stage – initial manifestations. This This

stage is characterized by the appearance of stage is characterized by the appearance of the peripheral angiodistonic syndrome or the peripheral angiodistonic syndrome or sensory neuropathy of hands. Patients sensory neuropathy of hands. Patients complaint to a transient pain and paresthesia. complaint to a transient pain and paresthesia. Disturbance of sensibility mostly is observed Disturbance of sensibility mostly is observed in the area of distal phalanxes. Trophic in the area of distal phalanxes. Trophic disturbances appear. Sometimes can be disturbances appear. Sometimes can be acrospasm of fingers that passes quickly. This acrospasm of fingers that passes quickly. This stage is functional and difficult for diagnostics. stage is functional and difficult for diagnostics. Capacity for work is not disturbed. Capacity for work is not disturbed.

Clinical pictureClinical pictureII stage – moderately expressed II stage – moderately expressed

manifestations. manifestations. Characterized by more stable Characterized by more stable pain syndromes, paresthesias and vascular pain syndromes, paresthesias and vascular disturbances. A complaint is increasing. Pains and disturbances. A complaint is increasing. Pains and paresthesias are longer. It is observed a change of paresthesias are longer. It is observed a change of tone as of the great vessels as of capillaries. tone as of the great vessels as of capillaries. Disturbance of sensibility is more expressed, the Disturbance of sensibility is more expressed, the trophic disturbances are increasing, and syndrome trophic disturbances are increasing, and syndrome of vegetative-sensory polyneuritis declares itself of vegetative-sensory polyneuritis declares itself together with the dystrophic disturbances of together with the dystrophic disturbances of locomotor system. It becomes difficult for patient locomotor system. It becomes difficult for patient to fulfil his job.to fulfil his job.

Clinical pictureClinical pictureIII stage – expressed manifestations.III stage – expressed manifestations.

Often attacks of angiospasm. Disorders of Often attacks of angiospasm. Disorders of sensibility not only of polyneurotic character. sensibility not only of polyneurotic character. Sudden reduction, and sometimes complete fallout Sudden reduction, and sometimes complete fallout of vibration sensibility, expressed trophic of vibration sensibility, expressed trophic disturbances. The disease is accompanied by the disturbances. The disease is accompanied by the development of sensomotor polyneuropathy, development of sensomotor polyneuropathy, encefalopolyneuropathy with generalized encefalopolyneuropathy with generalized acrospasm that changes by paresis of capillaries, acrospasm that changes by paresis of capillaries, cyanosis of hands. Complications are possible. Ill cyanosis of hands. Complications are possible. Ill persons are disabled.persons are disabled.

Clinical pictureClinical picture

IV stage – generalized. IV stage – generalized. Can be Can be met seldom, appear during the long progressing of met seldom, appear during the long progressing of disease. Pathologic process is characterized by the disease. Pathologic process is characterized by the generalization of vascular disturbances as a result generalization of vascular disturbances as a result of central nervous system’s affection, namely of of central nervous system’s affection, namely of those sectors that regulate the activity of vascular those sectors that regulate the activity of vascular system. Such patients have vascular disorders not system. Such patients have vascular disorders not only on hands, but also expressed on legs. only on hands, but also expressed on legs.

Vibration induced gangrene

Clinical picture of vibration Clinical picture of vibration disease from local influence of disease from local influence of vibrationvibration

The vibration disease conditioned by the The vibration disease conditioned by the local vibration more frequent meets among the local vibration more frequent meets among the workers with the hand mechanized instruments. workers with the hand mechanized instruments. The disease develops gradually, mainly at The disease develops gradually, mainly at workers with large experience of work (10 - 15 workers with large experience of work (10 - 15 years).years).

A clinical picture is conditioned by A clinical picture is conditioned by vegetative-vascular, neuromuscular, sensible vegetative-vascular, neuromuscular, sensible and trophic disturbances.and trophic disturbances.

