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Hand Paresthesias in Drivers Fond of Motorcycles - Cés

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  • 1. HAND PARESTHESIAS INDRIVERS FOND OFMOTORCYCLES• º
  • 2. HAVS (HAND ARM VIBRATION SYNDROME)SD. DE RAYNAUD, ENTUMECIMIENTO, HORMIGUEO Y DÉFICIT NEUROSENSORIAL Y DISMINUCIÓN DE LAFUERZA DE AGARRE.EN CONJUNTO, ESTOS PROBLEMAS DE SALUD SE DENOMINAN HAVS Y PUEDE LLEGAR A SERSIGNIFICATIVAMENTE INCAPACITANTE EN LOS CASOS MÁS SEVEROS.EL TERMINO HAVS COMENZÓ A GENERALIZARSE COMO LA DESCRIPCIÓN DE UN CONJUNTO DE ALTERACIONESDE TIPO VASCULAR, NEUROSENSORIAL, Y MÚSCULO-ESQUELÉTICOS ASOCIADOS CON LA EXPOSICIÓNEXCESIVA A HTV.HA HABIDO UNA SERIE DE INFORMES QUE TRATAN LA POSIBLE BASE FISIOPATOLÓGICA DE LOS ELEMENTOSDE HAVS. SIN EMBARGO, LA RELACIÓN EXACTA ENTRE LA DOSIS Y CUALQUIERA DE LOS ELEMENTOSVASCULARES O NEUROSENSORIAL DE HAVS NO ESTA DEL TODO ACLARADO.WHITE FINGER, NUMBNESS AND TINGLING, NEUROSENSORY DEFICIT IN THE HANDS, AND LOSS OF GRIPSTRENGTH.COLLECTIVELY THESE HEALTH PROBLEMS ARE TERMED HAVS AND CAN BECOME SIGNIFICANTLY DISABLING INSEVERER CASES.THE TERM HAVS BEGAN TO HAVE WIDESPREAD COINAGE AS DESCRIBING THE RANGE OF VASCULAR,NEUROSENSORY, AND MUSCULOSKELETAL PROBLEMS ASSOCIATED WITH EXCESSIVE EXPOSURE TO HANDTRANSMITTED VIBRATION.HTV. THERE HAVE BEEN A NUMBER OF REPORTS THAT ADDRESS THE POSSIBLEHAVS.
  • 3. -OSCILLATION OF A BODY ABOUT A REFERENCE POSITION AND CAN BEDESCRIBED IN TERMS OF AMPLITUDE AND FREQUENCYVIBRATION
  • 4. -VASCULAR.-VIBRATION WHITE FINGER.VWF (14)-VASCULAR INJURY (7)-MUSCULAR-FIBROSIS/NECROSIS/STRUCTURAL DISORGANIZATION (3, 18,14)-MUSCLE WEAKNESS, PAIN.(23)-NERVE-SENSORINEURAL DISTURBANCES.(14)-IMPAIRED BLOOD FLOW,INTRANEURAL EDEMA, CHEMICALIRRITABLITY(10),-DEMIELINATION / RE-INNERVATION, FIBROSIS(3)RESPONSETOVIBRATION
  • 5. EPIDEMIOLOGICAL STUDY OF VIBRATION SYNDROME IN RESPONSE TO TOTALHAND-TOOL OPERATING TIME.TOT.(14)(0-2000-5000-8000 HOURS IN CHAIN SAWWORKERS)KMIYASHITA,SSHIOMI,NITOH,TKASAMATSU,ANDHIWATA-RAYNAUDS PHENOMENON INCREASED IN FREQUENCY AND SEVERITY-ABNORMAL FINDINGS IN CIRCULATORY FUNCTION-LOSS OF PAIN SENSE, AND VIBRATORY SENSE.