Sindrom karpalnog tunela u stomatološkoj ordinaciji

While working, a dentist uses his hands in different positions for longer or shorter periods of time. Most often it is the position in which instruments are being held – hand in flexion. Considering the frequency of the repetitive hand movement, anatomical structures involved tend to suffer damage which can result in loss of function of the hand. Carpal tunnel syndrome (CTS) is the most often overstrain syndrome of upper limbs, caused by repetitive overstraining of hand flexor tendons. Frequent strain in combination with dental handpiece instrument vibrations can lead to inflammation and edema of tendons and their sheaths (tenosynovitis) in the carpal tunnel. Carpal tunnel is a contained space in which an increase in volume of anatomical structures leads to a rise in pressure. This results in pressure on the median nerve and consequential pain in the wrist. The severity of symptoms depends on the duration and intensity of pressure on the nerve. The syndrome affects 0,05% to 0,15% of the general population, but 19% to 33% of dental professionals. There is a higher occurrence in individuals older than 30 and it is three times more common in women than men. Most common symptoms are numbness, burning sensation or tingling in the area innervated by the median nerve, while in the most severe cases anesthesia can occur. Phalen’s test and Durkan’s compression test are most commonly used diagnostic methods. Golden standard diagnostic is electrodiagnostic testing, while alterations can also be diagnosed with electromyoneurography, electromyography, ultrasonography and magnetic resonance imaging. It is important to react as soon as the first symptoms occur. Therapy can either be conservative or surgical, depending on the severity and duration of symptoms.