Low Vibration Tools

The most characteristic complaints are:The most characteristic complaints are:

-sudden appearance of attacks of albication of fingers -sudden appearance of attacks of albication of fingers on the hands which arise up at local or general cooling on the hands which arise up at local or general cooling (symptom of dead fingers),(symptom of dead fingers),-dull aching -dull aching of of arms which disturbs patient at night arms which disturbs patient at night and in rest, and in rest, -often pains are accompanied by paresthesias in the -often pains are accompanied by paresthesias in the form of numbness, feeling of formication,form of numbness, feeling of formication,general weakness, headache without clear general weakness, headache without clear localization, dizziness, bad sleep, promoted irritability, localization, dizziness, bad sleep, promoted irritability, there can be complaints for the pain in the area of heart.there can be complaints for the pain in the area of heart.

Vascular disorders.Vascular disorders. More frequent they More frequent they show up violations of peripheral circulation of show up violations of peripheral circulation of blood, change of capillaries’ tone, violations of blood, change of capillaries’ tone, violations of general hemodynamics. general hemodynamics.

There is There is violation of sensibility by the violation of sensibility by the polyneurotic typepolyneurotic type. At the initial stages of . At the initial stages of disease the decline of pain sensitiveness turns disease the decline of pain sensitiveness turns out only on the ends of fingers, with progress of out only on the ends of fingers, with progress of illness there is the considerable decline of pain, illness there is the considerable decline of pain, temperature and vibration sensitiveness as a temperature and vibration sensitiveness as a "jacket" or "semi jacket"."jacket" or "semi jacket".

Trophic disordersTrophic disorders show up hyperkeratosis show up hyperkeratosis on the palms and lateral surfaces of fingers. on the palms and lateral surfaces of fingers. Quite often is observed an erasing of picture on Quite often is observed an erasing of picture on the skin, especially on distal phalanxes. Nails the skin, especially on distal phalanxes. Nails are thickened, turbid, deformed or polished as are thickened, turbid, deformed or polished as “watch crystals”.“watch crystals”.

Atrophy of muscles during vibration diseases

RoentgenogramsRoentgenograms can reveal ossific can reveal ossific formations and centers of osteosclerosis. In a formations and centers of osteosclerosis. In a spinal column, the changes in intervertebral spinal column, the changes in intervertebral disks and joints prevail, mainly of degenerative-disks and joints prevail, mainly of degenerative-dystrophic character.dystrophic character.

Main syndromes of vibration disease:Main syndromes of vibration disease:

1. Angiodistonic1. Angiodistonic - it is observed at - it is observed at influence of high-frequency vibration in initial influence of high-frequency vibration in initial one and moderately marked stages. Basic one and moderately marked stages. Basic complaints on pains in hands at night, complaints on pains in hands at night, paresthesias. Objectively there are insignificant paresthesias. Objectively there are insignificant vegetative vascular disorders (chilling and vegetative vascular disorders (chilling and cyanosis of hands, hyperesthesia on separate cyanosis of hands, hyperesthesia on separate phalanxes.phalanxes.


2. Angiospastic syndrome2. Angiospastic syndrome - meets at I, ІІ and ІІІ - meets at I, ІІ and ІІІ stage of vibration disease at influence of high-frequency stage of vibration disease at influence of high-frequency and medium-frequency vibration. For this syndrome the and medium-frequency vibration. For this syndrome the marked paresthesias and moderate arm aches are typical, marked paresthesias and moderate arm aches are typical, attacks of angiospasm of the type of "white fingers". attacks of angiospasm of the type of "white fingers". Objectively we find the reduction of skin temperature on Objectively we find the reduction of skin temperature on hands, the increase of the threshold of vibration hands, the increase of the threshold of vibration sensibility, disturbance of all types of sensitiveness of the sensibility, disturbance of all types of sensitiveness of the type of "gloves", spasm of capillaries. The angiospastic type of "gloves", spasm of capillaries. The angiospastic reactions depending on severity of disease can spread on reactions depending on severity of disease can spread on lower extremities, vessels of heart, cerebrum.lower extremities, vessels of heart, cerebrum.


