2012 Annual Conference

Alexander, Kaitlin R

U.S. Army-Baylor University Doctoral Program in Physical Therapy

Evidence suggests that dental personnel have an increased prevalence of upper-extremity disorders, including carpal tunnel syndrome (CTS).  Previous research has also reported that military dental personnel potentially have a higher prevalence of CTS than their civilian counterparts.  Unfortunately, the number of studies and inclusion of nerve conduction confirmation of CTS in practicing military dental personnel is limited.  Therefore, the purpose of this study was to determine the presence of electrodiagnostic abnormalities of the median and ulnar nerves in active duty military dental personnel assigned at Fort Sam Houston, Texas. 

Twenty United States Army dental personnel (6 females, 14 males) ranging in age from 26-56 years old (mean + SD= 38  + 9.8 years) participated in the study.  Participants had an average of 13.3+ 7.96 years (range 2-29 years) of dental experience.

Subjects completed a history form, were interviewed, underwent nerve conduction testing, and had a physical examination of the cervical spine and bilateral upper extremities. Physical examination measures included range of motion, manual muscle testing (various muscles of the C4-T1 myotomes), sensation (light touch and quantitative vibration perception threshold testing), muscle stretch/pathologic reflexes, wrist ratios, and provocation testing (cervical quadrant, Spurling’s, upper limb tension testing, Phalen’s, and Tinel’s at the carpal, Guyon’s, and cubital tunnels).   Electrophysiological status of the bilateral median and ulnar nerves served as the reference standard for neuropathy and was obtained by performing motor, sensory, and ulnar/median comparison nerve conduction studies.

Seven of the 20 subjects (35%) presented with abnormal electrophysiologic values.  Five of the 20 subjects (25%) had electrophysiologic findings consistent with median mononeuropathy at or distal to the wrist.  Additionally, two of the 20 subjects (10%) presented with electrophysiologic values suggestive of ulnar mononeuropathy at or distal to the wrist.  Three of the seven subjects with electrophysiologic evidence of neuropathy had supporting historical and physical examination findings. 

The prevalence of median and ulnar neuropathies in this small sample of U.S. Army dental personnel (35%) far exceeds that reported in the general population.  This study also suggests that upper neuropathies in practicing military dentists may include both the median and ulnar nerve at the wrists.  Our current findings, which included the gold standard of nerve conduction testing, reinforce previous studies and suggest a need for  multi-site longitudinal  research that investigates effective screening, treatment and prevention of upper extremity mononeuropathies  in dental personnel.