GUIDED BY: DR.MAHMOOD MOOTHEDATH DR.ASEELA AHMED SUBMITTED BY THRIPTHI RAJ P K.

GUIDED BY:

DR.MAHMOOD MOOTHEDATH

DR.ASEELA AHMED

ERGONOMICS IN DENTISTRY

SUBMITTED BY THRIPTHI RAJ P K

CONTENTS*INTRODUCTION

*PRINCIPLES OF ERGONOMICS

*ERGONOMICS IN DENTAL OFFICE

*WHAT IS A MSD?

*SIGNS AND SYMPTOMS OF MSD

*RISK FACTORS FOR MSDs

* OFF JOB ACTIVITIES THAT CONTRIBUTE TO MSDs

*ERGONOMIST’S PERSPECTIVE OF DENTAL HYGIENE WORKPLACE

*FACTORS LEADING TO RSIs

*RSIs

*MUSCLE STRENGTHENING EXCERCISES

*EYE TO FUTURE

*CONCLUSION

INTRODUCTION*ERGONOMICS(from the greek ergon,meaning ‘’work’’,nomos meaning ‘’law’’)deals with adaptation of the work environment to the human body.

*The goal of ergonomics is to help people stay healthy while performing their work more effectively.

*This can be done by changing workplace design,modifying instruments,strengthening muscles,taking breaks,using certain products and providing proper training.

PRINCIPLE OF ERGONOMICS*Ergonomics designs the work area &the task

around the human body, rather than requiring the human to adapt to poorly designed equipment and working environment.

ERGONOMICS IN DENTAL OFFICE The members of the dental team most

frequently perform their work in a seated position & often use excessive motions and have unbalanced postures.Many dental professionals experience pain associated with MSDs.

Prior to 1985,low back pain was the most commonly reported MSD or RSI for dentists.Since then there has been a rise in MSDs from extended work days,awkward postures,prolonged standing or unsupported sitting,poorly designed workstations,improper work habits &instuments that are difficult to manipulate.

WHAT IS AN MSD?

*A MSD is an injury of the muscles, nerves, tendons, ligaments, joints, cartilage, blood vessels or spinal discs.

*These disorders can occur from a single incident,such as lifting a heavy weight or can develop gradually from repeated stress on a part of the body.

*MSDs can affect any part of the body,but most commonly occur in the back, neck, shoulder, elbow & wrist.

SIGNS OF MSDs

• Decreased range of motion

• Loss of normal sensation

• Decreased grip strength

• Loss of normal movement

•Loss of cordination

SYMPTOMS OF MSDs•Excessive fatigue in the shoulders&neck• Tingling,burning or other pain in arms•Weak grip,cramping

of hands• Numbness in fingers &hands

• Clumsiness&dropping of objects

• Hypersensitivity in hands &fingers

RISK FACTORS FOR MSDs•Repitition

•Forceful exertions

•Awkward postures

•Contact stress

•Vibration

•Poorly designed equipment /workstation

•Improper work habits

•Genetics

•Medical conditions

•Poor fitness level

•Physical/mental stress

•Lack of rest/recovery

•Poor nutrition

•Environmental

factors

•Poor lighting

POSTURE

Posture affects the ability of the dentist to reach,hold & use equipment.Most dentists are seated while working on patients.Although sitting is generally less fatiguing than standing,any position will eventually become fatiguing over time.This may lead to low back pain.

NEUTRAL POSITION

*Sit upright with your weight evenly distributed

*Feet flat on the floor

*Back pressed against back of the chair for lumbar support

The properly aligned spine resembles a gentle ‘S’.When the spine is properly aligned,the ears,shoulders,hips are in straight vertical alignment providing balance,support&equal distribution of weight through out the spine.

DEVIATIONS & PROBLEMS

Deviations from neutral position such as leaning forward,twisting,over bending back&reaching cause strains&sprains.strains result from exteme stretching of muscles or ligaments.Sprains usually involve a sudden twist or wrenching of a joint with stretching or tearing of ligaments.Shoulder problems can be caused by repeatedly reaching behind the body for instruments or supplies.

