title: Relationship between arm pain and distension of arteries and veins caused by elevation of transmural pressure in local vascular segments.
abstract: BACKGROUND
  Exposure to high +Gz forces may induce arm pain, which has been hypothesized to be caused by pressure-induced overdistension of local blood vessels. The purpose of the present investigation was to study the pressure-distension relation of veins and arteries in the human arm and the relation between arm pain and distension of local vessels.
  
  
  METHODS
  Increased distending pressures (DP) in the vasculature of the arm were accomplished by placing the subject (n = 8) in a pressure chamber with one arm positioned through a port in the chamber door, and increasing chamber pressure to +180 mm Hg in a stepwise manner. Diameters in the brachial artery and in the brachial, radial and cephalic veins were measured by ultrasonography. Changes in forearm volume were estimated from measurement of tissue impedance. Perceived pain was rated using a 10-point scale.
  
  
  RESULTS
  Arm pain increased with pressure to a maximum rating of 8.5 (= median; range: 4-10). Increasing DP from 30 to 180 mm Hg resulted in a steady increase (p < 0.05) in venous diameter which varied from 12 +/- 8% (mean +/- SD) in the brachial vein to 23 +/- 14% in the radial vein. Inthe brachial vein diameter increases were most pronounced at the sites of the venous valves. Arterial diameter was unchanged up to a DP of about 200 mm Hg (calculated as diastolic arterial pressure + applied chamber pressure), but then increased by 32 +/- 9% (p < 0.001). Forearm impedance dropped with increasing pressure (delta = 23 +/- 5%; p < 0.01); the rate of change was non-linear with a faster change at the highest DP which may indicate pressure distension of precapillary resistance vessels.
  
  
  CONCLUSIONS
  Elevation of pressure in arm vessels to levels that may occur in pilots flying high-performance aircraft results in distension not only of veins but also of arteries and probably of smaller precapillary vessels. Therefore, and because these changes coincide with the development of severe arm pain, local overdistension of blood vessels remains a plausible cause of G-induced arm pain.
authors.affiliation: Aviation Medicine Dept., National Defence Research Establishment, Karolinska Institutet, Stockholm, Sweden. ola.eiken@fyfa.ki.se
authors.forename: O
authors.initials: O
authors.lastname: Eiken
authors.forename: R
authors.initials: R
authors.lastname: Kölegård
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001132:Arm / Q000098:blood supply*; D001158:Arteries / Q000000981:diagnostic imaging / Q000502:physiology; D001273:Atmosphere Exposure Chambers; D001808:Blood Vessels / Q000502:physiology*; D004108:Dilatation, Pathologic / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D006874:Hydrostatic Pressure / Q000009:adverse effects*; D018471:Hypergravity / Q000009:adverse effects*; D008297:Male; D010146:Pain / Q000209:etiology*; D018709:Statistics, Nonparametric; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging / Q000502:physiology