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Mobile Devices Can Be a Real Pain
JNP
Mobile Devices Can Be a Real Pain The use of smartphones is pervasive. In the midst of patient encounters, I am often interrupted by a buzz, jingle, or song! Smartphone owners 18-24 years old send 2,022 texts per month on average—67 texts on a daily basis— and receive another 1,831.1 Research shows that devices are also used to take pictures (82%), access the internet (56%), send and receive e-mail (50%), record video (44%), seek medical information online (31%), and bank (29%).2 Users are involved in distracted driving and walking accidents and now increased use of mobile devices is being linked to a variety of musculoskeletal injuries. The more time spent staring at those little screens, the longer people keep their elbows bent, which diminishes blood flow to the nerve and results in injury. “Cell-phone elbow” is not a new diagnosis but simply a new name for cubital tunnel syndrome. The 2 biggest controllable risk factors are prolonged flexion of the elbow at greater than 90 and pressure placed directly on the ulnar nerve as it passes around the underside of the elbow. Bending the elbow tighter than 90 for an extended period will stretch the ulnar nerve by 8%-15%. Compounding the problem is resting on the flexed elbow when using the cell phone at a desk or in a car, which leads to direct nerve compression, in addition to elbow flexion. In susceptible people, holding the bent-elbow position for
CURRENT ISSUES IN NP PRACTICE Laurel Halloran, PhD, APRN extended periods can lead to decreased blood flow, inflammation, and compression of the nerve. The first symptoms patients often notice 832
The Journal for Nurse Practitioners - JNP
include numbness, tingling, or aching in the forearm and hand, a pain similar to hitting the “funny bone.” As symptoms progress, they can include a loss of muscle strength, coordination, and mobility that can make writing and typing difficult. In chronic, untreated cases, the ring finger and pinky can become clawed (Froment’s sign). Tinel’s sign is usually positive. In most cases, lifestyle changes can help alleviate symptoms. Most important is avoidance of activities that require the elbow to be bent more than 90 . Additional changes include using a handsfree headset for the cell phone, altering workstations so elbows are not overly flexed, and not leaning on elbows for extended periods. More serious cases are referred to occupational or physical therapists for ultrasound to loosen scar tissue, in addition to stretching, deep massage, and “nerve-gliding” exercises to reduce pressure on the nerve. Treatments may also include anti-inflammatory injections or surgery. The thumbs were not made to perform repeated forceful pressing motions. Sustained and prolonged gripping, repetitive pushing, and repetitive movements with the thumb and fingers and quickly using small buttons increases the tension in the muscles and tendons, magnifying risk for thumb tendinitis or “repetitive strain injury.” This has also been labeled “Nintenditis,” “blackberry thumb,” and “iPod finger.”3 Patients present with pain and swelling at the base of the thumb. As the injury becomes worse, the pain may travel up the forearm or down the thumb. Patients may also complain of increased pain with these activities, such as wringing motions of the wrist (unscrewing a jar lid, turning a key, or buttoning a shirt), increased pain with pinching and grasping, or clumsiness and dropping objects when pain causes grip to be shaky. Diagnosis of this tenosynovitis is confirmed by a positive Finkelstein test. Treatment is aimed at decreasing inflammation. Patients should avoiding gripping objects with the affected thumb as well as any Volume 11, Issue 8, September 2015
actions that exacerbate pain. Immediate treatment may include reducing swelling by applying ice to the thumb and wrist, antiinflammatory medications, or (if indicated) corticosteroid joint injection. If required, thumb abduction splints or braces may be used to promote joint rest. Physical or occupational therapy may be an appropriate treatment, along with rehabilitation exercises and advice on avoiding repetitive strain. Using a device that allows switch between keypad and stylus spreads out the work to different muscle groups. A larger stylus can also help lessen the strain and force. Another way to lessen the load on the thumb is to frequently switch to the index finger to type. In serious cases, surgery may be required to alleviate pain and disability. Recently, I saw a 14-year-old patient who was complaining of upper shoulder and neck pain. She had no injuries, but she bent over her cell phone constantly and sent over 100 text messages a day. “Text neck” is an overuse syndrome involving the head, neck, and shoulders. It can result from excessive strain on the spine from looking in a forward and downward position at hand-held mobile devices (phone, video game unit, computer, e-reader). Every inch of forward head posture increases the weight of the head on the spine by an additional 10 pounds. Forward head posture can add up to 30 pounds of abnormal leverage on the cervical spine.4 This pulls the spine out of alignment causing headaches, neck pain, shoulder and arm pain, and even disk herniation. Three major strategies should be employed to address “text neck.”