REACHING MOVEMENTSKeep frequently used items such as air water syringe, handpiece, saliva ejector &high volume oral evacuator within a comfortable distance.Adjust the instrument tray &equipment so that items are within normal horizontal reach.Keep the operatory light within a safe maximum vertical reach,the reach created by the vertical sweep of your forearm.Other supplies used less frequently should be placed within maximum horizontal reach, the reach created when your upper arm is fully extended.Reaches should be to the front only.Reaching behind your back &lifting can cause shoulder injury. When turning is necessary,rotate the chair rather than twisting your body.

IMPORTANCE OF POSTUREImproper workstation set up

Force dentist to assume harmful postures

*Pressure on nerves &blood vessels

*Strain on muscles

*Decrease circulation

*Wear &tear on joint structures

SOME IMPROPER POSTURES THAT DENTISTS TAKE

*Working with neck in flexion/tilted to one side

*Shoulders elevated

*Side bending to left or right

*Excessive twisting

*Forward bending

*Shoulders flexed&abducted

*Elbows flexed >90degree

*Wrists flexed/deviated in grasping

*Position maintained for 40+minutes per patient

TIPS FOR WORKING WITH GOOD POSTURE

1)Always try to maintain an erect posture

- Position your chair close to the patient.

- keep feet flat on the floor

2) Use an adjustable chair with lumbar, thoracic support.

3) Work close to your body

-position your chair close to patient &tray close to you.

-think of 90degree rule.

4)Minimize excessive wrist movements -try to keep them in neutral position5)Avoid excessive finger movements -retrian yourself to use shoulders&arms to

position your hands.6)Alternate work positions between sitting,

standing & side of the patient -allows certain muscles to relax while shifting

the stress onto other muscles&increasing the circulation

7)Adjust the height of your chair&the patient’s chair to a comfortable level

-too high patient’s chair elevation of shoulder neck problems

-too low patient’s chair flex your neck down neck problems

8)Check the placement of adjustable light -position the light so you don’t have to strain

your neck to see patients mouth9)Check the temperature in the room -too cold work place decrease blood flow to

extremities

ERGONOMIC CHAIR SIDE TIPS

*Use muscles to remain balanced for ease of movement

*Avoid prolonged awkward positions

*Do not remain in one position for an extended time

*Do not constantly lean forward or to the side

*Remain in good physical condition

*Take break to stretch the neck,shoulders&hands

*Avoid repetative,forceful movements

*Rearrange items in the operatory for easy use

REPETITION & FORCE

*Repetitive motion,overflexion &overextension of the wrist increase risk for cumulative trauma disorders(CTDs).

*To help prevent CTDs take periodic breaks&when scheduling patients,alternate difficult procedures with less stressful procedures.

OFF JOB ACTIVITIES THAT CONTRIBUTE TO MSDs

*Home computer use

*Repititive activities using the fingers

*Sports activities

*Prolonged/awkward postures at home

*Use of household tools

*Activities involving repeated heavy lifting, bending, twisting or reaching

ERGONOMIST’S PERSPECTIVE OF THE DENTAL HYGIENE

WORKPLACEWORK PLACE ENVIRONMENT

DENTAL HYGIENE WORK ENVIRONMENT

ALTERATIONS TO DENTAL HYGIENE PRACTICE

REPETITIVE STRAIN INJURIES

Ergonomic design &lay out

Layout &convenience of equipment placement in treatment area

• Eliminate stretching for dental light&bracket table

• Reduce twisting motion of the back,shoulders&elbow while reaching for instruments

•Lumbar joint dysfunction•Carpal tunnel syndrome•Thoracic outlet compression•Tension neck syndrome

Worker &equipment crossing point

•Dull hand instruments•Vibrations&stress from rotary instruments•Improperly designed hand instruments

• Maintain hand instruments

• Do not use handpieces with curly or retracting cords

• Use balanced instruments

•Carpal tunnel syndrome•Trigger finger nerve syndrome•De quervain’s syndrome

Tasks &work to be performed

•Repetitive movements&hand fatigue•Clinician fatigue &stress on body

•Change clinician positions•Alternate instrument handle design&diameter•Use proper client&clinician positioning

