Clinical, electrophysiological, and ultrasound evaluation for early detection of musculoskeletal hand disorders and nerve entrapment in mobile phone users

ABSTRACT Introduction: Smartphone overuse may lead to musculoskeletal manifestations, such as carpal tunnel syndrome (CTS) and arthritis of hand joints, with an increased median nerve cross-sectional area (CSA). Objective: The aim of this study is the early detection of musculoskeletal hand disorders using ultrasound techniques, and to detect nerve entrapment using clinical evaluation, ultrasound, and electrophysiological studies, in university employees younger than 35 years using mobile phones. Function is assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Materials and methods: Cross-sectional controlled study included 74 smartphone users classified into two groups according to a smartphone addiction scale (SAS), into high and low smart phone users, with 35 non-smartphone users with matched age and gender as a control group. A clinical assessment of nerve entrapment symptoms was performed, and the Michigan Hand Outcomes Questionnaire (MHQ), with a total score from 0 to100, was used to assess hand function. Electrodiagnostic studies of median and ulnar nerves were used to detect early nerve entrapment. Bilateral ultrasound was performed in order to assess the median nerve CSA and involvement of thumb and small hand joints. The data collected were analyzed using the SPSS program version 20. Results: CSAs of median nerves were significantly higher in the dominant hand of high smartphone users than in low and non-smartphone users (p < 0.001). There was a significant positive correlation between CSA and SAS (r = 0.45), visual analogue scale (VAS) (r = 0.61), and duration of smartphone use (r = 0.80), with negative correlation with MHQ (r = -0.63). Significant differences in were found in the electrophysiological studies of median and ulnar nerves. The mean ultrasound score for both hands was higher in the high smartphone users compared to low smartphone users (15.08 ± 4.17 vs. 6.46 ± 1.38, p < .001). Conclusions: There is increased median nerve CSAs among high smartphone users associated with prolongation of both sensory and motor latencies and slow conduction velocities. Caution should be exercised when using mobile phones, in order to minimize the risk of developing hand musculoskeletal disorders.

Reliability of combination of hyaluronic acid application and early rehabilitation in prevention of postoperative adhesions after primary tendon repair

Background: The aim of the study was to evaluate the efficacy of hyaluronic acid application after tendon repair in prevention of postoperative adhesions, and to clarify the best circumstances that must be fulfilled to obtain this goal. Tissue adhesion usually happens due to injury, foreign-body reaction, bleeding, or infection but is considered an important factor for wound healing. As a result, tendons repair after injury is usually complicated due to limited postoperative movement. Several methods were used to try to prevent postoperative adhesions but most of them did not give satisfactory results as the mechanism of adhesion formation is still unclear.Methods: Fifty patients were included in this prospective study performed at department of plastic, reconstruction and burn surgery, faculty of medicine, Menoufia University over the period of approximately two years (January 2016 to November 2017).Results: Close follow up of the function of the repaired tendons was evaluated repeatedly over the period of 6 months. 40 patients showed excellent progress in regaining function with less possibility of performing adhesions, these patients also expressed satisfaction and comfort toward the regained function. 10 patients showed reasonable progress and were mildly satisfied.Conclusions: Application of hyaluronic acid in addition to a well-planned rehabilitation plan is a good and reliable method against adhesions when performing primary tendon repair.