OCCUPATIONAL HAZARDS FOR DENTISTS

[Drsumitra]

Traction Devices
Caution should be taken when applying traction to any newly injured area, and is should not be performed in these cases unless specifically recommended by your doctor. Lumbar (low back) traction can be accomplished through various products which keep the pelvis stationary while using gravity to force separation of the vertebrae and thereby open the spinal canals that the nerves exit through. However, the multifidous muscle which attaches to the lumbar vertebrae may not allow the separation of the vertebrae if the muscle is in too much spasm. Some types of traction allow for better separation when the multifidous muscle is in spasm. One such type of traction is performed by doctors of chiropractic through applying pressure manually to the spine while a flexing table tractions the spine in a downward motion. In the earlier stages, light traction can provide an unloading of the spine, thereby releasing the nerve pressure between each segment created from a decrease in circulation and an increase of inflammation within the joint space. In later stages, traction combined with body movement may also help to break up scar tissue build up between the joints. When the muscles are in too much spasm to allow for this type of traction, upright types of traction units can enable a person to move their body during the therapy to avoid further muscle spasm, while providing a relieving therapy to the spine. Home traction units may be beneficial, but caution should be taken not to apply too much traction too quickly to the back, as this may initiate a spasm to the surrounding musculature. Therefore, only traction units which can gradually increase the separating of the vertebrae and allow unloading of the spine without reaching too much drastic pull would be recommended.

        

[Drsumitra]

Ultrasound
Ultrasound is an extremely effective way to stimulate proper tissue healing. Sound waves are generated from a crystal vibrating inside the head of the ultrasound wand and then transmitted through sound conducting gel to the tissue. This allows the sound waves to break down unwanted scar tissue, increase circulation to the area, and help relax the musculature. This can be extremely beneficial in the case where the Myofascial Pain Syndrome has caused soft tissue irritation to the back. Ultrasound can only be used in the presence of a licensed health practitioner.

Ice Packs
Ice can be used in the initial 72 hours of an injury to reduce inflammation and numb the pain associated with Myofascial Pain Syndrome. One potential problem with ice is that temporarily it will tighten the musculature even more. Also it should be noted that ice should not be used for longer than 20 minutes to an area, as it will cause a reversal reaction which will allow the tissue to become more inflamed. For low back inflammation we recommend using a combined brace and ice gel pad to put a more firm pressure over the irritated area. This will also provide support over the injured area while providing ice therapy. Patients we surveyed feel that the brace and ice gel pad combination below works extremely well (see Soft Back Brace section for more information on bracing).

Hot Packs
Hot packs are useful for increasing circulation and thereby loosening up the muscle tissue. Waiting to use heat therapy until three days after the onset of when the initial irritation of the Myofascial Pain Syndrom first occurred will give the swelling a chance to go down, as heat increases the inflammation to the area. It is believed that moist heat is better than dry, as there is less possibility for dehydration to the musculature. We found a simple to use moist heat pack (depicted below) which contains beads that activate upon being heated up in a microwave to give off moist steam without adding water. This occurs from a natural process by which the beads retain moisture from the air. The ease of use, combined with the comfort of this product, make it a very popular therapy with the patients we survey

        

[Drsumitra]

Humans exposed to amalgam prenatally won’t suffer major health problems from the amalgam, according to a new study.

The study indicated that there were some detectable effects, however. Boys appeared to be adversely impacted while girls benefitted. These results appear to be coincidental because mercury isn’t beneficial to any human.

This study appeared in the November issue of the Journal of the American Dental Association.

The effects from mercury are compounded with children and fetuses because their brains are still in the process of developing.

There have been few studies done regarding this topic, according to the United States Food and Drug Administration. This study was only one section of comprehensive research analyzing prenatal mercury contact in the Seychelles Islands. The study indicated that eating fish did little, if any, harm to humans.

The data came from nearly 800 mothers in the Seychelles Islands. The babies began to be part of the research at 6 months old in 1989 and 1990. The mothers were given 12 fish meals each week. The children were then part of the study through age 19.

There were 711 children still part of the study when they were 66 months old. It was not difficult to analyze the dental history of the mothers, since dental coverage is free in the Seychelles Islands.