•Lumbar joint dysfunction•Carpal tunnel syndrome•Cervical spondylosis•Strained pronator muscle

Psychological aspects &factors

Practice management&appointment scheduling

•Alternate involved dental treatments with less complicated maintenance appointments•Lengthen appointment times

•Tension neck syndrome•Adhesive capsulitis•Strined pronator muscle•Lateral epicondylitis

FACTORS LEADING TO REPITITIVE STRAIN

INJURIESERGONOMIC FACTORS IN DENTISTRY

GOOD PRACTICES

STAFF TRAININGBALANCE & EXCERCISE

WORK PLACE CHANGES

INSTRUMENT DESIGN

EQUIPMENT DESIGN

ERGONOMICS

1)ENVIRONMENTAL FACTORS

-Flexibility of muscles & tendons is important for reducing the occurence of RSI.Flexibility can be accomplished through physical exercise & maintaining comfortable room temperatures.

-colder the room the less relaxed & flexible are muscles &tendons.

-relaxed atmospheres with minimal background noise contribute to a positive psychological state for clinician & clients

2)EQUIPMENT FACTORSDENTAL UNIT

-Treatment area consists of the dental unit & chair, dental light, clinician’s chair

•EQUIPMENT •DESCRIPTION &USE

•Contoured seat •Should provide comfort to a variety of clients during treatment

•Lumbar support •A contoured design gives additional support to the torso&lumbar region

•Arm rests •Support the client’s arms comfortably

•Foot or side power controls •Move chair up/down &into a fully supine poosition•Provides options to the clinician to access all areas of client’s mouth with minimum back&neck strain•Foot controls provide clinician with extra adaptability &range of motion

•360degree rotation lever or foot control

•Allows dental chair to be rotated 360degree.•Beneficial to provide access for wheel chair bound clients•Benefits left handed clinician to adjust the dental chair for proper clinician/client positioning

DENTAL CHAIR

DENTAL UNITEQUIPMENT DESCRIPTION &USE

•Dental chair Support client

•Dental light Transmit illumination into client’s oral cavity

•Handpiece lines Attach motor driven handpiece from the power source to the dental unit

•Water lines Bring water to various parts of the dental unit including handpiece,three-way syringe,cup filler

•Three-way syringe Provides air,water or a combination of air&water

•Evacuation lines High speed/low speed suction with autoclavable or disposable attachment tips

•Instrument tray Movable stainless steel instrument tray usually attached to the dental light post

• cuspidor Movable cup or bowl utilized for expectoration by the client;many are equipped with a water flush system&many have a disposable paper lining

•Cup filler Automatic water cup filler is activated by sensors when the disposable cup is empty

CLINICIAN’S CHAIR -Should have a broad,heavy base &be readily mobile with a minimum of five rolling casters to maneuver around the client’s head during care

-The seat of the chair should allow for adequate body support&be adjusted easily for proper heights so the clinician’s feet are flat on the floor with thighs parallel with the floor

-Too high chair position causes body weight to be supported by the spine,back &shoulders

-Too low position causes clinician to slump &sit with a curved spine

CORDS ON POWERED INSTRUMENTS Dental units are equipped with power –driven instruments &air/water syringes.These may be attached to the dental unit via:

Retractable cords-retract back into the dental unit to save space &avoid tangling

Curly cords-coiling characteristics allow cord to hang down a shortened distance&save space

Straight cords-straight,free hanging cord

Retractable &curly cords are encumbering and repetitive pulling motion increases fatigue &shoulder,arm muscle strain

A straight cord creates no tension while the clinician is using the motor driven instrument.