-MUSCLE ATROPHY, OBSERVED IN THE DORSAL INTEROSSEOUS MUSCLES,-WITH UNDER 2000 HOURS EXPOSURE, "LATENT INTERVARL "OF THE HAVSHAND MUSCLE PATHOLOGY AFTER LONG-TERM VIBRATION EXPOSURE.(3)(ABDUCTOR POLLICIS BREVIS MUSCLE IN PATIENTS SUFFERING HAVS)LARSE.NECKING,GO.RANLUNDBORG,RONNIELUNDSTRO.M,LARS-ERICTHORNELLandJANFRIDE!N-DIRECT MUSCLE DAMAGE (NECROSIS, FIBROSIS AND STRUCTURALDISORGANIZATION)-MUSCLE DENERVATION AND RE-INNERVATION.STRUCTURAL NERVE CHANGES AT WRIST LEVEL IN WORKERS EXPOSED TOVIBRATION.(18) (BIOPSIES OF THE DORSAL INTEROSSEOUS NERVE)Trygve Stromberg, Lars B Dahlin, Arne Brun, Goran Lundborg-BREAKDOWN OF MYELIN AND BY INTERSTITIAL AND PERINEURIAL FIBROSIS.RESPONSETOVIBRATION
  • 6. INTRANEURAL EDEMA FOLLOWING EXPOSURE TO VIBRATION.(10)(RAT-TAIL 82HZ, 4 H/ 5 DAYS)by G6ran l.undborq.l- Lars B Dahlin," Nils Danielsen,2 Hans A Hansson," Lars E Neckinq, IImari Pyykk64- EPINEURIAL EDEMA.RESPONSETOVIBRATION
  • 7. -PATHOPHYSIOLOGY OF NERVE COMPRESSION SYNDROMES:RESPONSE OF PERIPHERAL NERVES TO LOADING.(13)BY DAVID REMPEL, M.D., M.P.H.†, SAN FRANCISCO, CALIFORNIA, LARS DAHLIN, M.D., PH.D.‡, AND GÖRAN LUNDBORG, M.D., PH.D.‡, MALMÖ, SWEDENTHE JOURNAL OF BONE AND JOINT SURGERY VOL. 81-A, NO. 11, NOVEMBER 1999-PATHOPHYSIOLOGY OF NERVE COMPRESSION.(29)S.E. Mackinnon / Hand Clin 18 (2002) 231–241-NERVE COMPRESSION INJURY AND INCREASED ENDONEURIALFLUID PRESSURE: A "MINIATURE COMPARTMENT SYNDROME"(4)GORAN LUNDBORG, ROBERT MYERS, HENRY POWELLRESPONSETO PRESSION
  • 8. 20 MM/HG -↓ EPINEURAL FLOW30 MM/HG -ENDONEURIAL EDEMA-IMPAIRMENT AXONAL TRANSPORT-PERINEURIAL/EPINEURIAL THICKENING50 MM/HG - ESTRUCTURAL ALTERATIONS IN MYELIN.80 MM/HG -STOP BLOOD FLOW-WALLERIAN DEGENERATION.RESPONSE TO PRESSION.
  • 9. Mackinnon SE, Dellon AL. Surgery of the peripheral nerve.
  • 10. The cascade of the biological response tocompression includes endoneurial edema,demyelination, inflammation, distal axonaldegeneration, fibrosis, growth of new axons,remyelination, and thickening of the perineuriumand endothelium. The degree of axonaldegeneration is associated with the amount ofendoneurial edema.Pathophysiology of Nerve Compression Syndromes: Response of Peripheral Nerves to Loading(13)DAVID REMPEL, LARS DAHLIN, GÖRAN LUNDBORG.