The researchers didn’t know everything they needed to know about the mothers’ dental history, however. They projected an upper and lower limit for amalgam exposure of each mother. They also looked at the dentition of the mothers 10 years after birth.

The research team studied many different factors of each child. They also weighed the outcomes based on all of these factors.

There was nothing significant found that would state that there was a correlation between amalgam surfaces and any of the possible outcomes. But there was a correlation between the sex of the child and the lower exposure limit of amalgam.

Despite the information that prenatal amalgam exposure doesn’t have a major impact on children, mothers would still be best served to hold off on amalgam restorations until their child is born.

        

[drmithila]

 The liabilities and risks that dentists face regarding infection control for both staff and patients extend beyond financial ramifications. For infection control lapses involving patients, there is the possible violation of state dental board regulations, which can result in fines and license suspensions for serious violations. For infection control lapses involving employees, there is the risk of OSHA violations, which also carry fines and penalties. In addition, civil liabilities can occur when an illness, or the serious risk of illness, to either patients or employees occurs. Lawsuits have resulted from issues involving needlesticks, dental unit waterlines, improper sterilization, etc.

“Ambulatory healthcare, including dentistry, is currently a center of attention for infection prevention in the United States. One article reported more than 30 major infection prevention breaches in ambulatory centers during the last 10 years,” OSAP says. “A few cases have been so significant in scale and egregious behavior that several states are considering making infection prevention malfeasants not just a tort issue, but also a criminal violation.”

To avoid infection control risks and liabilities, OSAP emphasizes that knowledge and communication are the best defenses. Dentists who ensure both they and their staff are aware of the Centers for Disease Control and Prevention guidelines, and state and federal regulations, are acting in a responsible manner. Regular training in infection control for all personnel, including the dentist, should be documented. Attendance as a team at such infection control CE courses as the OSAP Annual Infection Prevention Symposium should be followed by discussions in a staff meeting about what was learned in the course.

“All staff members must be aware of their facility’s infection prevention program. Progressive offices make it a point to actively involve office personnel (including input) in their facilities’ programs, often through regular office meetings,” OSAP emphasizes. “Patients must be aware of the activities performed by the office. Communication about infection prevention between office and patients, and among office personnel, is essential.”

        

[drmithila]

 According to the Organization for Safety, Asepsis and Prevention (OSAP), during the mid-1990s, when the case of the Florida dentist who infected six patients with HIV became national news, there was public outcry (and subsequent legislation) to require certain precautions be taken to prevent disease transmission. Patient awareness and fear of infection, along with the late 1980’s uncertainty about the exact modes of HIV transmission, drove dental professionals to adopt universal precautions and begin considering all blood and certain body fluids as potentially harboring bloodborne viruses. Later, these expanded into standard precautions, which encompass all body fluids (with the exception of sweat) and all infectious diseases—not just bloodborne viruses.

“This changed the standard of care, and dental professionals who did not adopt these changes exposed themselves to potential liability if a patient or employee contracted or suspected they contracted an illness in the dental office,” explains the nonprofit association. “For the last five years, major infection prevention groups have refined their emphases, including a shift from the term ‘infection control’ to ‘infection prevention.’ Control indicates a reduction in numbers of cases, while prevention means elimination—‘zero tolerance.’”

        

[Drsumitra]

Hepatitis B is a highly-infectious disease which is caused by the hepatitis B virus (HBV); hepatitis B affects a person’s liver and causes an inflammation (which is called “hepatitis”). A person can be protected from serious complications that can result from hepatitis B by a hepatitis B vaccine; this vaccine can save a person from potentially fatal hepatitis B complications like liver cirrhosis and liver cancer.

Patients with hepatitis B or even hepatitis B symptoms should inform their dentist of their condition when going in for a dental appointment; informing the dentist of the presence of hepatitis B is even more important when a dental procedure or surgery needs to be done, because the dentist would have to take extra precautionary measures for both the patient and for himself.