3)POSITIONING FACTORS*Wrist,arm,elbow &shoulder positionShoulders-held in the lowest,most relaxed position

Elbow-held close to clinician’s body at a 90degree angle

Arm-forearms held in the same plane as the wrist &hand

Wrist-should never be bent;it is held straight

*Back &neck support

- poor posture of the clinician results in uneven support of the spine &rupture of an intervertebral disc

*Head position

-aligned with the spine

-head is erect

*Eyes

-directed downward

-distance from eyes to client’s oral cavity is approximately 14-16inches

OPTIMAL OPERATOR POSITIONING*Position the head as upright as possible

*Ensure that the back is straight&supported by a back rest

*Keep elbows close to the body

*Keep thighs parallel to the floor

*Work from a neutral position

*Reposition the patient as necessary rather than reaching, leaning & bending for access

4)PERFORMANCE FACTORS*GRASP & FULCRUM

Fundamentals of grasp include holding the instruments firmly,maintaining a secure grip & maintaining control of the instrument without causing undue strain or fatigue to the clinician’s hand,arms &shoulders.

Modified pen graspPalm grasp

*FULCRUM &HAND STABILIZATION

-Fulcrum area on which the finger rests & against which it pushes while performing instrumentation.

-fulcrum provides a basis for steadiness &control during stroke activation

-utilization of a proper fulcrum &hand stabilization reduces RSIs

Intraoral fulcrum

-established by resting the pad of the ring finger (fulcrum finger)inside the mouth against a tooth surface

-pivoting on the fulcrum finger helps to maintain a firm grasp,stability &proper wrist motion

Extraoral fulcrum -positioned outside of the client’s mouth -decreased chance of RSI by offering clinician less cumbersome ways to instrument hard-to-reach areas of client’s mouth. when no fulcrum is used ,lateral pressure on the instrument during activation slipping of instrument. To stabilize the instrument & gain control,clinician will automatically tighten the grasp on the instrument.This places stress on hand&arm muscles,tendons,ligaments leading to increasedoccurence of RSI

•WRIST MOTION DURING INSTRUMENT ACTIVATION -Pivoting on the fulcrum causes hand,wrist & forearm to move in one unified motion called’’wrist rock’’.Failure to instrument using the unified motion causes clinician to extend or flex the wrist.This contribute to RSIs. -Use of digital motion(push/pull motion of instruments by utilizing only digits or fingers)during instrument activation contributes to RSIs

•APPOINTMENT MANAGEMENT -Alternate new clients with continued clients -alternate root debridement &therapeutic scaling with maintenance appointments -alternate difficult appointments with less tasking ones -allow for ‘’buffer time’’ in daily schedule

5)INSTRUMENT FACTORS*ERGONOMIC INSTRUMENT HANDLES

-larger in diameter&lighter in weight

-function of large diameter handles to open the grasp just enough to dissipate the mechanical forces over a large area of muscles

-alternate use of different hand muscle groups(while using instruments with several styles of handles) decreases the occurence of RSI

*BALANCED INSTRUMENTS

-means working end is centered over the long axis of the instrument handle -balanced instrument lateral pressure placed on instrument activation will be aimed toward the working end. -not balanced lateral pressure causes instrument to turn slightly in clinician’s fingers to compensate this clinician grasp instrument handle tighter RSI

*MECHANIZED INSTRUMENTS -Use of ultrasonic &sonic instruments reduces repitative hand instrumentation motions

*VIBRATING INSTRUMENTS -cause fatigue &hand,arm,shoulder muscle strain.

REPETITIVE STRAIN INJURIES

1)HAND,WRIST &FINGER INJURIES CARPAL TUNNEL SYNDROME-about 19-33% of the dentists report symptoms of CTS

-occurs when the median nerve become compressed within the carpal tunnel

-function of the median nerve is sensory&motor;it supplies sensation to the thumb,index finger,middle finger &half of the ring finger

-carpal bones of the wrist &transverse carpal ligament form the carpal tunnel.Inside the tunnel are 9 flexor tendons &median nerve

SYMPTOMS -Earliest sign numbness in the area supplied by median nerve -pain in the hand,wrist,shoulder,neck,lower back -nocturnal pain in the hand &forearm -pain in the hand while working -morning stiffness &numbness -loss of strength in hand;weakened grasp -cold fingers -increased fatigue in fingers, hand,wrist,forearm,shoulders