  • 11. MINI-SINDROME COMPARTIMENTALAFECTACIÓN FLUJO ENDONEURAL↓EDEMA ENDONEURAL↓PERINEURO INTACTO↓MINIATURE COMPARTMENT SYNDROMERESPONSETO PRESSION
  • 12. Multiple and double crush syndrome-Upton and McComas; who stated that a proximal level of nervecompression could cause more distal sites to be susceptible to compressionAlterations of axoplasmic flow
  • 13. TREATMET1.- DRIVER POSITION & SETTING2.- DRIVING TECHNIQUES3.- DOWN MOTORCYCLE VIBRATION
  • 14. ! PRESSION.CARPAL TUNNEL PRESSURE 3 TO 5 MM/HG WITH THE WRIST IN A NEUTRALPOSITION.PLACING THE HAND ON A COMPUTER MOUSE ↑ P 16 TO 21 MM/HG.USING THE MOUSE TO POINT AND CLICK ↑ P 28-33 MM/HG.WRIST EXTENSION 40º+ MP 0º 63MM/HG.DRIVER POSITION.WRIST EXTENSION AND ULNAR DEVIATION, FLEXION MP, EXTENSION PIP.PERMANENT/CONTINUOUS MUSCLE ACTION. (LUMBRICAL,INTEROSEOUS,FDS,FCU,PRONATOR TERES....)
  • 15. HTTP://CYCLE-ERGO.COM/
  • 16. ! VIBRATION! ARM POSITION! GLOVESHANDLE-BARSBAR-ENDS1.- DRIVER POSITION & SETTING
  • 17. que podemos hacer....
  • 18. 1.-AUTOTREATMENT- 2 TIME A DAY- NEURODINAMICS(N.D) GLINDING EXERCICES-IMPROVING INTRANEURAL CIRCULATION, AXOPLASMIC FLOW, NEURALCONNECTIVE TISSUE VISCOELASTICITY, AND BY REDUCING MECANSENSITIVITY(BUTLER, 2000; SHACKLOCK, 2005).-NERVE GLIDING EXERCISES MAY ALSO LIMIT FIBROBLASTIC ACTIVITY ANDMINIMISE SCAR FORMATION VIA NORMAL AND EARLY USE OF MESONEURIALGLIDING TISSUES (MILLESI ET AL., 1995)2.-OUR TREATEMENT-SOFT-TISSUE WORK-INHIBITIÓN TENSIONS (PRONADOR TERES, FCU, HYPOTHENAR MUSCLES)-STRETCHING (INTEROSEOUS ≢, FDS,FCU, ABD+OPP V..)-N.D.TREATMENT
  • 19. -Epidemiological study of vibration syndrome in response to total hand-tool operating time.(14)KMIYASHITA,SSHIOMI,NITOH,TKASAMATSU,ANDHIWATABrtishJournalofIndustrialMedicine 1983;40:92-98-Hand muscle pathology after long-term vibration exposure.(3)LARSE.NECKING,GO.RANLUNDBORG,RONNIELUNDSTRO.M,LARS-ERICTHORNELLandJANFRIDE!NJournal of Hand Surgery (British and European Volume, 2004) 29B: 5: 431–437-Structural nerve changes at wrist level in workers exposed to vibration.(18)Trygve Stromberg, Lars B Dahlin, Arne Brun, Goran LundborgOccupationalandEnvironmentalMedicine 1997;54:307-311-Intraneural edema following exposure to vibration.(10)by G6ran l.undborq.l- Lars B Dahlin," Nils Danielsen,2 Hans A Hansson," Lars E Neckinq, IImari Pyykk64Scand J Work Environ Health 13 (1987) 326 -329-VIBRATION CAUSES ACUTE VASCULAR INJURY IN A TWO-STEP PROCESS:VASOCONSTRICTION AND VACUOLE DISRUPTION.(7)SANDYA R. GOVINDARAJU1, JAMES LW. BAIN1, THOMAS J. EDDINGER2, DANNY A. RILEY1,THE ANATOMICAL RECORD: ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGYVOLUME 291, ISSUE 8, PAGES 999–1006, AUGUST 2008-RESPONSETOVIBRATION