The infectious nature of hepatitis B would require the dentist to be extra careful when doing dental treatments and procedures on the patient, who in turn would have to get his or her physician’s go-signal before undergoing any dental procedure. This is Dentistry can give you access to the contact information of dentists in your local area, who are experienced and qualified to deal with the dental concerns of hepatitis B patients.

Hepatitis B Symptoms
Hepatitis B can start with the following symptoms, which, when experienced on their own, may not alarm the patient. However, when seen together, these hepatitis B symptoms can be very clear warning signs of trouble.

A general feeling of ill health
Body aches
Nausea
Vomiting
Mild Fever
Dark urine
Appetite loss
Development of jaundice
Hepatitis B Prevention
The only known and proven way to prevent a patient from getting hepatitis B is to get the hepatitis B vaccine. Avoiding the risk factors listed below can also greatly reduce the possibility of getting infected with the hepatitis B virus.

Sexual contact with persons infected with hepatitis B
Unprotected sex with multiple partners
Using the same needle used by other patients for injections
Exchange of body fluids with patients suffering from hepatitis B
Patients with hepatitis B should consult their physician before having any dental procedure done – this is for the safety of both the patient AND the dentist who will do the necessary procedures. This is Dentistry will guide you in finding a competent and experienced dentist in your local area, who can expertly give you the dental care you need

 

        

[Drsumitra]

The practice of dentistry is demanding and stressful.Dental procedures can be carried out both in sitting and standing positions.Physical problems may arise if appropriate working position is neglected.Three important things should be taken care of before starting a dental procedure are :-

a)Dental chair position

b)Patient position

c)Operator (Dentist)position

 

 

Dental chair position
Modern dental chairs are designed to provide total body support.Chair design and adjustment permit maximal operator access to the work area.

The adjustment control switches should be conveniently located.To improve infection control,chairs with foot switch for patient positioning are recommended.

The patient should have direct access to the chair.The chair should be low, the back rest upright and the arm rest adjusted to allow the patient to get into the chair.

After the patient is seated, the arm rest is returned to its normal position.The headrest cushion is positioned to support the head and elevate the chin slightly away from chest so that neck muscle strain is minimal and swallowing is facilitated.The chair is then adjusted to place the patient in a reclining position.

The patient in a comfortable position is more relaxed and more capable of co -operating with the dentist.

 

Patient position
The common patient positions in dentistry are

1) Supine position

2)Reclined position

3)Upright position

The choice of the patient position varies with the operator, type of procedure,area of mouth involved.

In supine position the patient’s head knees and feet should be approximately at the same level.

In general,Head should not be lower than feet.But only in emergency conditions like Syncope,Patient’s head should be positioned lower than the feet.

After completing the procedure,chair should be placed in upright position.So that patient can leave the chair easily and gracefully, preventing undue stress or loss of balance.

upright and recline position on top supine and emergency position bottom
Operating position
Proper operating positions and good posture reduce fatigue and physical strain and possibility of developing musculo- skeletal disorders.

Most dental procedures can be accomplished while seated.Unnecessary curvature of the spine or slumping of should be avoided.Back and chest are held in upright position with the shoulders squared which promotes proper breathing and circulation.

Proper balance and weight distribution on both feet is essential when operating in a standing position.

Operating positions may be described by the location of the operator or by the location of the operators arm in relation to patient position.

For a right handed operator there are essentially 3 positions.They are RIGHT FRONT, RIGHT AND RIGHT REAR positions.These are sometimes referred as 7-,9-,and 11-o’clock positions,respectively.

7,9,11 indicate dentist position and 12 indicate patient position
For a left handed operator LEFT FRONT ,LEFT AND LEFT REAR positions.these are referred as 5-,3-,and 1-o’clock positions, respectively.

There is another position called DIRECT REAR position in which operator is located directly behind the patient and looks down over the patient’s head.

Proper seating of the patient ,operator, assistant and working position enhance providing the dental treatment without an unnecessary decline in efficiency and productivity because muscle tension and fatigue

 

        

[drmithila]

Alternative materials to amalgam for fillings may have less negative impact on human health and the environment, according to a recently published report. The Health Care Research Collaborative report compared mercury-based dental fillings with alternatives currently available in the U.S. and found that the effects of mercury outweigh the known effects of resin-based composites and glass ionomer fillings.
"We found no evidence of a negative effect on patients’ health from either mercury amalgam or the alternatives used in restoration. Yet the alternatives were less hazardous to the general environment and the public’s health," said Dr. Peter Orris, co-author of the report and professor of occupational and environmental health sciences.