CHAIRSIDE PREVENTIVE MEASURES -Maintain good operator posture -neutral forearm &wrist position:avoid pinching the median nerve in the carpal tunnel -keep shoulders relaxed -use a unified motion(wrist,hand,forearm)during scaling&polishing;avoid flexion &extension of the wrist -avoid extremes in temperatures - limit exposure to vibrating instruments -avoid forceful pinching &gripping of instrument handles -wear properly fitting gloves -perform tendon gliding exercises

ASSESSING SYMPTOMS

-If symptoms are felt in the little finger &right half of the ring finger not CTS

2 TESTS:

•PHALEN’S TEST-place the back of the hands against each other.Hold flexed wrists together at a 90degree angle for 1minute.Subjective sensory changes will be felt within 1minute.Sensory changes indicate a +ve test.

•TINEL’S SIGN-entails tapping of the median nerve at the ventral side of the wrist.If nerve compression is present,sensation is felt in the fingers.The sensation could range from a tingling feeling to an electrical type shooting pain.

TREATMENTConservative treatment•Corticosteroid injections-to reduce inflammation•Iontophoresis-an electrical current delivery system of corticosteroid•Antiinflammatory medications &vitamins•Wearing a wrist brace during early stagesSurgical treatment•Transverse carpal ligament is cut to relieve pressure on the median nerve•New procedure-use an endoscope or small fiber optic camera &a procedure similar to traditional surgery except that no incision is made in the palm (a small incision is made in the wrist).

COMMON DRUG THERAPIES FOR CTS

•Anti inflammatory drugs

-naproxen sodium 550mg tablets

-prednisone 10mg tablets

-aspirin 325mg tablets

•Vitamins

-B6

•THORACIC OUTLET COMPRESSION -RSI resulting in compression of the brachial artery &plexus nerve trunk at the thoracic outlet -affects hand,wrist,arm &shoulder -compression of the neurovascular bundle (brachial plexus,subclavian artery,subclavian vein) results in decreased blood flow to the nerve functions of the arm -compression occurs at the neck where the scalene muscles create an outlet or tunnel.The nerves &bloodvessels run from the neck into the arm &hand.SYMPTOMS -Numbness &tingling along the side of the arms &hands

-neck &shoulder muscle spasms -weakness &clumsiness in the hand &fingers -coldness of the extremities -absence of radial pulseRISK FACTORS -Poor posture -tilting of the head too much -hunching of the shoulders -positioning dental chair too high

TEATMENT•Initially-physical therapy,strengthening of shoulder muscles,posture retraining exercises•Surgery-directed at reducing source of compression

CHAIR SIDE PREVENTIVE MESURES -Maintain proper clinician positions:head erect,back straight,shoulders in neutral position -proper height of the dental chair&client positioningASSESSING SYMPTOMS -signs relate to both decreased motor function(nerve compression)&arterial symptoms(decrease blood flow).

•SURGICAL GLOVE INJURY -ill fitting gloves contribute to thisSYMPTOMS -Commonly mistaken for CTS &TOC because of similar symptoms -tingling in the fingers -cold extremities -loss of muscle control &hand strength -numbness or pain in fingers

RISK FACTORS-wearing gloves too tight-compromises proper circulation to clinician’s hands &fingers-wrist is also at a risk if additional pressure is placed on the carpal tunnel by a glove that is too tight across the wrist.-wearing gloves too loose-cause clinician to grasp the instrument handle tighter to compensate for the feeling of lack of control.CHAIR SIDE PREVENTIVE MEASURES-Wear properly fitting gloves-do tendon gliding exercices &stretch the hand &fingers

ASSESSING SYMPTOMS If symptoms arrest when gloves are taken off or when different gloves are worn SGITREATMENT -Wear properly fitting gloves -if pressure to the wrist &compression of the median nerve in the carpal tunnel continue treatment as seen in CTS.

