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    Two common reasons your wrist hurts — and how to treat it

    Many dentists complain of pain in the hands and wrist, but aren't sure what's causing it or how they can take care of it.

    In dentistry, two of the most commonly reported pain syndromes of the wrist occur in nearly the same area.

    Easily confused, but of entirely different origin, de Quervain’s disease is a painful inflammation of the tendons in the thumb, whereas osteoarthritis (OA) of the thumb is a degenerative joint process. Both appear frequently among dental professionals, since a primary risk factor is repetitive thumb use.

    These syndromes can be debilitating, and OA of the thumb can force early retirement, especially among female dentists and hygienists. Therefore, it is a good investment in your health to implement early ergonomic prevention strategies.

    Fig 1Fig 1de Quervain’s disease (also known as de Quervain’s Tenosynovitis) affects two thumb tendons that move the thumb forward and away from the hand at the CMC joint, between the base of the thumb and the wrist. Symptoms include pain, tenderness and swelling on the thumb side of the wrist (Fig. 1). Oftentimes gripping is difficult, and movement of the thumb worsens the pain. While the name implies a tendonitis, the newest research reveals that it is more likely a thickening and degeneration of the tendon synovial membrane.

    In dentistry, this is most often due to forceful, sustained or repetitive thumb abduction (flexed forward, out of the plane of the hand) combined with angling the hand sharply to one side. Scaling, extractions or suctioning with a palmar grip are a few examples of tasks in dentistry that can lead to the problem. Women are four times more prone to develop this problem than men, and frequency is highest in team members 35-55 years of age. The test for de Quervain’s is quite simple: with the thumb held in a fist, angle your wrist toward the little finger, or “pinky” side (Fig. 2). It is normal to experience discomfort; however, if it produces pain, you may have de Quervain’s disease.

    Related article: 5 ergonomics tips that could save your career

    Interventions include ergonomic modification, cortisone injections, splinting, ice, anti-inflammatory meds, frequent breaks, gentle stretching and surgery. Regardless of the intervention, ergonomics in the operatory should always be addressed to prevent recurrence or worsening of symptoms. Most importantly, avoid a forceful pinch combined with angling the wrist sharply to one side.Fig. 2Fig. 2

    Hygienists should consider the following motion when scaling: grip the instrument in a straight, or neutral, wrist posture, use a finger fulcrum and lock the wrist as you roll the forearm from side to side. To decrease pinch force, consider larger diameter handles (10 mm+), using ultrasound and ensuring sharpness of hand instruments.

    A certified hand therapist (CHT) may be a good referral to request from your doctor for conservative therapy before considering surgery. You should also know that the muscles of the same tendons that cause de Quervain’s disease may develop trigger points that can also refer wrist pain and mimic this syndrome. A good resource for troubleshooting and differentiation is “The Trigger Point Therapy Workbook” by Clair Davies.

    If considering surgery, the success rate is quite higher than carpal tunnel surgery and provides relief in many cases.

    Dr. Bethany Valachi, PT, MS, CEAS
    Dr. Bethany Valachi, PT, MS, CEAS is DPR’s ergonomics editor and author of the book,“Practice Dentistry Pain-Free” and clinical ...

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