[Clinical features of the hand-arm vibration syndrome in miners].
BACKGROUND
It is well known that the vibrating tools used by the miners can cause hand-arm vibration syndrome. However no detailed reports on this field could be found in the Hungarian literature.


OBJECTIVE
The aim of this study was to clarify the clinical features of the hand-arm vibration syndrome of the miners.


METHODS
The circulation, the peripheral nerves and the osteoarticular system of the upper extremities of 152 miners were examined by means of cold provocation test, Allen-test, measurement of systolic blood pressure performed by Doppler flowmeter, clinical neurological and neurographic examination and X-ray investigation of the bones and joints.


RESULTS
Hand-arm vibration syndrome was diagnosed in 87 patients (57.2%). The most common symptom was the lesion of the circulation which occurred in 78 patients (89.6%). The peripheral nerves were affected in 44 cases (50.5%). Radiological alteration of the bones and joints of the upper extremities was observed in 32 patients (36.8%). Out of 78 damaged cases the frequency of the vascular diseases was as follows: angiopathy (diminished systolic blood pressure in the fingers): 66 patient (84.6%), occlusion of the hand arteries (positive Allen-test) and arterial form of the thoracic outlet syndrome (positive elevation-test) respectively: 28 and 28 cases (35.9%), Raynaud phenomenon (positive cold-provocation test): 26 cases (33.3%). The peripheral nerves were examined in detail in 141 cases. Pathological alterations were observed in 78 patients (55.3%) in the following forms: carpal tunnel syndrome: 66 cases (84.6%), peripheral neuropathy of the upper limbs: 20 patients (25.6%), lesion of the ulnar nerve: 3 cases (3.8%), brachial plexus lesion: one patient (1.3%). Radiological alteration was most common in the carpal region (87 cases, 57.2%). The frequency of the lesion of cubital (40.4%) and shoulder region (40.7%) was practically the same. In the carpal region the most common alterations were the degenerative processes (23 cases, 15.1%) followed by the aseptic osteonecroses (22 patients, 14.5%). In the cubital region the periarticular changes (31 patients, 23.9%) were most common followed by degenerative changes (21 cases, 16.2%) and the osteochondrosis dissecans (13 cases, 10.1%). In the shoulder region the degenerative processes were the most common changes (41 patients, 34.7%), first of all in the acromioclavicular joint (21 cases, 17.8%). Aseptic necrosis was observed in two patients.


CONCLUSIONS
The miners are professionally exposed not only to hand-arm vibration, but also to increased physical stress. The symptoms on the upper limbs can develop as the result of both exposures.
Kákosy
Tibor
T
Fodor József Országos Közegészségügyi Központ, Országos Munkahigiénés es Foglalkozás-egészségügyi Intézet.
Németh
László
L
Kiss
Gábor
G
Lászlóffy
Marianna
M
Kardos
Kálmán
K
D000328:Adult; D000368:Aged; D001132:Arm; D001808:Blood Vessels / Q000503:physiopathology; D001842:Bone and Bones / Q000503:physiopathology; D012090:Cumulative Trauma Disorders / Q000209:etiology* / Q000503:physiopathology; D006225:Hand; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007592:Joint Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008906:Mining; D009784:Occupational Diseases / Q000209:etiology* / Q000503:physiopathology; D016273:Occupational Exposure / Q000009:adverse effects*; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology; D010525:Peripheral Nerves / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology / Q000209:etiology; D012039:Regional Blood Flow; D013577:Syndrome; D034941:Upper Extremity / Q000293:injuries / Q000503:physiopathology*; D014732:Vibration