•GUYON’S CANAL SYNDROME-caused by ulnar nerve entrapment at the wrist.-this syndrome differs from CTS in that the ulnar nerve does not pass through the carpal tunnel.It passes through a tunnel formed by the pisiform &hamate bones&the ligaments that connect them.SYMPTOMS -Numbness &tingling in the little finger &the right side of the ring finger -loss of strength in the lower forearm -loss of movement of the small muscles in the hand -clumsiness of the hand

RISK FACTORS -Holding the little finger a full span away from the hand &fulcrum finger causes nerve entrapment &symptoms of GCS.CHAIRSIDE PREVENTIVE MEASURES -Repositioning of the little finger while scaling &polishing -periodic hand stretchesASSESSING SYMPTOMS -affect little finger &half of the ring finger

TREATMENTConservative treatment -hand strengthening exercises -wearing a hand/wrist splint at night to decrease pinching of the ulnar nerve -antiinflammatory medicationsSurgery -relieve ulnar nerve entrapment -cutting of the guyon’s canal is completed

•TRIGGER FINGER NERVE SYNDROME -Affects the movement of the tendons as the fingers &thumb are bent and moved. -inflamed tendons &tendon sheaths,thickened tenosynovium Nodule formation (from constant irritation of pulling the tendon)-as finger is flexed,nodule passes under the ligament &becomes stuck.finger cannot be extended back to its original positionSYMPTOMS -Inability to extend the fingers or thumb after they are flexed.

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RISK FACTORS -Repititive use of fingers &hands -digital motion during instrumentation -pinching the instrument handleCHAIRSIDE PREVENTIVE MEASURES -Minimizing finger motion&utilization of proper grasp, fulcrum &unified motion of the hand,wrist,forearm -grasp the instrument handle using the pads of the fingers &thumb instead of pinching with the tips of the fingersASSESSING SYMPTOMS When a nodule forms on the tendons of the fingers or thumb,a palpable click will be felt as the nodule snaps under the finger pulley

TREATMENTInitial treatment with corticosteroids-reduce inflammation& shrink the nodule to relieve triggeringSurgery- a small incision made in the palm to locate the pulley in question, it is cut

•DE QUERVAIN’S SYNDROME -inflammation of the tendons &tendon sheaths at the base of the thumb or ‘’anatomic snuff box’’SYMPTOMS -Aching &weakness of the thumb(along the base) -pain migrating into the forearmRISK FACTORS -repetitive ulnar deviation of the wrist while reaching for instruments or during instrumentation -twisting &bending the wrist in an ulnar direction -using a forceful grip on the instrument handle

CHAIR SIDE PREVENTIVE MEASURES -Avoid ulnar wrist deviation during instrumentation -eliminate twisting of the wrist when reaching for instruments -maintain a neutral wrist position &unified motion during dental care proceduresASSESSING SYMPTOMS Finkelstein’s test-bend the thumb into palm of the hand.Grasp the thumb with 4 fingers. Place the wrist in the ulnar deviation position by bending the wrist toward little finger. Pain over the tendons &tendon sheaths at the base of the thumb indicates the syndrome.

TREATMENT•Milder cases-anti inflammatory medication, immobilization of the wrist, a wrist splint, or ergonomic adjustments to the work environment. •When simple measures fail-corticosteroid injections, progressive physical &occupational therapy •Severe/chronic cases-surgery(relieving pressure on the tendon)

2)ELBOW &FOREARM INJURIES• STRAINED PRONATOR MUSCLE -muscle involved in SPM is an elongated narrow pronator

muscle in the forearm flexor of the elbow joint. -caused by compression of the median nerve as it passes

under the pronator muscle. The pronator muscle wraps around the anterior aspect of the elbow.