www.npjournal.org
A strong neck and back are less prone to strain. Exercise that strengthens these muscles (such as yoga or Pilates), or even and simple regular regimen of squeezing the shoulder blades together, will provide preventive care. Second, good posture is essential. Remind patients to practice keeping neck back and keeping ears over shoulders and the eyes straight forward, when using electronic devices. Finally, acknowledge how much time is spent using electronic devices. Commit to splitting that up into smaller chunks with regular breaks. An overuse syndrome can only be healed by breaking the pattern of overuse! When seeing a patient with a neck, elbow, or hand complaint, remember to ask, “How much time do you spend on your cell phone or mobile device?” References 1. Lenhart A. Teens, Smartphone’s and texting. http://www.pewinternet .org/files/old-media/Files/Reports/2012/PIP_Teens_Smartphones_and_ Texting.pdf/. 2012. Accessed April 15, 2015. 2. Dunagan M. Cell phone activities. 2012. http://pewinternet.org/ w/media//Files/Reports/2012/PIP_CellActivities_11.25.pdf/. Accessed April 28, 2015. 3. Jonsson P, Johnson PW, Hagberg M, Forsman M. Thumb joint movement and muscular activity during mobile phone texting: a methodological study. J Electromyogr Kinesiol. 2011;21(2):363-370. 4. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014;25:277-279.
Section Editor Laurel Halloran, PhD, APRN, is coordinator of the master’s and doctoral programs in nursing at Western Connecticut State University in Danbury, and a family nurse practitioner. She can be reached at [email protected].
1555-4155/15/$ see front matter © 2015 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2015.05.014
The Journal for Nurse Practitioners - JNP
833
Mobile Devices Can Be a Real Pain The use of smartphones is pervasive. In the midst of patient encounters, I am often interrupted by a buzz, jingle, or song! Smartphone owners 18-24 years old send 2,022 texts per month on average—67 texts on a daily basis— and receive another 1,831.1 Research shows that devices are also used to take pictures (82%), access the internet (56%), send and receive e-mail (50%), record video (44%), seek medical information online (31%), and bank (29%).2 Users are involved in distracted driving and walking accidents and now increased use of mobile devices is being linked to a variety of musculoskeletal injuries. The more time spent staring at those little screens, the longer people keep their elbows bent, which diminishes blood flow to the nerve and results in injury. “Cell-phone elbow” is not a new diagnosis but simply a new name for cubital tunnel syndrome. The 2 biggest controllable risk factors are prolonged flexion of the elbow at greater than 90 and pressure placed directly on the ulnar nerve as it passes around the underside of the elbow. Bending the elbow tighter than 90 for an extended period will stretch the ulnar nerve by 8%-15%. Compounding the problem is resting on the flexed elbow when using the cell phone at a desk or in a car, which leads to direct nerve compression, in addition to elbow flexion. In susceptible people, holding the bent-elbow position for
CURRENT ISSUES IN NP PRACTICE Laurel Halloran, PhD, APRN extended periods can lead to decreased blood flow, inflammation, and compression of the nerve. The first symptoms patients often notice 832
The Journal for Nurse Practitioners - JNP
include numbness, tingling, or aching in the forearm and hand, a pain similar to hitting the “funny bone.” As symptoms progress, they can include a loss of muscle strength, coordination, and mobility that can make writing and typing difficult. In chronic, untreated cases, the ring finger and pinky can become clawed (Froment’s sign). Tinel’s sign is usually positive. In most cases, lifestyle changes can help alleviate symptoms. Most important is avoidance of activities that require the elbow to be bent more than 90 . Additional changes include using a handsfree headset for the cell phone, altering workstations so elbows are not overly flexed, and not leaning on elbows for extended periods. More serious cases are referred to occupational or physical therapists for ultrasound to loosen scar tissue, in addition to stretching, deep massage, and “nerve-gliding” exercises to reduce pressure on the nerve. Treatments may also include anti-inflammatory injections or surgery. The thumbs were