3. The syndrome of vegetative-sensory 3. The syndrome of vegetative-sensory polyneuritispolyneuritis arises up at influence of vibration of arises up at influence of vibration of different frequencies, meets at moderate and marked different frequencies, meets at moderate and marked VD. The syndrome is characterized by the intensive VD. The syndrome is characterized by the intensive pains and paresthesias in extremities, disturbance of pains and paresthesias in extremities, disturbance of superficial sensitiveness after a polyneurotic type, superficial sensitiveness after a polyneurotic type, reduction of skin temperature, more expressed reduction of skin temperature, more expressed vegetative disorders (chilling, hyperhidrosis, cyanosis vegetative disorders (chilling, hyperhidrosis, cyanosis of hands)of hands)


4. Syndrome of vegetative myofascitis4. Syndrome of vegetative myofascitis is is characterized by the combination of vegetative-sensory characterized by the combination of vegetative-sensory polyneuritis with the dystrophic changes in the muscles polyneuritis with the dystrophic changes in the muscles of shoulder (fasciculitis, myositis, fibromyositis) and of shoulder (fasciculitis, myositis, fibromyositis) and tendinous apparatus. A syndrome is characterized by tendinous apparatus. A syndrome is characterized by the presence of expressed pains and paresthesias in the presence of expressed pains and paresthesias in hands, by the diminution of strength, by the dystrophic hands, by the diminution of strength, by the dystrophic changes in muscles and other tissues of locomotor changes in muscles and other tissues of locomotor system, by the disorder of sensitiveness after a system, by the disorder of sensitiveness after a polyneurotic and segmental types.polyneurotic and segmental types.


5. Syndrome of somatic nerves’ lesion 5. Syndrome of somatic nerves’ lesion (neuritis, plexitis, radiculitis).(neuritis, plexitis, radiculitis). Neuritis and Neuritis and plexitis in pure form at influence of vibration plexitis in pure form at influence of vibration meet rarely; it is possible to speak about its meet rarely; it is possible to speak about its combination with other symptoms, typical for combination with other symptoms, typical for VD, vegetative-sensory polyneuritis, vegetative VD, vegetative-sensory polyneuritis, vegetative myofascitis.myofascitis.


6. Diencephalic with neurocirculatory 6. Diencephalic with neurocirculatory disturbances. disturbances. Cerebral symptoms develop on a Cerebral symptoms develop on a background of peripheral vegetative-vascular background of peripheral vegetative-vascular and sensible disturbances, characteristic for VD and sensible disturbances, characteristic for VD of long duration. Cerebral symptoms are of long duration. Cerebral symptoms are characterized by cerebral vasomotor and characterized by cerebral vasomotor and vestibular disturbances, which are developed as vestibular disturbances, which are developed as vegetative-vascular crises.vegetative-vascular crises.


7. Vestibular syndrome7. Vestibular syndrome - develops at - develops at influence of general vibration. It is influence of general vibration. It is characterized by dizziness, nystagmus, ataxy, characterized by dizziness, nystagmus, ataxy, vestibular crises.vestibular crises.

Vibration disease from Vibration disease from the influence of general vibrationthe influence of general vibration

Syndromes of vibration disease conditioned Syndromes of vibration disease conditioned by general vibration:by general vibration: - cerebral-peripheral,- cerebral-peripheral,- angiodistonic,- angiodistonic,-- vegetative-vestibular, vegetative-vestibular, vegetative-sensory polyneuropathy.vegetative-sensory polyneuropathy.

Diagnostics of vibration diseaseDiagnostics of vibration disease

The diagnosis of vibration disease is The diagnosis of vibration disease is proposed on the basis of the collected proposed on the basis of the collected complaints, anamnesis of disease and life, study complaints, anamnesis of disease and life, study of professional route, sanitary and hygienic of professional route, sanitary and hygienic description work conditions.description work conditions.

The typical additional The typical additional signs of vascular disorderssigns of vascular disorders

1.1. Symptom of "white spot". Symptom of "white spot". You ask a patient to clench You ask a patient to clench firmly the fist of hand and through 5 sec quickly unclench it. In a norm firmly the fist of hand and through 5 sec quickly unclench it. In a norm the white spots which appeared have to vanish in 5 sec. If spots do not the white spots which appeared have to vanish in 5 sec. If spots do not disappear quickly – the test is positive.disappear quickly – the test is positive.