SYMPTOMS

-Similar to those of CTS

RISK FACTORS -Repetitive &constant holding of the arms away from the

body with the palm &thumb side of the hand rotated downward during instrumentation

CHAIR SIDE PREVENTIVE MEASURES -Maintain neutral arm position: hold the arms close to the

body -maintain neutral wrist position -avoid rotation &twisting of the forearm

ASSESSING SYMPTOMS -Phanel’s&Tinel’s test-rule out CTSTREATMENT -anti-inflammatory medication -corticosteroid injections -environmental changes in work place

•LATERAL EPICONDYLITIS -Known as tennis elbow, a degenerative disorder of the elbow -resulting from inflammation of the wrist extensor tendons on the lateral epicondyle of the elbow.SYMPTOMS -Aching or pain in the elbow - sharp shooting pain during elbow extensionRISK FACTORS -Repetitive &constant use of a forceful grip or grasp -forceful wrist &elbow movements

CHAIR SIDE PREVENTIVE MEASURES -Maintain neutral wrist position during instrumentation - utilize proper clinician positions ASSESSING SYMPTOMS -palpation of the wrist extensor muscles at the lateral epicondyle of the elbow during resisted wrist extension. Pain during this may indicate LE TREATMENT -rest -use of anti-inflammatory medications -alterations in the work environment -a wrist splint to eliminate wrist extension -physical therapy -corticosteroid injections

•RADIAL TUNNEL SYNDROME -A condition affecting the radial nerve as it is entrapped in the radial tunnel SYMPTOMS -pain at the lateral side of the elbow when the arm &elbow are being used CHAIR SIDE PREVENTIVE MEASURES -maintaining proper wrist position &motion ASSESSING SYMPTOMS -often mistaken for LE -electrical tests must be performed on radial nerve -history must be assessed TREATMENT -rest -anti-inflammatory medication -surgery to relieve tension &pressure on radial nerve

CUBITAL TUNNEL SYNDROME-condition affecting the ulnar nerve as it crosses behind the elbow

-when the elbow is bent, the nerve is pulled up between bones causing compression & entrappment of the ulnar nerve

SYMPTOMS

Pain & numbness in the outer side of the ring finger & little fingerPain sometimes relieved when the elbow is straightened

-alter instrument grasps

-Avoid prolonged use of palm grasp

-Avoid leaning on the elbow when sitting at a table

ASSESSING SYMPTOMS

Pain or numbness usually disappear while straightening the elbow

RISK FACTORS

Prolonged gripping or grasping of instruments in the palm of hands

Holding the elbow in a flexed position during procedures

CHAIR SIDE PREVENTIVE MEASURES

-maintain a neutral elbow position

TREATMENT

Physical & occupational therapy

Anti inflammatory medications

Use of an elbow extension splint

Surgery- creates a new cubital tunnel for ulnar nerve

3)SHOULDER INJURIES

TRAPEZIUS MYALGIACaused by static loading in the shoulder or stabilizing muscles over a long period of time

SYMPTOMS

Pain & tenderness in the descending part of the trapezius muscle

RISK FACTORS

Long dental procedures which cause clinician to remain in one position for too long

CHAIR SIDE PREVENTIVE MEASURES

Manage appointment times

Take break during long procedures

Change body positions

ASSESSING SYMPTOMS

Consistent pain & tenderness in the area of trapezius muscle

TREATMENT

Rest

Physical therapy

Stretching exercises

Massage

ROTATOR CUFF INJURIES

Include rotator cuff tendinitis & rotator cuff tears

Both affect the connective tissue in the shoulder & both are common causes for pain in the shoulder

SYMPTOMS

Pain when lifting the arm 60-90°

Functional impairmentRISK FACTORS

Static loading on the shoulder muscle

Improper body support

TREATMENT Active rehabilitation partnered with corticosteroid injections & anti inflammatory medications -Surgery

CHAIR SIDE PREVENTIVE MEASURES

Avoid repetitive twisting & reaching for dental instruments

Maintain neutral shoulder & arm positions

ASSESSING SYMPTOMS

Constant pain in shoulders & increasd pain when raising the arms

MRI & further medical testing

ADHESIVE CAPSULITIS-frozen shoulder

-results from immobility of the shoulder due to severe injury to shoulder or repeated occurrence of rotator cuff tendonitis

SYMPTOMS

-Pain in shoulders

-limited range of motion of the shoulder

CHAIR SIDE PREVENTIVE MEASURES

-avoid repetitive twisting &reaching for instruments

-maintain proper shoulder &arm positions

ASSESSING SYMPTOMS

-limited range of motion &constant pain in shoulder during lifting of the arms along with history of rotator cuff tendonitis

