J.Jpn. Surg. Soc.. 57(1): 86-108, 1956

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CLINICAL STUDIES ON RAYNAUD'S PHENOMENON DUE TO VIBRATING TOOLS

Raynaud's phenomenon was observed in workers who are continuously using only chipping hammers. It was more frequently observed in workers using chipping hammers against cast iron than in workers against steeI casting, and it was not observed in workers using riveting hammers and rammers against mild steel and rivets. ChiseI of chipping hammers delivered 30-50 blows per second and the amplitude was 1.5- 2.5 mm.
The phenomenon which originates from the 5th finger, was observed only in the left hand holding chisels. It occurred 2-15 years after the beginning of using vibrating tooIs. The symptoms rapidly increaed during 1-2 years after onset of phenomenon and then the progress became very slow.
In 2 of 10 cases, using of vibrating tools was stopped 1 and 5 years after onset of the phenomenon respectively, but symptoms did not disappear. In 5 of 10 cses showing Raynaud's phenomenon and in 3 of the other 9 cases withoul Raynaud 's phenomenon, numbness of the hand was observed and in 2 other cases convulsive attacks of the fingers were seen.
Time of occurrence, occasion and symptoms during attacks of Raynaud's phenomenon were typical. Skin temperature and capillary microscopic findings of fiingers and blood pressure during inter-seizure period were fairly normal. According to arteriography arterial arch of the volar side of the hand and finger arteries were found to be thinner than usual, but no obstruction was observed. By plethysmographic exminations vasoconstriction was observed throughout summer and winter seasons in a group with symptoms and during only winter in another group without symptoms. Amplitude of volume pluse wave on the affected side was smaller than that of the normal side. The vasoconstriction increased by application of cold water and it decreased by injection of Benzyl-imidazoline.
By roentgenological examinations of the upper extremity, increase of antero-posterior diameter of the upper arm, increase of antero-posterior of Iateral diameter of the forearm, thickening of finger bones, protuberances of the radius and upper part of the ulna, flattening of the capitulum radii, deformities of the olecranon and the coronoid process and so on, were observed.
According to the findings mentioned above, a pneumatic hammer disease which was observed by the authors, is a localized and functional circulatory disorder caused by continuous stimuli of a kind of vibration and it is a state of so-called vasoconstriction. Only one organic change is the finding of bone and joint which is showing a state of abnormally severe contraction of muscles of the upper extremity.
(author's abstract)

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