On the basis of the current findings, mercury dental amalgam use contributes significantly to the environmental mercury burden and damages fetal neurological development during pregnancy, according to the investigators.

According to the report, dental offices were the source of 50 percent of all mercury pollution in 2003. In addition, the Environmental Protection Agency estimates that approximately 122,000 dental offices discharge about 3.7 tons of mercury each year.

"Unlike dental amalgam, environmental releases of constituents found in resin-based alternatives are expected to be very small, except in very special circumstances. Thus, exposure to resin-based alternative materials is expected to be, mostly, limited to patients and their dental care providers," the report concludes.

The report recommends "a phase-out of virtually all usage of dental mercury," which "must take into account the practical availability of alternative materials, the equipment needed to utilize non-mercury alternatives, the training of dentists to utilize these alternatives, and the costs to the patient and society."

It further highlights that the use of alternative products is growing and some countries, such as Denmark, Sweden and Norway, have banned amalgam already, except for specific individual cases.

The research collaborative was initiated by the University of Illinois, the Healthier Hospitals Initiative and Health Care Without Harm.

The report was published on June 13 on Health Care Without Harm’s website under the title "Mercury in Dental Amalgam and Resin-Based Alternatives: A Comparative Health Risk Evaluation."

Health Care Without Harm is an international nonprofit association that promotes environmental responsibility in health care. It is coordinated by the University of Illinois at Chicago’s School of Public Health.

 

        

[Drsumitra]

A physician, a nurse, and a dentist have joined forces to create a series of seminars aimed at getting dentists and physicians to better understand the need for a collaborative approach to screening patients at risk of heart disease, diabetes, and stroke.

Dr. Bale and Doneen, developers of the Bale/Doneen method of cardiovascular disease (CVD) prevention, have long advocated the importance of using a systematic approach to reduce the incidence of CVD. They and Dr. Nabors, who founded OralDNA, worried that the AHA’s conclusions could mislead the medical and dental communities, as well as the general public.

"There is indisputable, level A evidence that periodontal disease is independently associated with CVD risk, and the AHA paper certainly stated that," Dr. Bale told DrBicuspid.com.

In fact, given the science presented in the AHA article, coupled with the burden CVD places on society, "we cannot afford to wait for the acquisition of causality data to incorporate assessing and treating periodontal disease in an effort to minimize CVD risk," he, Dr. Nabors, and Doneen wrote in their white paper.

Now they are working to bring dentists and physicians together to promote collaborative care of patients at risk of CVD through a series of continuing education (CE) courses that emphasize the oral/systemic link and its impact on the risk of heart attacks, stroke, and diabetes. Their first seminar, "Vascular inflammation: The oral/systemic connection," will take place November 2 in Las Vegas.

"One of our goals is to bring dentists and physicians together in the new understanding of how inflammation works and why these two groups can influence systemic inflammation by reducing known biomarkers known to create high risk," Dr. Nabors told DrBicuspid.com. "Dentists and dental hygienists can be a significant influence of prevention or effective treatment in the oral connection to vascular inflammation."

Doneen and Dr. Bale already give similar courses to physicians, and two years ago began inviting dentists to attend as well, he noted.

"Our course is designed to spur collaboration between the dental and medical communities to help reduce the horrible morbidity and mortality of CVD," Dr. Bale said. "We have this level of evidence telling us that periodontal disease is independently associated with the risk of CVD, so any program designed to minimize that risk has to take into account perio disease. Which means we need to work out better ways for the two disciplines to interact and collaborate to get better results."

Doneen agreed.

"We know that if we want to reduce the occurrence, we need to learn how to bridge that gap," she said. "It is critical to disseminate the science behind the relationship [between CVD and perio disease] and get both sides to understand the link. "The dental community needs to know how to communicate with the medical community, and vice versa."