TREATMENT

-physical therapy

-anti inflammatory drugs

-heat/ice regimens

-noninvasive treatment of forced shoulder movement with use of general anesthetic if therapy fails

NECK &BACK INJURIESLUMBAR JOINT DYSFUNCTION-occurs from repetitive &continued twisting and rotating of the spine

-improper support of spine

intervertebral discs are put under tremendous pressure

injury

SYMPTOMS

-discomfort &pain in the lumbar region of the spine

RISK FACTOR

-Too much rotation of the midsection of the body create strain on the lumbar curve

TREATMENT-rest-workplace adjustments-physical therapy-drug therapy-surgery

CHAIR SIDE PREVENTIVE MEASURES

-Avoid twisting the back &spine

-properly support body weight

-modified equipment placement to avoid twisting to reach instruments

ASSESSING SYMPTOMS

-constant lower back pain

-limited movement of back &spine

TENSION NECK SYNDROME-tension myalgia

-involves the cervical muscles of the trapezius muscle

SYMPTOMS

-pain or stiffness around the cervical spine in the neck

-pain between the shoulder blades; pain may also radiate down the arms

-muscle tightness &tenderness in neck

-limited neck movement

RISK FACTORS

-improper positioning of clinician’s head &neck during procedures

-bending of neck result in pressure &stress on cervical spine

CHAIR SIDE PREVENTIVE MEASURES

-maintain proper clinician head &neck position to support neck &spine

-maintain proper height of dental chair

-support weight of the head properly over the entire spine not just with cervical portion of the spine

-keep the back straight during procedures

-periodic breaks &stretching exercises

ASSESSING SYMPTOMS-If limited neck motion with pain &discomfortTREATMENT -Physical therapy -stretching exercises -massage therapy -ultrasonic &electrical muscle stimulation to increase blood flow

CERVICAL SPONDYLOSIS &CERVICAL DISC DISEASE - lead to degeneration of the cervical spine -affect the neck, scapula, shoulders, arms causing osteoarthritis of cervical spine &disc degeneration.SYMPTOMS -stiffness &limited motion of neck -crepitus during active or passive movements of neck -pain in the upper/middle cervical region of spine -pain in scapula of shoulder regions -muscle spasmsRISK FACTORS -repeated stress &strain placed on the neck &cervical spine

CHAIR SIDE PREVENTIVE MEASURES -maintain proper head &neck position during instrumentation -properly seat clients for easy access to the mouthASSESSING SYMPTOMS -monitor occurrence of pain during neck motion & crepitus in the cervical spineTREATMENT -posture retraining exercises -strengthening exercises for neck &back muscles -rest -anti-inflammatory drugs -cervical collar -physical therapy

MUSCLE STRENGTHENING EXERCISESHelp keep the muscles strong &healthy

To warm the muscles &joints of your hands, slowly open &close your hands which ends with your fingers tucked into your palm, also press your palms together &then relax them.

Hold one arm out in front of your body with your hand extended. With fingers of other hand gently pull back extended fingers to increase the stretch

To relieve eye strain look up &focus eyes at a distance for about 20 seconds

Head rotations for neck stiffness

Shoulder shrugging-pull shoulders up toward ears & then roll them backward &forward in a circular motion.

EYE TO THE FUTURE

To enjoy a healthy and pain free career, you must keep your muscles, tendons, nerves, joints healthy. Remember to apply ergonomic principles in all of your daily activities. Do not ignore early signals of pain and stiffness. The longer the symptoms are ignored, the more severe the damage. Dentistry can be a physically stressful profession, but it is also a very rewarding profession that benefits both practitioners and patients.

CONCLUSIONBegin to make some changes in the way you practice by incorporating some of these suggestions into your regular routine during the work day. You will find that you have less fatigue at the end of the day, experience less pain and you will be able to provide the quality of service that you and your patients demand.

REFERENCE•Dental hygiene theory and practice- Darby & Walsh

•Modern dental assisting- Doni.L.Bird & Debbie.S.Robinson

•Internet([email protected])

THANK YOU…