Cherniack M G
Occupational Medicine Program, Yale University School of Medicine, New Haven, CT 06510.
Arch Intern Med. 1990 Mar;150(3):519-22.
Vibration delivered to the hand and arm by industrial pneumatic tools is a common cause of vascular and neurovascular problems, including cold-induced vascular spasm (vibration white finger) and peripheral neuropathies with paresthesias, dysesthesias, and sensory abnormalities. A decade ago, the US Public Health Service estimated that 1.2 million American workers were at risk. Differentiation of primary and secondary Raynaud's phenomenon from the thoracic outlet syndrome and from the carpal tunnel syndrome pose potential diagnostic difficulties. Despite growing public recognition of upper extremity problems caused by repetitive trauma, there have been few investigations of vibration-induced disorders in the United States. This is not true worldwide, particularly in Northern Europe, where there has been significant intervention in medical surveillance and tool design. There does appear to be, however, frequent misdiagnosis and misdirected surgery. This has particular significance for the clinician, since in the 1990s, cumulative trauma injuries are expected to exceed all other work-related injuries.
工业气动工具传递到手部和手臂的振动是导致血管和神经血管问题的常见原因，包括冷诱发的血管痉挛（振动性白指）以及伴有感觉异常、感觉迟钝和感觉障碍的周围神经病变。十年前，美国公共卫生服务局估计有120万美国工人面临风险。将原发性和继发性雷诺现象与胸廓出口综合征和腕管综合征区分开来存在潜在的诊断困难。尽管公众越来越认识到重复性创伤导致的上肢问题，但在美国，对振动引起的疾病的调查却很少。在世界范围内情况并非如此，特别是在北欧，那里在医疗监测和工具设计方面进行了重大干预。然而，确实似乎存在频繁的误诊和手术方向错误的情况。这对临床医生具有特别重要的意义，因为在20世纪90年代，累积性创伤损伤预计将超过所有其他与工作相关的损伤。