While many physicians may not fully understand periodontal disease and its causes and effects, they do understand clinical testing and see value in periodontal tests performed in conjunction with urine and other tests to determine a patient’s risk of CVD, Dr. Nabors noted.

"What Dr. Bale and I spent the last decade doing is focusing on CVD, particularly prevention," Doneen said. "Our focus is on the health of the arterial system, which has huge systemic implications, and dentists play an important role in this, as do cardiologists and rheumatologists. The current system is focused on treating end-stage disease. What about backing up the train 20 years and realizing the body is developing issues and work together to help slow or even stop this process?"

The Bale/Doneen/Nabors courses are unique because they will focus on the information that both physicians and dentists need to understand in order to work together, such as the types of lab tests physicians typically used to evaluate CVD risk and the science behind the perio/heart disease link, Dr. Bale noted. There will also be mock patient visits to help medical providers understand their role in periodontal assessments and help dental providers understand how to communicate with patients and physicians about CVD risks.

If dentists are taught the right questions to ask and what to look for, and then relate that information to the patient and physician, they can become screeners for diabetes, heart disease, and stroke, Dr. Nabors added.

"That is a huge change in the potential level of responsibility that dentists can have for patient care," he said. "And in our opinion this couldn’t be more exciting."

 

        

[Drsumitra]

Removing amalgam fillings from patients with a history of health complaints dramatically reduced the number of complaints, according to a small study in Acta Odontologica Scandinavica (July 2, 2012).
“Some patients attribute health complaints to amalgam fillings and report improvement of health after replacement of amalgam fillings,” wrote the study authors, from Uni Research in Norway. “The aim of the present study was to characterize the changes of different health complaints after replacement of amalgam fillings and compare with an external reference group from the general population.”

 

        

[Drsumitra]

Herpes simplex is a common viral infection that presents with localised blistering. It affects most people on one or more occasions during their lives.

There are two main types of herpes simplex virus (HSV), although there is considerable overlap.

Type 1, which is mainly associated with facial infections (cold sores or fever blisters)
Type 2, which is mainly genital (genital herpes)
Both type 1 and type 2 herpes simplex viruses reside in a latent state in the nerves which supply sensation to the skin. During an attack, the virus grows down the nerves and out into the skin or mucous membranes where it multiplies, causing the clinical lesion. After each attack it ‘dies back’ up the nerve fibre and enters the resting state again.

First or primary attacks of Type 1 infections occur mainly in infants and young children, which are usually mild or subclinical. In crowded, underdeveloped areas of the world up to 100% of children have been infected by the age of 5. In higher socioeconomic groups the incidence is lower, for example less than half of university entrants in Britain have been infected.

Type 2 infections occur mainly after puberty, often transmitted sexually. The initial infection more commonly causes symptoms.

How do you get the infection?

The infection can be passed on from someone else with an active infection and it can also be passed on from individuals without symptoms.

The virus is shed in saliva and genital secretions, during a clinical attack and for some days or weeks afterwards. The amount shed from active lesions is 100 to 1000 times greater than when it is inactive. Spread is by direct contact with infected secretions.

Minor injury helps inoculate the virus into the skin. The virus can be inoculated into any body site to cause a new infection, whether or not there has been a previous infection of either type. The source of the virus may be from elsewhere on the body especially in nail biters or thumb suckers. Herpes simplex can also be inoculated from external sources. Examples include:

Nailfold infection in a health-care worker (‘herpetic whitlow’)
Facial blisters in a rugby player (‘scrum pox’)
Suckling infant with mouth sores
Following the initial infection immunity develops but does not fully protect against further attacks. However where immunity is deficient, both initial and recurrent infections tend to occur more frequently and to be more pronounced and persistent.

Primary herpes simplex

Primary infections may be mild and unnoticed, but they are often more severe than recurrences. Initial infections with Type 2 virus are generally more marked than with Type 1 virus.

Herpetic gingivostomatitis
Herpetic gingivostomatitis (mouth infection) is the most common clinical manifestation of primary Type 1 infection. Most cases occur in children between the 1 and 5 years of age.

