Carpal Tunnel Syndrome - CTS

June 09, 2013

  

Hands are integral to the work of dental care professionals, but because of the physical demands of prolonged awkward postures and sustained grips on dental tools, dentists and dental hygienists often experience hand, wrist, and arm pain. Carpal tunnel syndrome is a common ailment and concern for most everyone in the dental field. It can make even the simplest chairside movements and tasks a challenge. That is managing or preventing carpal tunnel syndrome is essential for anyone pursuing a long career as a dental professional.

What is Carpal Tunnel Syndrome?

It is a nerve-related disorder that involves compression or irritation of the median nerve at the wrist. The median nerve is what provides sensation to the thumb and fingers on the palm side of the hand, excluding the pinky finger. It also facilitates nerve signals to the muscles around the base of the thumb for thumb and finger movement. The carpal tunnel is the narrow passageway that houses the median nerve. It runs on the inside of the forearm from the elbow to the hand and is surrounded by bone, ligaments, and tendons. But when the tissues around the tunnel become injured or inflamed, the passage narrows and puts pressure on the median nerve. This is ultimately what causes the limiting and painful condition known as CTS.

What are risk factors for carpal tunnel syndrome?

Anatomic factors can increase the risk of irritation or damage to the median nerve. For example, people with smaller carpal tunnels are more likely to develop the condition. Also, wrist dislocation or fracture can deform the bones in the wrist and alter the space within the carpal tunnel. CTS is also highly related to underlying systemic diseases like osteoarthritis, rheumatoid arthritis, hypothyroidism, and diabetes mellitus. Other risk factors include lifestyle conditions such as smoking, long-term alcohol intake, and obesity. But there are also work-related risk factors including forceful exertion, mechanical stress, repetitive hand motions, prolonged closure of the palm, and exposure to vibration. As such, CTS has a high incidence rate amoung dental care professionals. 

Signs and symptoms of carpal tunnel syndrome

Symptoms develop slowly at first but can progress to more painful and more permanent issues. Compression of the median nerve often results in:

- Weakening of the hands or wrists
- Pain or aching in the hands or wrists
- Shocking pain that radiates up the arm to the elbow
- Numbness or tingling in the fingers (usually the thumb, index, and middle fingers)
- Incoordination in the hand
- Loss of grasp

What are diagnostic techniques to confirm CTS?

The doctor may order an ultrasound, x-ray, or MRI to rule out other common causes of wrist pain. The most reliable diagnostic tools are clinical symptoms and electro neurologic evaluation. For Tinel’s nerve percussion test, the doctor uses a reflex hammer to tap or press on the median nerve. If the fingers tingle or feel a shock-like sensation the test is positive for carpal tunnel syndrome. For Phalen’s maneuver, the doctor has the patient press the backs of the hands and fingers together with wrists flexed and remain in that position for one or two minutes. If the fingers get numb or tingle the test is positive for carpal tunnel syndrome. And one of the strongest tests for evidence of CTS is using a small electrode on the skin to send a mild electrical current down the median nerve to measure how fast the pulse travel. The more damage to the median nerve the more time it takes for the current to move from elbow to fingers.

Preventing Carpal Tunnel Syndrome

Complications from CTS can be rare, but it is important to manage discomfort and atrophy. These are some useful tips that can help prevent or mitigate the development of CTS:

Wrist exercises

Pain and inflammation can stiffen the wrist, making it harder to move, This exacerbates symptoms and can lead to a vicious cycle. It is important to exercise small joints to keep them flexible and lubricated. That way inflammation is less likely to occur. Squeeze hands into fists and release several times, and flex and stretch the wrist throughout the day to prevent stiffness.

Ergonomic hand tools

The type of tools can also have a significant impact on the symptoms of CTS. Dental professionals should try to avoid heavy tools or tools that are difficult to hold because they are thin and straight. Look for lightweight instruments with resin or silicone handles.

Ergonomic seating

Dental professionals posture can be another common factor, especially tension in the back and shoulders which can translate to poor alignment and pressure on the wrists. Ergonomic stools can support healthier sitting positions. And though most of their time is spent with patients, dental professionals might also consider more ergonomic desk chairs and computers.

Managing existing health conditions

Last, but not least, it is important to mitigate other health conditions like diabetes, obesity, cancer, and other autoimmune diseases that can contribute to CTS.

When to seek treatment for Carpal Tunnel Syndrome?

In early stages, CTS may be mild enough to shake out the numbness, relieve tingling, and restore hand and wrist function. But the pain and numbness will become more constant over time. It is time to see a doctor if signs and symptoms of CTS constantly interfere with work, normal activities, and sleep patterns. Without treatment, permanent nerve damage can occur

Comments