过度使用智能手机会影响手部功能


  【24drs.com】新研究显示,相较于没那么常使用智能手机者,最常频繁使用智能手机的大学生,最可能发生正中神经肿大,手部功能与捏的力量受损。不过,在线发表于6月3日Muscle & Nerve期刊的这篇文章是横断面研究,还未充分厘清过度使用智能手机与腕隧道症候群(carpal tunnel syndrome,CTS)的关联。
  
  第一作者、土耳其伊斯帕尔塔Suleyman Demirel大学物理医学与复健系医学部的Esra Erkol Inal医师表示,这篇研究结果的实际临床证据未知,需要后续研究探讨智能手机高度使用者正中神经肿大的临床证据。
  
  另外,Inal医师表示,青少年应该知道这些袖珍设备的危险。
  
  研究者指出,手持智能手机强迫使用者必须反覆进行手腕的弯曲/伸展,使用大拇指打字,这些动作都与腕隧道症候群的病因-病理生理学有关。
  
  这个议题越来越重要,因为有更多年轻人使用智能手机与其它手持装置。研究者发现,学生们目前平均一天有3小时以上用他们的手机打字、收发邮件、安排行程、浏览网页。
  
  这篇研究包括了102名大学生,其中66人用单手使用智能手机,另外36人没有使用智能手机。研究者根据他们的智能手机使用情况将他们分成3组:未使用者、低度使用者、高度使用者。
  
  他们是依据智能手机成瘾量表(Smartphone Addiction Scale,SAS)进行分类,土耳其版的问卷包括33个问题、使用6分量表,分数越高表示智能手机成瘾风险越高。
  
  Inal医师表示,目前没有官方的智能手机成瘾诊断准则,但是,根据网络成瘾,过度使用智能手机的定义是,它干扰了使用者的日常生活。有报告指出,智能手机成瘾有许多特征,例如:耐受、戒断症候群、全神贯注、情绪失调、渴求、失控。
  
  这篇研究中,学生们的SAS分数是84分(中位数分数)以上者,被视为高度使用者,分数低于84分者被视为低度使用者。
  
  研究者进行许多功能评估。为了评估手部功能,他们使用了「Duruoz Hand Index」这份有18个问题的问卷评估日常活动,包括需要力量和旋转的动作、需要灵活度和精确度的动作、以及影响前3根手指灵活度的动作,研究对象对进行这些任务的困难度进行排序。
  
  为了评估抓与捏的强度,研究者使用Jamar手部测力计以及捏力计,研究对象尽可能施力挤压手把、且维持最大握力。
  
  研究者还进行了双侧超音波检查,在研究对象休息和被动屈曲/伸展时,从纵向和轴向观察手腕远端插入点的拇长屈肌(FPL)肌腱,他们也拍摄双手大拇指的纵向和轴向影像。
  
  使用视觉类比量表(visual analogue scale,VAS),研究对象评比他们的惯用手在前一周时、手休息与手动作的疼痛程度。
  
  研究者发现,智能手机高度使用者的正中神经比率显著高于非使用者(P = .022),超音波也显示各组的拇长屈肌肌腱都有扩大,但是以智能手机高度使用者最显著。
  
  Inal医师指出,这代表过度使用,当检查频繁使用智能手机者的手部时,医师应注意正中神经与拇长屈肌肌腱。
  
  这篇研究也显示,视觉类比量表分数与捏力强度有关,智能手机高度使用者和未使用者动作时的VAS疼痛分数都高于智能手机低度使用者(P值分别是P = .016和 P > .05)。
  
  Inal医师指出,大拇指的疼痛随著SAS分数增加而增加,大拇指过度使用可以解释大拇指疼痛,也会影响过度使用者的捏力强度。
  
  藉由以双手使用智能手机取代单手使用,或许可以预防手腕的重复弯曲/伸展,减少正中神经的肿大;把按键设定在智能手机的顶端也可以减少这些风险。
  
  Inal医师表示,但是,我们认为,每天使用智能手机的时间是影响正中神经、捏力强度与手部功能的最重要因素。
  
  资料来源:http://www.24drs.com/
  
  Native link:Smartphone Overuse May Affect Hand Function

Smartphone Overuse May Affect Hand Function

By Pauline Anderson
Medscape Medical News

New research shows that university students who most frequently use a smartphone are more likely to have an enlarged median nerve and to have impaired hand function and pinch strength compared with those who use their smartphones less often.