After an incubation period of 4 to 5 days the symptoms begin with fever, which may be high, restlessness and excessive dribbling. Drinking and eating are painful and the breath is foul. The gums are swollen and red and bleed easily. Vesicles (little blisters) occur in white patches on the tongue, throat, palate and insides of the cheeks. The white patches are followed by ulcers with a yellowish coating. The local lymph glands are enlarged and tender.

The fever subsides after 3-5 days and recovery is usually complete within 2 weeks.

Genital herpes
Infection with Type 2 HSV occurs after the onset of sexual activity and results in genital herpes. Penile ulceration from herpetic infection is the most frequent cause of genital ulceration seen in sexual health clinics. The ulcers are most frequent on the glans, foreskin and shaft of the penis. They are sore or painful and last for 2 to 3 weeks if untreated.

In the female, similar lesions occur on the external genitalia and the mucosae of the vulva, vagina and cervix. Pain and difficulty passing urine are common. Infection of the cervix may progress to a severe ulceration.

Recurrent herpes simplex

After the initial infection, whether obvious or inapparent, there may be no further clinical manifestations throughout life. Recurrences are more frequent with Type 2 genital herpes than with Type 1 oral herpes.

Recurrences can be triggered by:

Minor trauma to the affected area
Other infections including minor upper respiratory tract infections
Ultraviolet radiation (sun exposure)
Hormonal factors (in women, flares are not uncommon prior to menstruation)
Emotional stress
Operations or procedures performed on the face
Dental surgery
In many cases no reason for the eruption is evident.

Recurrent infections differ from first infections in the smaller size of the vesicles and their close grouping. Recurrences of Type 1 infection can occur on any site but they are most frequently on the face, particularly on the lips (‘herpes simplex labialis’). They do not usually result in blisters inside the mouth. Recurrences of Type 2 infection may also occur on any site but most often affect the genitals or buttocks. Recurrent HSV tends to always affect the same region, but not necessarily the identical site.

Itching or burning is followed an hour or two later by small, closely grouped vesicles on a red base. They normally heal in 7-10 days without scarring. Generally the affected person feels quite well but they may suffer from fever, pain and have enlarged lymph nodes nearby.

Although the vesicles usually form an irregular cluster, they may be arranged in a line rather like shingles (zosteriform distribution), particularly when affecting the lower chest or lumbar region.

White patches or scars may occur at the site of recurrent HSV attacks, which may be more obvious in those with brown skin.

Complications

Eye infection
Herpes simplex may cause swollen eyelids and conjunctivitis with opacity and superficial ulceration of the cornea (dendritic ulcer). The lymph gland in front of the ear is often enlarged and tender.
Throat infection
Throat infections may be very painful.
Eczema herpeticum
HSV in patients with atopic dermatitis or Darier disease may result in a severe rash known as eczema herpeticum. Numerous blisters and scabs erupt on the face or elsewhere, associated with swollen lymph glands and fever.
Erythema multiforme
Recurrent erythema multiforme is an uncommon reaction to herpes simplex. Erythema multiforme mainly appears on the hands, forearms and lower legs and is characterised by target lesions, which sometimes blister.
Nervous system
The nerves to the face may be infected by HSV, producing temporary paralysis of the affected muscles, sometimes with each attack. Rarely neuralgic pain may precede each recurrence of herpes by 1 or 2 days (Maurice’s syndrome). Meningitis is rare.
Widespread infection
This is more likely to arise in debilitated patients and may be serious.

 

        

[drmithila]

The Eco-Dentistry Association (EDA), an international membership association formed to promote environmentally sound practices in dentistry, supports the U.S. Environmental Protection Agency’s (EPA) efforts to curtail mercury waste from dental offices.

In a recent EPA press release, the agency stated its intention to propose a rule next year requiring all dental practitioners to separate the mercury from dental amalgam waste before disposal.

“While we’ve preferred voluntary installation of amalgam separators and recognize the challenges dentists face in understanding the environmental impact of their practices, unfortunately, we see the highest rate of separator installation in areas where the requirements are mandatory,” said Susan Beck, director of the EDA, in a press release.

The EPA is recommending that dental offices voluntarily install and utilize “existing technology,” such as amalgam separators, she noted.