not made to perform repeated forceful pressing motions. Sustained and prolonged gripping, repetitive pushing, and repetitive movements with the thumb and fingers and quickly using small buttons increases the tension in the muscles and tendons, magnifying risk for thumb tendinitis or “repetitive strain injury.” This has also been labeled “Nintenditis,” “blackberry thumb,” and “iPod finger.”3 Patients present with pain and swelling at the base of the thumb. As the injury becomes worse, the pain may travel up the forearm or down the thumb. Patients may also complain of increased pain with these activities, such as wringing motions of the wrist (unscrewing a jar lid, turning a key, or buttoning a shirt), increased pain with pinching and grasping, or clumsiness and dropping objects when pain causes grip to be shaky. Diagnosis of this tenosynovitis is confirmed by a positive Finkelstein test. Treatment is aimed at decreasing inflammation. Patients should avoiding gripping objects with the affected thumb as well as any Volume 11, Issue 8, September 2015
actions that exacerbate pain. Immediate treatment may include reducing swelling by applying ice to the thumb and wrist, antiinflammatory medications, or (if indicated) corticosteroid joint injection. If required, thumb abduction splints or braces may be used to promote joint rest. Physical or occupational therapy may be an appropriate treatment, along with rehabilitation exercises and advice on avoiding repetitive strain. Using a device that allows switch between keypad and stylus spreads out the work to different muscle groups. A larger stylus can also help lessen the strain and force. Another way to lessen the load on the thumb is to frequently switch to the index finger to type. In serious cases, surgery may be required to alleviate pain and disability. Recently, I saw a 14-year-old patient who was complaining of upper shoulder and neck pain. She had no injuries, but she bent over her cell phone constantly and sent over 100 text messages a day. “Text neck” is an overuse syndrome involving the head, neck, and shoulders. It can result from excessive strain on the spine from looking in a forward and downward position at hand-held mobile devices (phone, video game unit, computer, e-reader). Every inch of forward head posture increases the weight of the head on the spine by an additional 10 pounds. Forward head posture can add up to 30 pounds of abnormal leverage on the cervical spine.4 This pulls the spine out of alignment causing headaches, neck pain, shoulder and arm pain, and even disk herniation. Three major strategies should be employed to address “text neck.”
www.npjournal.org
A strong neck and back are less prone to strain. Exercise that strengthens these muscles (such as yoga or Pilates), or even and simple regular regimen of squeezing the shoulder blades together, will provide preventive care. Second, good posture is essential. Remind patients to practice keeping neck back and keeping ears over shoulders and the eyes straight forward, when using electronic devices. Finally, acknowledge how much time is spent using electronic devices. Commit to splitting that up into smaller chunks with regular breaks. An overuse syndrome can only be healed by breaking the pattern of overuse! When seeing a patient with a neck, elbow, or hand complaint, remember to ask, “How much time do you spend on your cell phone or mobile device?” References 1. Lenhart A. Teens, Smartphone’s and texting. http://www.pewinternet .org/files/old-media/Files/Reports/2012/PIP_Teens_Smartphones_and_ Texting.pdf/. 2012. Accessed April 15, 2015. 2. Dunagan M. Cell phone activities. 2012. http://pewinternet.org/ w/media//Files/Reports/2012/PIP_CellActivities_11.25.pdf/. Accessed April 28, 2015. 3. Jonsson P, Johnson PW, Hagberg M, Forsman M. Thumb joint movement and muscular activity during mobile phone texting: a methodological study. J Electromyogr Kinesiol. 2011;21(2):363-370. 4. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014;25:277-279.
Section Editor Laurel Halloran, PhD, APRN, is coordinator of the master’s and doctoral programs in nursing at Western Connecticut State University in Danbury, and a family nurse practitioner. She can be reached at [email protected].
1555-4155/15/$ see front matter © 2015 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2015.05.014
The Journal for Nurse Practitioners - JNP
833