However, the study, published online June 3 in Muscle & Nerve, was cross-sectional and doesn't yet clearly link heavy smartphone use to carpal tunnel syndrome (CTS).

"The exact clinical relevance of the study findings is not known," said lead author Esra Erkol Inal, MD, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Suleyman Demirel University, Isparta, Turkey. "Future studies are warranted to address the clinical relevance of median nerve enlargement in high smartphone users."

Still, she adds, "Youngsters should be aware of the dangers of these pocket devices," said Dr Inal.

Increasing Use

A hand-held smartphone compels the user to engage in repetitive flexion/extension of the wrist and to use their thumb to text, movements that are involved in the etio-pathophysiology of CTS, the researchers note.

The issue is of increasing importance as more young people use smartphones and other hand-held devices. Research suggests that students now typically spend more than 3 hours a day texting, emailing, scheduling, and browsing the Internet on their mobile phone.

The current study included 102 university students, 66 of whom used a single-hand-held smartphone and 36 of whom didn't use a smartphone. Researchers divided participants into 3 groups according to their level of smartphone use: nonusers, low users, and high users.

They based this use according to the Smartphone Addiction Scale (SAS). The Turkish version of this scale consists of 33 questions rated on a 6-point scale, with higher scores indicating higher risk for smartphone addiction.

There are no official diagnostic criteria for smartphone addiction, but based on Internet addiction, it's defined as the overuse of smartphones to the extent that it disturbs the users' daily lives, said Dr Inal.

"It has been reported that smartphone addiction has many features of addiction, such as tolerance, withdrawal symptoms, preoccupation, mood dysregulation, craving, and loss of control," she noted.

Students in the study with an SAS score of 84 (the median score) or greater were considered high users and those with a score under 84 were considered low users.

Researchers carried out several functional evaluations. To assess hand function, they used the Duruoz Hand Index, an 18-item questionnaire that evaluates daily activities, including those requiring force and rotational motions, those requiring dexterity and precision, and those affecting the flexibility of the first 3 fingers. Participants rated the difficulty in performing these tasks.

To evaluate grip and pinch strength, researchers used a Jamar hand dynamometer and pinch meter while participants squeezed the handle as hard as possible and maintained maximal grip contraction.

Imaging Evaluations

The investigators also carried out bilateral ultrasonography. They observed the longitudinal and axial views of the flexor pollicis longus (FPL) tendon from the distal insertion point to the wrist, at rest and during passive flexion/extension. They imaged bilateral thumb joints axially and longitudinally.

Using a visual analogue scale (VAS), participants rated pain in the dominant hand during the previous week while the hand was at rest and while moving the hand.

The researchers found that the median nerve ratios were significantly higher in participants with high smartphone use compared with nonusers (P = .022). Ultrasonography also showed the enlargement of FPL tendon in all groups, but most markedly in high smartphone users.

This suggests overuse, noted Dr Inal. "Clinicians should be careful about the median nerve and the flexor pollicis longus tendon when examining the hand of someone who is a frequent smartphone user."

The study also showed that SAS scores correlated with pinch strength and that VAS pain in movement was significantly higher among high smartphone users and nonusers than in lower smartphone users (P = .016 and P > .05, respectively).

Pain in the thumb rose with an increase in SAS score, noted Dr Inal. Overuse of the thumb may explain the thumb pain, which could have affected pinch strength in overusers, she said.

It might be possible to prevent the repetitive flexion/extension of the wrist and lessen the enlargement of the medial nerve by using a smartphone with two hands instead of one. Putting the keys at the top of the smartphone may also lessen these risks.

"But we think that duration of daily smartphone use is the most important factor affecting the median nerve, pinch strength, and hand function," said Dr Inal.

Dr Inal has disclosed no relevant financial relationships.

Muscle Nerve. Published online June 3, 2015.

    
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