Thanks for another article on carpal tunnel syndrome (Dr. Curt Hamann and colleagues, "Prevalence of Carpal Tunnel Syndrome and Median Mononeuropathy Among Dentists" February JADA). Unfortunately, the article did not leave me with a lot of new information or new modes of diagnostic testing.
A couple things concern me about the diagnosis and treatment of carpal tunnel syndrome, or CTS.
I see more young people with CTS who are not necessarily in the high-risk categories.
I have seen some carpal tunnel surgeries that have been only moderately successful.
I see more middle-aged and older dental health care professionals who have neck, back and nerve impingement problems.
I notice a drop-off in the overall physical fitness of middle-aged and older health care providers.
Current articles dealing with CTS often deal with diagnostic testing of neuroanatomy and muscular anatomy from the "elbow to the fingers."
After having many of the CTS symptoms myself and going through some diagnostic testing, I’ve come to realize that "medianulnar" neuropathy may be the result of any impingement along the neural "route." Most vulnerable areas include, but are not limited to, C-4 through C-7 vertebrae, shoulder area, elbow and carpal tunnel area.
My suspicion is that most impingement occurs at the cervical level. Years of postural positioning and compromised neuromuscular activity causes alteration of cervical vertebrae positioning, disk changes, vertical collapse and eventual impingement. I’m not surprised that most dentists in the study diagnosed with neuropathy tended to be older.
I would like to see a long-term electromyographic study of those back-neck muscle groups on functioning dentists, magnetic resonance imaging comparisons of vertebrae and disk repositioning and vertebral videofluoroscopy. Some of the research by Stuart M. McGill on the faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Ontario, Canada, has proven to be most interesting.
Together with that input, dentistry might get some better preventive advice as to muscle-specific physical therapy, preventive exercise regimes and better postural protocols to help prevent some CTS, as well as some upper and lower back maladies.
