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.

Knowledge, attitudes and compliance with hand hygiene practices among health care workers in Alexandria main university hospital

Background: Hand hygiene is the simplest and most cost-effective practice for controlling health care associated infections [HCAIs]. Level of adherence and determinants of poor compliance to hand hygiene [HH] among health care workers [HCWs] should be investigated in all health care settings

Objective[s]: The study was conducted to assess knowledge and attitudes of health care workers towards hand hygiene and to assess their degree of compliance with moment one hand hygiene

Methods: A cross sectional study including HCWs [residents and nurses] in Alexandria Main University Hospital was conducted. The World Health Organization questionnaires and observational checklists were used to collect data in addition to a structured questionnaire to assess attitudes towards hand hygiene. Knowledge and attitude scores were calculated

Results: Only 15.5% of the studied HCWs had satisfactory level of hand hygiene related knowledge and more that half of them [55.8%] had a fair level of knowledge. The majority of HCWs [91.3%] agreed that hand hygiene practices are not practical in emergency situations. About half [49.5%] of them didn't feel guilty when they omit hand hygiene practices. Hand hygiene practices were missed in the vast majority of opportunities [>95%]. Gloves were not available at any of the internal medicine or surgical wards but were rarely or intermittently available at the studied intensive care units [66.7% and 33.3% respectively]. The most common cited barriers to hand hygiene practices among the studied HCWs were lack of sinks, soap, paper towels and alcohol-based hand rub

Conclusion: Training, education and motivation of HCWs in Alexandria Main University Hospital in addition to availability of the required resources and supportive environment are the best ways to improve the level of compliance with hand hygiene