2.2. Pile’s symptom.Pile’s symptom. A pulse is found on both radial arteries, and A pulse is found on both radial arteries, and then by rapid motion lift up the hands of patient. Thus a pulse can then by rapid motion lift up the hands of patient. Thus a pulse can vanish on a few seconds. Such test is positive.vanish on a few seconds. Such test is positive.

3.3. Test on reactive hyperemia.Test on reactive hyperemia. You impose a cuff on a You impose a cuff on a shoulder and pump a pressure 180 - 200 mm of column of mercury. shoulder and pump a pressure 180 - 200 mm of column of mercury. Then ask to lift hands up, in 2 min. to put hands down, take cuff off Then ask to lift hands up, in 2 min. to put hands down, take cuff off and write down time of hand’s reddening. In a norm the reddening and write down time of hand’s reddening. In a norm the reddening begins in 1,5 - 2 sec. and passes in 15 sec. Lengthening of this time begins in 1,5 - 2 sec. and passes in 15 sec. Lengthening of this time testifies to the spasm of vessels, and shortening - about their atony.testifies to the spasm of vessels, and shortening - about their atony.


4.4. Test of Boholyepov.Test of Boholyepov. A patient stretches both hands with A patient stretches both hands with the unbended fingers ahead. At that you pay attention on colouring the unbended fingers ahead. At that you pay attention on colouring of skin, state of veins and capillary net of nail bed of fingers. Then of skin, state of veins and capillary net of nail bed of fingers. Then a patient lifts a right hand up, and put down a left on 30 sec. After a patient lifts a right hand up, and put down a left on 30 sec. After it, returns hands in previous position. We look after the change of it, returns hands in previous position. We look after the change of vein and capillary circulation of blood. Normally, the changes of vein and capillary circulation of blood. Normally, the changes of blood filling are normalized in 30 sec. At insufficiency of blood filling are normalized in 30 sec. At insufficiency of circulation of blood, pallor or cyanosis, which arose up disappear circulation of blood, pallor or cyanosis, which arose up disappear slower, than the more expressed is a disorder of peripheral slower, than the more expressed is a disorder of peripheral circulation of blood.circulation of blood.


5. Cold test.5. Cold test. The hands of explored are dipped into a The hands of explored are dipped into a cold water (+10°С) on 5 min. At albication of fingers cold water (+10°С) on 5 min. At albication of fingers the test is considered positive. Pay attention on the test is considered positive. Pay attention on prevalence and intensity of the process, mark the time prevalence and intensity of the process, mark the time of renewal of skin temperature after cooling. Normally of renewal of skin temperature after cooling. Normally it does not exceed 20 min. At patients with vibration it does not exceed 20 min. At patients with vibration disease there is an acute deceleration of renewal of skin disease there is an acute deceleration of renewal of skin temperature.temperature.

Capillaroscope

Diagnostic of sensory during vibration disease

Diagnostic of sensory during vibration disease

Medical treatmentMedical treatmentDuring VD conditioned by the influence of local During VD conditioned by the influence of local vibration, which flows mainly with neurovascular vibration, which flows mainly with neurovascular disorders and pangs, are recommended disorders and pangs, are recommended -- the ganglionic blockers (Gexameton, the ganglionic blockers (Gexameton, Benzogexoniy), Benzogexoniy), -- small doses of central anticholinergic drugs small doses of central anticholinergic drugs (Difacil, Aminazin, Amizil),(Difacil, Aminazin, Amizil), and vasorelaxants (Nicotinic acid, No-shpa, and vasorelaxants (Nicotinic acid, No-shpa, Novocaine).Novocaine).

