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How Can I Prevent Wrist Pain?

I have been experiencing sharp, aching pain in my right wrist and arm at seemingly random intervals. The dentist suggested taking ibuprofen, but it doesn’t seem to help. How can I prevent this pain from recurring?

QUESTION: I recently graduated from dental hygiene school and started my career in clinical practice. I have been experiencing sharp, aching pain in my right wrist and arm at seemingly random intervals. The dentist suggested taking ibuprofen, but it doesn’t seem to help. How can I prevent this pain from recurring?

ANSWER: Work-related musculoskeletal disorders progress in stages–from mild to severe. The repetitive motion required when providing oral hygiene services is a significant risk factor for work-related musculoskeletal disorders. Other factors that increase the likelihood of on-the-job injury include the excessive and frequent force employed during instrumentation, the tightness of the working hand’s grasp, awkward body positioning, the pace of the day, and psychosocial issues.

As a new graduate, you may need to develop work-hardening practices for physical conditioning. Many recent graduates go from treating one patient or two patients per day with 3-hour appointment times to eight patients per day in 45-minute to 60-minute appointments. A strenuous workload and high stress levels can cause muscle tightening and tension in the body. Employing strategies to effectively manage these issues is key to health maintenance. Stretching throughout the day can improve blood flow and reduce discomfort. Shoulder rolls and finger stretches when changing instruments are two strategies that can be implemented immediately.

Does your body get rest and recovery time? If possible, try alternating between difficult and easy dental hygiene patients. Also, ask an experienced colleague to observe your body mechanics and suggest changes to ensure your working posture is neutral and relaxed. Periodically assess your arm posture. Relaxing your shoulders and keeping your elbows close to your body and at the working height of the oral cavity will improve circulation and facilitate a neutral posture.

Precision work with fine motor skills periodically requires the elbows to be lower than the oral cavity, which can be hard on the body. Remember to check your posture throughout the day, not only at work, but also during activities of daily living. The placement of the patient chair impacts your posture, as well. There should be clearance between the underside of the treatment chair and your thighs.

Adjusting the patient chair and the occlusal plane of the teeth you are working on will encourage the maintenance of a neutral posture. What you do outside of work may also contribute to the pain. Home duties, such as vacuuming, dusting, shoveling snow, and gardening, require the use of repetitive motion. Lifting heavy loads–from overloaded grocery bags to placing toddlers into car seats–can also exert negative effects on musculoskeletal health. Popular hobbies, including painting, knitting, and tennis, require fine motor skills and may place additional stress on fatigued hands and arms. Sleep position may also incite pain if the hands become flexed or extended throughout the night. Try to reduce or take frequent breaks from these types of activities.

If symptoms do not subside, you should see a health care provider for diagnosis and treatment. Physical therapy may be helpful in addressing the source of your pain (read “Injury Prevention with Physical Therapy” for more information).

The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele Carr, RDH, MA, and Rachel Kearney, RDH, MS, on ethics and risk management; Durinda Mattana, RDH, MS, on fluoride use; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpening; Stacy A. Matsuda, RDH, BS, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Jessica Y. Lee, DDS, MPH, PhD, on pediatric dentistry; Bryan J. Frantz, DMD, MS, and Timothy J. Hempton, DDS, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to dimensionsofdentalhygiene.com/asktheexpert to submit your question.

From Dimensions of Dental Hygiene. April 2014;12(4):74.

 

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