Median and ulnar neuropathies in US Army dental personnel at Fort Sam Houston, Texas.
BACKGROUND
Dental personnel have an increased prevalence of upper-extremity (UE) musculoskeletal (MSK) disorders, including carpal tunnel syndrome (CTS). Military dental personnel report more UE MSK complaints than their civilian counterparts. Literature using nerve conduction studies (NCS) to diagnose UE neuropathy in dental personnel is lacking.


OBJECTIVE
The purpose of this descriptive study was to determine the presence of electrodiagnostic abnormalities of the median and ulnar nerves in active duty military dental personnel assigned to Fort Sam Houston, TX.


METHODS
Twenty (14 male, 6 female) active duty, US Army dentists (n=9), preventive dental specialists (n=4), dental assistants (n=3), dental lab technicians (n=3), and dental logistics technician (n=1) assigned to the Dental Command at Fort Sam Houston, TX, volunteered to participate in the study. The mean age of the dental personnel was 38±9.8 years (range: 26 to 56 years). The mean time in dental practice was 13.3±7.96 years (range: 2 to 29 years). The mean length of time in the US Army dental services was 11.8±7.7 years (range: one to 26 years).


METHODS
Subjects completed a history form, were interviewed, and underwent a physical examination of the cervical spine and bilateral upper extremities. Nerve conduction studies of the bilateral median and ulnar nerves were performed. Electrophysiological variables served as the reference standard for median and ulnar neuropathy and included distal sensory latencies, distal motor latencies, amplitudes, conduction velocities, and comparison study latencies. Descriptive statistics for subject demographics and nerve conduction study variables were also calculated.


RESULTS
Seven of the 20 subjects (35%) presented with abnormal electrophysiologic values suggestive of an upper extremity mononeuropathy. Five of the subjects had abnormal electrophysiologic values of the median nerve at or distal to the wrist (3 bilateral, 2 unilateral). Two subjects had abnormal ulnar nerve findings at or distal to the wrist (1 bilateral, 1 unilateral). Three of the 7 subjects with electrodiagnostic evidence of median and ulnar neuropathies had positive findings on physical examination. However, there was no significant correlation between the NCS and history/physical examination findings.


CONCLUSIONS
The prevalence of mononeuropathies in this sample of US Army dental personnel is similar to previous research involving dental assistants and preventive dental specialists and far exceeds that reported in the general population. This is the first dental study to report electrodiagnostic findings of ulnar mononeuropathy at or distal to the wrist. The NCS findings did not correlate with subjective or physical exam findings. Prospective research investigating screening, examination items, and injury prevention measures in dental personnel appears to be warranted.
US Army-Baylor University Doctoral Program in Physical Therapy, US Army Medical Department Center and School, Fort Sam Houston, TX.
Scott W
SW
Shaffer
Kaitland
K
Alexander
Daniel
D
Huffman
Charles
C
Kambe
Ronald
R
Miller
Josef H
JH
Miller
David G
DG
Greathouse
D000328:Adult; D003726:Dental Assistants; D003815:Dentists; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D008297:Male; D020423:Median Neuropathy / Q000175:diagnosis*; D008875:Middle Aged; D008889:Military Personnel; D013781:Texas; D020424:Ulnar Neuropathies / Q000175:diagnosis*
carpal tunnel prevalence; clinical electrophysiological testing; median nerve; nerve conduction studies; ulnar nerve