Potential Risk of Developing Peripheral Neuropathy in Heavy Motor Vehicle Driving: A Cross-sectional Study

Abstract

Introduction: There is a growing concern regarding increasing road traffic accidents due to overburdened drivers, which also affect their general health. Drivers maintain the extreme position of arm, forearm, and legs which during distant journeys may put increased constraint on nerves passing in forearm and legs in addition to the vibrations transmission i.e., Hand Arm Vibration Syndrome (HAVS) and Foot Transmitted Vibration (FTV). Aim: To find out if chronic repeated movements at wrist and foot along with vibration transmitted from steering wheel and pedals influence the nerve conduction parameters and to find out which nerves are more prone to neurological conduction defects. Materials and Methods: A cross-sectional study was conducted over a period of two years in Neurophysiology Lab, Department of Physiology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India. Mean peak sensory and motor latency, mean motor and sensory Nerve Conduction Velocity (NCV), Sensory Nerve Action Potential (SNAP) and Compound Muscle Action Potential (CMAP) of median, ulnar and common peroneal nerve in Professional Heavy Vehicle Drivers (PHVD) was compared with non-drivers using Medicaid System’s (Electromyography) EMG/ (Nerve Conduction Velocity) NCV equipment with Neuroperfect Software. Student’s unpaired t-test was used to assess the significance of difference in nerve conduction study findings. Results: Heavy vehicle drivers showed slow Sensory Nerve Conduction Velocity (SNCV) (drivers: 51.40±3.30, non-drivers: 53.66±3.60 in right hand p-value 0.0001) and (drivers: 52.51±3.78, non-drivers: 53.87±3.61 in left hand p-value=0.0145) and increase in sensory latency (drivers: 3.71±0.72, non-drivers: 2.89±0.56 in right hand p-value<0.0001 and drivers: 3.4±0.81 non-drivers: 2.76±0.70 in left hand p-value <0.0001) of median nerve. Ulnar nerve sensory latency was prolonged (drivers: 2.98±0.52, non-drivers: 2.76±0.42 in right hand p-value 0.0021 and drivers: 2.97±0.42, non-drivers: 2.80±0.65 in left hand p-value 0.0386) and sural nerve sensory latency was prolonged (drivers: 3.05±0.55, non-drivers: 2.78±0.54 in right leg p-value=0.0011 and drivers: 2.92±0.45, non-drivers: 2.69±0.40 in left leg p-value 0.0004).There was no significant difference in Motor Nerve Conduction Velocity (MNCV), motor latency, SNAP and CMAP of median, ulnar and common peroneal nerve among heavy vehicle drivers in comparison to non-drivers. Conclusion: We conclude that pressure and vibrations transmitted at hand and foot along with repeated movements at forearm wrist and pedals leads to more neurological conduction defects in median nerve than in ulnar and sural nerve. Flexibility in delivery time, incorporating judicious breaks in duty, better ergonomics design may help in improving work conditions of drivers.