Getting the Upper Hand on Pain: Preventing Hand ... - IneedCE.com

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<strong>the</strong> Treatment of Myofascial Pain. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:145-66. 17. Chin DH, Jones NF. Repetitive motion hand disorders. CDA J. 2002; 30(2):149-60. 18. Ericson, WB. Median Nerve Entrapment in <strong>the</strong> Forearm: Diagnosis and Treatment, Poster presentation, American Society for Surgery of <strong>the</strong> <strong>Hand</strong>, 59th Annual Meeting, NewYork, NY, 2004. 19. Feldman RG, Goldman R, KeyserlingWM. Peripheral nerve entrapment syndromes and ergonomic factors. Am J Ind Med. 1983;4(5):661-81. 20. Centers for Disease Control. Occupational disease surveillance: carpal tunnel syndrome. MMWR. 1989;18:36-44. 21. Dong H, Barr A, Loomer P, Rempel D. The effects of finger rest positions on hand muscle load and pinch force in simulated dental hygiene work. J Dent Educ. 2005; 69(4):453-60. 22. Pattison AM, Matsuda S, Pattison GL. Extraoral fulcrums—<strong>the</strong> essentials of using extraoral fulcrums for periodontal instrumentation. Dimensions of Dental Hygiene. 2004;2(10):20, 21-3. 23. Matsuda S. Technique—proper grasp. Dimensions of Dental Hygiene. 2005;3(9):26, 28. 23. Matsuda S. Troubleshooting technique—sharpening. Dimensions of Dental Hygiene. 2005; 3(6):32, 34. 24. Matsuda S. Instrumentation of biofilm. Dimensions of Dental Hygiene. 2003;1(1):26-8, 30. 25. Morse TF, Michalak-Turcotte C, Atwood-Sanders M, Warren N, Paterson DR, et al. A pilot study of hand and arm musculoskeletal disorders in dental hygiene students. J Dent Hyg. 2003; 77(30):173-9. 26. Dong H, Barr A, Loomer P, LaRoche C, Young E, et al. The effects of periodontal instrument handle design on hand muscle load and pinch force. J Am Dent Assoc. 2006;137(8): 1123-30. 27. Simmer-Beck M, Bray KK, Branson B, Glaros A, Weeks J. Comparison of muscle activity associated with structural differences in dental hygiene mirrors. J Dent Hyg. 2006; 80(1):8. 28. Glasscoe D. The better way to sharpen dental instruments—CD. Professional Dental Management Inc. 2006. 29. Kumar C. Biomechanics in Ergonomics. Philadelphia, PA: Taylor & Francis; 1999:165-75. 30. Stockstill JW, Harn SD, Stickland D, Hruska R. Prevalence of upper extremity neuropathy in a clinical dentist population. J Am Dent Assoc. 1993;124:67-72. 31. Weiss S, Falkenstein N. <strong>Hand</strong> Rehabilitation: a Quick Reference Guide and Review, 2nd ed. St. Louis, MO: Elsevier Mosby; 2005:346. 32. Travell JG, Simons DG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1. Baltimore, MD: LippincottWilliams &Wilkins; 1999. 33. Novak CB, Mackinnon SE. Repetitive use and static postures: a source of nerve compression and pain. J <strong>Hand</strong> Ther. 1997;10(2):151-9. 34. Adelman S, Eisner K. Arm pain in a dentist: pronator syndrome. J Am Dent Assoc. 1982; 105:61-2. 35. Valachi B, Valachi K. Mechanisms contributing to musculoskeletal disorders in dentistry. J Am Dent Assoc. 2003;134:1344-50. 36. Ritter A, Sensat M, Harn, S.Thoracic outlet syndrome: a review of <strong>the</strong> literature. J Dent Hyg. 1999;73:205-7. 37. Powell BJ, Winkley GP, Brown JO, Etersque S. Evaluating <strong>the</strong> fit of ambidextrous and fitted gloves: implications for hand discomfort. J Am Dent Assoc. 1994; 125:1235-42. 38. Christensen G. Operating gloves: <strong>the</strong> good and <strong>the</strong> bad. J Am Dent Assoc. 2001;132:1455-57. Resources • This CE course is Chapter 5 from <strong>the</strong> author’s book, Practice Dentistry Pain-Free: Evidence-based Strategies to Prevent Pain & Extend Your Career – B. Valachi· • It’s Not Carpal Tunnel Syndrome! – S Damany/J. Bellis· Physics Forceps extraction instrument at www. physicsforceps.com • The following related resources are available on <strong>the</strong> author’s website: www.posturedontics.com: Osteoarthritis vs. DeQuervain’s Disease in Dental Professionals (newsletter archives) WrisTimer – for preventing carpal tunnel· Wrist/hand exercises for dental professionals. Author Profile Bethany Valachi, PT, MS, CEAS. Ms. Valachi is a physical <strong>the</strong>rapist, dental ergonomic consultant and author of <strong>the</strong> book, “Practice Dentistry Pain-Free”. She is CEO of Posturedontics ® , a company that provides research-based dental ergonomic education and also lectures internationally—including <strong>the</strong> 2009 International Dental Ergonomics Congress in Krakow, Poland. Clinical instructor of