For medical treatment of asthenoneurotic syndrome indicate For medical treatment of asthenoneurotic syndrome indicate sedative (valerian, Novopasit) and tonics, and also biogenic sedative (valerian, Novopasit) and tonics, and also biogenic stimulators (aloe,stimulators (aloe, glutamic acid, plazmol, ginseng tincture, glutamic acid, plazmol, ginseng tincture, eleuterococ).eleuterococ). For the removal of pain syndrome: Analgin, nonsteroid For the removal of pain syndrome: Analgin, nonsteroid antiphlogistics (Ibuprofen, Voltaren, Indometacin, Butadion).antiphlogistics (Ibuprofen, Voltaren, Indometacin, Butadion).For the improvement of circulation (peripheral, coronal and For the improvement of circulation (peripheral, coronal and cerebral) of blood indicate the medicines which extend coronal cerebral) of blood indicate the medicines which extend coronal vessels and improve the cerebral circulation of blood: Devincan, vessels and improve the cerebral circulation of blood: Devincan, Vincapan, Apresin, Papaverine hydrochloride, Aprofen, Vincapan, Apresin, Papaverine hydrochloride, Aprofen, Cinarizin, Piracetam, Cavinton.Cinarizin, Piracetam, Cavinton.

For the increase of the tone of parasympathetic For the increase of the tone of parasympathetic nervous system, reduction of disturbances at vegetative-nervous system, reduction of disturbances at vegetative-sensory polyneuropathy prescribe: Prozerin, Oxazil, sensory polyneuropathy prescribe: Prozerin, Oxazil, Galantamin.Galantamin.

For the improvement of microcirculation are indicated: For the improvement of microcirculation are indicated:

ATF, Parmidin, Riboxin, anabolic hormones - Retabolil, ATF, Parmidin, Riboxin, anabolic hormones - Retabolil, Nerabol.Nerabol.

With the purpose of improvement of protein With the purpose of improvement of protein

metabolism prescribe: Unitol, Penicilamid.metabolism prescribe: Unitol, Penicilamid.

A good effect has application of medicines which normalize A good effect has application of medicines which normalize vein tone: Venoruton, vein vasodilators - nitrates (Nitrosorbid, vein tone: Venoruton, vein vasodilators - nitrates (Nitrosorbid, Nitroglycerine), arterial vasodilators - Apresin, antagonists of Nitroglycerine), arterial vasodilators - Apresin, antagonists of calcium - Nifedipin, Corinfar, Adalat.calcium - Nifedipin, Corinfar, Adalat.

From tonics is effective introduction of 40% s-n of glucose, From tonics is effective introduction of 40% s-n of glucose,

calcium gluconate, calcium chloride, preparations of bromine, calcium gluconate, calcium chloride, preparations of bromine, coffeine.coffeine.

Vitamins BVitamins B11, B, B1212, B, B66, PP., PP.Physiotherapy.Physiotherapy.

ProphylaxisProphylaxis The contra-indications to the employment on the The contra-indications to the employment on the

work related with influence of vibration work related with influence of vibration are the are the chronic diseases of the peripheral nervous system, chronic diseases of the peripheral nervous system, obliterating endarteritis, Raynaud's disease, disease of obliterating endarteritis, Raynaud's disease, disease of locomotor system, marked asthenic states, expressed locomotor system, marked asthenic states, expressed vegetative dysfunction, vagopaties with susceptibility to vegetative dysfunction, vagopaties with susceptibility to angiospasms, stenocardia, arterial hypertension of ІІ -III angiospasms, stenocardia, arterial hypertension of ІІ -III stages, disease of endocrine glands with stable disturbancestages, disease of endocrine glands with stable disturbance (saccharine diabetes), stomach and duodenal ulcer, (saccharine diabetes), stomach and duodenal ulcer, neuritis, polyneuritis, stable hearing loss of any aetiology, neuritis, polyneuritis, stable hearing loss of any aetiology, otosclerosis, chronic diseases of female breeding organs.otosclerosis, chronic diseases of female breeding organs.

Periodic medical examinations are realized Periodic medical examinations are realized not rarer once in 12 months with participation of not rarer once in 12 months with participation of internist, neurologist, otolaryngologist. At the internist, neurologist, otolaryngologist. At the inspection it is necessary to realize inspection it is necessary to realize capillaroscopy, measuring of skin temperature, capillaroscopy, measuring of skin temperature, cold test, to explore a vibration, pain cold test, to explore a vibration, pain sensitiveness, if necessary radiography of sensitiveness, if necessary radiography of hands, spine.hands, spine.

Documents

Vibration disease Doc. R.Bodnar. Vibration disease Vibration disease is a professional disease, the main etiological factor of which is industrial vibration