“Voluntarily and promptly installing a separator is the responsible thing to do,” she said. “Otherwise, dental office mercury waste ends up burdening local water treatment plants in the very communities in which dentists practice.”

Some dentists are not aware that they need an amalgam separator, Beck added.

“We often hear from high-tech dentists who no longer place amalgam fillings that they don’t think they need a separator. This is simply not so,” explained EDA co-founder Ina Pockrass. “While counterintuitive, dentists who only remove amalgam restorations actually generate, on an average, more mercury-containing waste than those who place the material.”

According to the EPA, 50% of the mercury entering local waste treatment plants — about 3.7 tons each year — comes from dental amalgam. Amalgam separators, however, can take 95% of the mercury out of the amalgam waste that is discharged to local treatment plants.

“Our message is simple,” Pockrass said. “Whether you put amalgam in or take it out, please deal with it responsibly by installing a separator.”

        

[drsnehamaheshwari]

 Carpal Tunnel Syndrome (CTS) is an entrapment idiopathic median neuropathy, causing paresthesia, pain, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel. The National Center for Biotechnology Information and highly cited older literature say the most common cause of CTS is typing. Carpal Tunnel Syndrome can be associated with any condition that causes pressure on the median nerve at the wrist. Some common conditions that can lead to CTS include obesity, oral contraceptives, hypothyroidism, arthritis, diabetes, and trauma. Carpal tunnel is also a feature of a form of Charcot-Marie-Tooth syndrome type 1 called hereditary neuropathy with liability to pressure palsies. Other causes of this condition include intrinsic factors that exert pressure within the tunnel, and extrinsic factors (pressure exerted from outside the tunnel), which include benign tumors such as lipomas, ganglion, and vascular malformation. More recent research by Lozano-Calderón has cited genetics as a larger factor than use, and has encouraged caution in ascribing causality.

A review of available scientific data by the National Institute for Occupational Safety and Health (NIOSH) indicated that job tasks that involve highly repetitive manual acts or specific wrist postures were associated with incidents of CTS, but causation was not established, and the distinction from work-related arm pains that are not carpal tunnel syndrome was not clear. It has been proposed that repetitive use of the arm can affect the biomechanics of the upper limb or cause damage to tissues. It has also been proposed that postural and spinal assessment along with ergonomic assessments should be included in the overall determination of the condition.

Patients with CTS experience numbness, tingling, or burning sensations in the thumb and fingers, in particular the index, middle fingers, and radial half of the ring fingers, which are innervated by the median nerve. Less-specific symptoms may include pain in the hands or wrists and loss of grip strength (both of which are more characteristic of painful conditions such as arthritis). Before the median nerve enters the carpal tunnel it passes first through the thoracic outlet and then the two heads of the pronator teres muscle of the forearm. As a consequence, inflammation, edema, or hypertrophy in the thoracic outlet or the forearm can impinge the median nerve, mimicking the effects of carpal tunnel syndrome, and patients may also report pain in the arm and shoulder. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction.

Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.

Generally accepted treatments, may include splinting or bracing, steroid injection, activity modification, physiotherapy, regular massage therapy treatments, chiropractic, medications, and surgical release of the transverse carpal ligament.

A 2007 study, conducted by Lozano-Calderon et al. in the Department of Orthopaedic Surgery at Massachusetts General Hospital, states that carpal tunnel syndrome is determined primarily by genetics and structure. It is presumed, therefore, that carpal tunnel syndrome is not preventable.[original research?]

However, others[who?] think it can be prevented by developing healthy habits like avoiding repetitive stress, practicing healthy work habits like using ergonomic equipment (wrist rest, mouse pad), taking proper breaks, using keyboard alternatives (digital pen, voice recognition, and dictation), and employing early passive treatment like taking turmeric (anti-inflammatory), omega-3 fatty acids, and B vitamins. Scientists have long abandoned the potential role of B-vitamins in carpal tunnel syndrome.

Those favoring activity as a cause of carpal tunnel syndrome speculate that activity-limitation might limit the risk of developing carpal tunnel syndrome, but there is little or no data to support these concepts. and they stigmatize arm use in ways that risks increasing illness.

        

[Author]

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