ergonomics at OHSU School of Dentistry in Portland, Oregon, Bethany has provided expertise on dental ergonomics to faculty and students at numerous dental universities. She has been widely published in various peer-reviewed dental journals and has developed patient positioning, chairside stretching and home exercise DVDs specifically for dental professionals. She offers free newsletters, articles and product reviews on her website at www.posturedontics.com. Disclaimer The author(s) of this course has/have no commercial ties with <strong>the</strong> sponsors or <strong>the</strong> providers of <strong>the</strong> unrestricted educational grant for this course. Reader Feedback We encourage your comments on this or any PennWell course. For your convenience, an online feedback form is available at www.ineedce.com. 8 www.ineedce.com
Online Completion Use this page to review <strong>the</strong> questions and answers. Return to www.ineedce.com and sign in. If you have not previously purchased <strong>the</strong> program select it from <strong>the</strong> “Online Courses” listing and complete <strong>the</strong> online purchase. Once purchased <strong>the</strong> exam will be added to your Archives page where a Take Exam link will be provided. Click on <strong>the</strong> “Take Exam” link, complete all <strong>the</strong> program questions and submit your answers. An immediate grade report will be provided and upon receiving a passing grade your “Verification Form” will be provided immediately for viewing and/or printing. Verification Forms can be viewed and/or printed anytime in <strong>the</strong> future by returning to <strong>the</strong> site, sign in and return to your Archives Page. 1. <strong>Hand</strong>, wrist and arm pain are much more prevalent among dental professionals than <strong>the</strong> general public, due to ________. a. intermittent grips and sustained awkward postures b. sustained grips and prolonged awkward postures c. sustained grips and ergonomic postures d. none of <strong>the</strong> above 2. Between _________ of dentists and nearly _________ of dental hygienists experience hand and wrist pain. a. 8 and 20 percent; 55 percent b. 13 and 25 percent; 65 percent c. 18 and 30 percent; 75 percent d. 23 and 40 percent; 75 percent 3. The origins of pain in <strong>the</strong> hand, wrist or arm are _________. a. never due to a problem in <strong>the</strong> same area b. always due to a problem in <strong>the</strong> same area c. always due to multiple problems d. sometimes due to a problem in ano<strong>the</strong>r area 4. Carpal tunnel syndrome is <strong>the</strong> _________ entrapment in <strong>the</strong> arm. a. least common peripheral nerve b. most common peripheral nerve c. least common regional nerve d. none of <strong>the</strong> above 5. For <strong>the</strong> hand to function properly, ________ flexor tendons and <strong>the</strong> median nerve must be able to glide easily within <strong>the</strong> carpal tunnel. a. five b. seven c. nine d. none of <strong>the</strong> above 6. Flexing <strong>the</strong> wrist forward and gripping a small instrument forcefully are two of <strong>the</strong> primary risk factors for _________. a. regional nerve pares<strong>the</strong>sia b. carpal tunnel syndrome c. trigger syndrome d. none of <strong>the</strong> above 7. _________ are primary risk factors for carpal tunnel syndrome. a. Low repetition work and long duration b. Low repetition work and short duration c. High repetition work and short duration d. High repetition work and long duration 8. Trying to keep your wrist straight and moving your entire hand, wrist and forearm as a unit ________, and is an appropriate ergonomic intervention to help prevent carpal tunnel syndrome. a. transfers <strong>the</strong> load from larger hand muscles to smaller arm and shoulder muscles b. transfers <strong>the</strong> load from smaller hand muscles to smaller arm and shoulder muscles c. transfers <strong>the</strong> load from smaller hand muscles to larger arm and shoulder muscles d. none of <strong>the</strong> above 9. Using an _________ instrument is preferable to angling your wrist while performing dental procedures. a. adjusted straight b. accentuated straight c. accentuated angled d. all of <strong>the</strong> above 10. _________ requires less force applied to <strong>the</strong> work surface and a less forceful precision grip than _________. a. Manual scaling; ultrasonic scaling b. Ultrasonic scaling; manual scaling