Vibration white finger

Assessment of vibration modulated regional cerebral blood flow with MRI

Human brain experiences vibration of certain magnitude and frequency during various physical activities such as vehicle transportation and machine operation, which may cause traumatic brain injury or other brain diseases. However, the mechanisms of brain pathogenesis due to vibration are not fully elucidated due to the lack of techniques to study brain functions while applying vibration to the brain at a specific magnitude and frequency. Here, this study reported a custom-built head-worn electromagnetic actuator that applied vibration to the brain in vivo at an accurate frequency inside a magnetic resonance imaging scanner while cerebral blood flow (CBF) was acquired. Using this technique, CBF values from 45 healthy volunteers were quantitatively measured immediately following vibration at 20, 30, 40 Hz, respectively. Results showed increasingly reduced CBF with increasing frequency at multiple regions of the brain, while the size of the regions expanded. Importantly, the vibration-induced CBF reduction regions largely fell inside the brain's default mode network (DMN), with about 58 or 46% overlap at 30 or 40 Hz, respectively. These findings demonstrate that vibration as a mechanical stimulus can change strain conditions, which may induce CBF reduction in the brain with regional differences in a frequency-dependent manner. Furthermore, the overlap between vibration-induced CBF reduction regions and DMN suggested a potential relationship between external mechanical stimuli and cognitive functions.

Vascular endothelial cells mediate mechanical stimulation-induced enhancement of endothelin hyperalgesia via activation of P2X2/3 receptors on nociceptors

Endothelin-1 (ET-1) is unique among a broad range of hyperalgesic agents in that it induces hyperalgesia in rats that is markedly enhanced by repeated mechanical stimulation at the site of administration. Antagonists to the ET-1 receptors, ET(A) and ET(B), attenuated both initial as well as stimulation-induced enhancement of hyperalgesia (SIEH) by endothelin. However, administering antisense oligodeoxynucleotide to attenuate ET(A) receptor expression on nociceptors attenuated ET-1 hyperalgesia but had no effect on SIEH, suggesting that this is mediated via a non-neuronal cell. Because vascular endothelial cells are both stretch sensitive and express ET(A) and ET(B) receptors, we tested the hypothesis that SIEH is dependent on endothelial cells by impairing vascular endothelial function with octoxynol-9 administration; this procedure eliminated SIEH without attenuating ET-1 hyperalgesia. A role for protein kinase Cε (PKCε), a second messenger implicated in the induction and maintenance of chronic pain, was explored. Intrathecal antisense for PKCε did not inhibit either ET-1 hyperalgesia or SIEH, suggesting no role for neuronal PKCε; however, administration of a PKCε inhibitor at the site of testing selectively attenuated SIEH. Compatible with endothelial cells releasing ATP in response to mechanical stimulation, P2X(2/3) receptor antagonists eliminated SIEH. The endothelium also appears to contribute to hyperalgesia in two ergonomic pain models (eccentric exercise and hindlimb vibration) and in a model of endometriosis. We propose that SIEH is produced by an effect of ET-1 on vascular endothelial cells, sensitizing its release of ATP in response to mechanical stimulation; ATP in turn acts at the nociceptor P2X(2/3) receptor.

Vibration syndrome diagnosis using a cooling test verified by computerized photoplethysmography

This study addresses the problem of vibration syndrome diagnosis by means of a cooling test verified by photoplethysmography. Measurement was taken on a small area on the fingertip plexus in which many arterio-venous anastomoses are present. In the opinion of many authors, flow disorders in this area are more typical for developing vibration syndrome than changes in the micro vessels. The study group comprised 128 subjects (58 women aged 40.9 +/- 5.4 years and 70 men aged 38.7 +/- 8.8 years) exposed to vibration. The control group consisted of 41 people (20 women aged 39.6 +/- 7.3 years and 21 men aged 39.3 +/- 6.4 years) who were not exposed to vibration. The patients were examined by a questionnaire and then a vibration perception threshold test and a cooling test were performed. The cooling test was verified both visually and using the computer method. Measurement data (S1, S2 and A) for each patient were obtained from averaging three pulse graphs. We departed from an average of 60 graphs (and more), the standard established in the literature, because of the cooling test specification, which causes huge thermodynamic parameter changeability in the plexus mass of the small finger under pulse waves coming one after another. A longer measurement time will reflect the thermal drift of the tested area in a direction to compensate for the reduced temperature. In the control group, all subjects showed an increase in planimetric indicators during the cooling test verified by computerized photoplethysmography. In the study group visual verification of the cooling test was positive in eight cases (6.2%) and the vibration perception threshold test was positive in seven cases (5.5%), but in computerized photoplethysmography the planimetric indicators decreased after cooling in 87 (67.4%) cases. Computer photoplethysmography is highly specific and shows greater sensitivity in detecting preclinical forms of vascular-type vibration syndrome when compared with palesthesiometry, the visually verified cooling test and the questionnaire. The proposed test enables the detection of vascular disorders in the prodromal period and gives time for preventive measures to be taken.

[White finger and hypertrophy of the lumbrical muscles]

Within the digital vascularization diseases, we found a compression of the radial and ulnar collateral arteries of a finger by hypertrophy of the lumbrical muscles which was presented clinically in the form of a chronic sub-ischemia. A surgical release made it possible to recover a vascularized and sensitive finger.

Clinical applications of quantitative sensory testing (QST)

Quantitative sensory testing (QST) has been used clinically for the last two decades, yielding a substantial number of publications regarding these applications. In this review we tried to amass together the major findings of these publications into one monograph, excluding those dealing with pain. This was done with the aim of assisting clinicians in the better use of QST techniques for the benefit of their patients.