Occupational vibration-induced disease

Japanese: 振動障害 - しんどうしょうがい（英語表記）Occupational vibration-induced disease

What is the disease?

Jackhammer ( Production ) This refers to health problems caused by using hand-held vibrating tools, such as tools and chainsaws, that transmit vibrations to the hands and arms. This refers to damage caused by hand-arm vibration (local vibration) that is transmitted through the hands and arms ( Hand-arm vibration ( Shuwan Shindo ) vibration disorder, localized vibration disorder, and occupational vibration disorder), but generally does not include disorders caused by whole-body vibration.

Vibration disorders consist of three types: peripheral circulatory disorders, characterized by sudden whitening of the fingers (Raynaud's phenomenon) that occurs mainly in cold weather; peripheral neuropathy, characterized by numbness and hypoesthesia in the fingers; and musculoskeletal disorders, characterized by joint symptoms (pain, limited range of motion) in the elbow joint and distal to the elbow and reduced grip strength.

In Japan, this condition was once known as white finger disease and was common among forestry workers, becoming a social problem. In recent years, however, the condition has been gradually spreading to industrial workplaces such as the construction industry, causing disabilities.

What is the cause?

The main cause is vibration, but the occurrence of injuries varies from person to person. The vibration level of the tool, the continuous use time, the duration of use, etc. exposure ( Bakuro ) Conditions related to the onset of the condition include environmental conditions including noise and cold, aging, and smoking habits.

How symptoms manifest

It consists of three types of disorders: peripheral circulatory disorders, the main symptom of which is Raynaud's phenomenon; peripheral neuropathy; and bone and joint disorders.

The first complaint of vibration disease is numbness in the fingers. This is followed by fatigue and weakness in the arms, and often severe numbness and pain in the arms after work or at night. A characteristic symptom is Raynaud's phenomenon in the fingers, which occurs when the whole body feels cold.

Testing and diagnosis

For diagnosis, it is extremely important to ask about work history related to the use of vibrating tools, and to confirm Raynaud's phenomenon in peripheral circulatory disorders. The diagnosis method for the presence or absence of peripheral circulatory disorders is resting and cold water load (10 degrees Celsius for 10 minutes), skin temperature test, Nail compression ( Nails open ) Inspection, thermography, Fingertip plethysmography ( The official website of the ) etc. are commonly practiced.

In recent years, the introduction of a new method (finger systolic blood pressure %) has been considered.

Treatment methods

The Ministry of Labor (at the time) had issued the "Guidelines for the Treatment of Vibration Disorders (Notification No. 585, October 1986)", but it is important to detect the condition early and treat it in its initial stages.

Physical therapy involves a combination of heat therapy and exercise therapy (paraffin baths for the hands and fingers, hot packs, alternating hot and cold water baths, and massage).

Drug therapy includes peripheral circulation improvers and peripheral nerve Activation ( Recover ) I take medicines, tranquilizers.

In terms of daily life guidance, it is important to avoid activities that involve vibration to the fingers, such as playing catch, keep warm, and refrain from smoking.

What preventive measures should be taken?

Since there is no fundamental treatment, prevention is the most important thing. Use light and low vibration tools, maintain the tools to keep the vibration level low, and limit the time of use. Compliance ( Junshu ) It is important to manage the work environment by keeping warm and protecting against the cold, using rest areas equipped with heating, and giving lifestyle advice on keeping warm in cold weather, not smoking, and exercising. There are standards for hand-arm vibration tolerance set by the Japan Society for Occupational Health, so we must follow these.

Toshio Matsui

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　削岩機(さくがんき)やチェーンソーなど、振動を手・腕に伝える手持ち振動工具を使用することによって起こる健康障害をいいます。手腕を介して伝搬する手腕振動（局所振動）による障害をいい（手腕振動(しゅわんしんどう)障害、局所振動障害、職業性振動障害）、通常、全身振動による障害は含みません。

　振動障害は、主として寒冷時に発作的に現れる手指の白色化現象（レイノー現象）を特徴とする末梢循環障害、手指のしびれ、感覚鈍麻を主体とする末梢神経障害、肘関節より末梢の関節症状（疼痛、可動域制限）や握力の低下などによる運動器障害の3つから構成されます。

　日本ではかつて白ろう病といわれ、山林労働者に多くみられ社会問題になりましたが、近年では建設業など、障害を起こす産業職場も次第に広がってきています。

原因は何か

　主たる原因は振動ですが、障害の発生には個人差があります。工具の振動レベル、連続使用時間、使用期間などの曝露(ばくろ)条件に、騒音、寒冷を含む環境条件、加齢、喫煙習慣などが発症に関係しています。

症状の現れ方

　レイノー現象を主徴とする末梢循環障害、末梢神経障害、骨・関節障害の3つからなります。

　振動病の最初の訴えは、手指のしびれです。次いで腕のだるさ、脱力感、しばしば作業後や夜間に腕の強いしびれと痛みが起こります。特徴的な所見は手指のレイノー現象で、全身に冷えを覚えた時に発症します。

検査と診断

　診断は振動工具使用に関する職歴の問診、末梢循環障害ではレイノー現象を確認することが極めて重要です。末梢循環障害の有無に関する診断法は、安静時および冷水負荷（10℃で10分）、皮膚温検査、爪圧迫(つめあっぱく)検査、サーモグラフィー、指尖容積脈波(しせんようせきみゃくは)などが一般的に行われています。

　近年、新しい方法（手指収縮期血圧％）の導入が検討されています。

治療の方法

　労働省（当時）により「振動障害の治療指針（基発第585号、昭和61年10月）」が示されていますが、早期に発見し、初期に治療することが重要です。

　理学療法として、温熱療法、運動療法を組み合わせて行います（手指のパラフィン浴、ホットパック、温水・冷水の交替浴、マッサージ）。

　薬物療法では、末梢循環改善薬、末梢神経賦活(ふかつ)薬、精神安定薬を使います。

　日常生活の指導では、キャッチボールなど手指への振動刺激のあるものを避ける、保温、禁煙する、などが重要です。

予防対策はどうするか

　根本的な治療法がないので、予防が最も大切です。軽量かつ低振動レベルの工具の使用、工具の低振動レベル保持のための保守管理、使用時間規制の遵守(じゅんしゅ)、防寒・保温を含めた作業管理、暖房設備が整った休憩設備の利用などの作業環境管理、生活指導での寒冷期の保温・禁煙・体操などが大切です。日本産業衛生学会の手腕振動許容基準があるので、それに沿うようにします。

松井　寿夫

出典　法研「六訂版家庭医学大全科」六訂版家庭医学大全科について　情報

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