c. Ultrasonic extractions; manual extractions d. none of <strong>the</strong> above Questions 11. The duration of use of ei<strong>the</strong>r ultrasonic or manual instruments is positively associated with _________ numbness/tingling. a. lower extremity b. upper extremity c. upper and lower extremity d. none of <strong>the</strong> above 12. Larger instrument handle diameters _________ and pinch force. a. decrease arm muscle load b. increase arm muscle load c. increase hand muscle load d. none of <strong>the</strong> above 13. Alternating between _________ may help prevent CTS symptoms. a. pitch sizes b. handle diameter sizes c. chairs d. all of <strong>the</strong> above 14. _________ and lightweight instruments help reduce pinch forces and forceful pinch grips. a. Smooth b. Textured c. Mottled d. none of <strong>the</strong> above 15. _________ require <strong>the</strong> use of more force, and have a deleterious effect on musculoskeletal health. a. fast instruments b. sharp instruments c. dull instruments d. a and c 16. _________ has been shown to increase pressure in <strong>the</strong> carpal tunnel. a. Light pinch grip b. Forceful pinch grip c. Forceful back angulation d. none of <strong>the</strong> above 17. Hygienists and dentists should try to use a _________ when possible. a. plantar grip b. palmar grip c. ulnar grip d. none of <strong>the</strong> above 18. Using 360-degree swivel instruments helps to _________. a. maintain neutral wrist and optimal finger position b. maintain optimal neutral wrist and a lateral finger position c. maintain optimal neutral wrist and finger position d. all of <strong>the</strong> above 19. Alternating between chairs with and without _________ can help avoid structural damage. a. rollers b. headrests c. armrests d. all of <strong>the</strong> above 20. Exposure to _________ is an aggravating risk factor associated with CTS. a. warmth b. cold c. humidity d. all of <strong>the</strong> above 21. Tinel’s sign is an electric shock–type sensation in <strong>the</strong> hand when <strong>the</strong> _________ is tapped gently at <strong>the</strong> wrist and is often seen in patients with carpal tunnel syndrome. a. superior palmar nerve b. inferior palmar nerve c. median nerve d. none of <strong>the</strong> above 22. Weakness of <strong>the</strong> _________ muscles at <strong>the</strong> base of <strong>the</strong> thumb is often seen in patients with carpal tunnel syndrome. a. plantar b. <strong>the</strong>nar c. phenar d. none of <strong>the</strong> above 23. Therapeutic interventions for <strong>the</strong> treatment of carpal tunnel syndrome include _________. a. ice b. massage c. ultrasound or acupuncture d. all of <strong>the</strong> above 24. _________ is a conservative treatment option for carpal tunnel syndrome. a. Nerve or tendon gliding exercises b. Modification of activities to decrease tendon excursion c. The use of anti-inflammatories or cortisone injections d. all of <strong>the</strong> above 25. _________ may mimic carpal tunnel syndrome. a. Cervical radiculopathy b. Poorly fitting gloves c. Thoracic outlet syndrome d. all of <strong>the</strong> above 26. _________ can mimic carpal tunnel syndrome. a. median nerve entrapment b. cervical radiculopathy c. thoracic outlet syndrome d. all of <strong>the</strong> above 27. Ambidextrous gloves exert one-third more force than do fitted gloves, and <strong>the</strong>ir use may result in _________. a. muscle ischemia b. nerve compression c. pain d. all of <strong>the</strong> above 28. Trigger points in <strong>the</strong> forearm muscles such as <strong>the</strong> _________ can cause compression on <strong>the</strong> median nerve and cause pain in <strong>the</strong> hand and wrist similar to that of carpal tunnel syndrome. a. pronator peretes b. dispator teres c. pronator teres d. all of <strong>the</strong> above 29. Older practitioners may be more prone than younger practitioners to _________ pain in <strong>the</strong> hands. a. glove-related b. chair-related c. leg-related d. all of <strong>the</strong> above 30. Intervention strategies should become an integral habit _________ to help prevent carpal tunnel syndrome. a. in <strong>the</strong> operatory b. at home c. only while working d. a and b www.ineedce.com 9
Page 1 and 2: Publication Date: July 2010 Review
Page 3 and 4: Inconsistencies abound in t
Page 5 and 6: Larger instrument handle diameters
Page 7: habits. The development of TOS has

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