DETERMINATION AND INCIDENCE OF PERSISTENT FINGER JOINT PAIN AMONG MALE COLLEGE STUDENTS DUE TO MOBILE PHONES OVERUSE.

Ahmed Abdelmoniem Ibrahim 1 , Mohamed raffat Mohamed atteya 2 , Ehab Mohamed Kamel 2 , Hamad Fahad hamad alshammri 2 and Abdulaziz Saud Abdulaziz Al-shaya 2 .  1. Ph D. PT Physiotherapy Department, Cairo university hospitals, Cairo; Egypt pox -11562. 2. Ph. D. PT Physical Therapy Department, College of Applied medical sciences, University of Hail–KSA pox. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


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The medical name for the condition is De Quervain's syndrome and is associated with the tendons connected to the thumb through the wrist. Causes for the condition extend beyond smart phones and gaming consoles to include activities like golf, racket sports, and lifting. (4) Work-related musculoskeletal disorders (WMSDs) of the upper extremities (UE) are common and potentially disabling, yet preventable. WMSDs comprise a heterogeneous group of diagnoses which include numerous specificclinical entities, including disorders of the muscles, tendons and tendon sheaths, nerve entrapment syndromes, joint disorders, and neurovascular disorders. In 1994, 332,000 musculoskeletal disorders due to repeated trauma were reported in United States workplaces, representing nearly 65% of the occupational disease cases . (4) The popularity of text messaging or SMS on mobile phones has given rise to a new injury called text Messaging injury .TMI is a form of Repetitive strain injury (RSI) which is described by pain associated with loss of function in a limb resulting from repetitive movement or sustained static loading . TMI is normally caused by overuse of thumb during text messaging on mobile phone . Besides TMI, there are other terms, such as Blackberry thumb and Gamers thumb, to describe RSI related to wire-less hand held and video games devices . The research into the effects of text messaging on the thumb and related fingers has been limited . Most RSI research concentrated on computers since keyboard users or office workers have been identified to have high levels of job discomfort. It has been found that upper extremity musculoskeletal disorder , such as carpal tunnel syndrome CTS are associated with computer keyboard usage . factors contributing to CTS and job discomfort were found to be related to speed and force of keyboard operation . Text messaging usually involves the use of thumb of one hand to type on phone keypad.
The movement of the thumb covers motion in planes of flexionextension , abduction -adduction and opposition . these motions occur simultaneously in three dimensions and as a result , it is difficult to determine the kinematics of the thumb. Measurements of thumb motion have been made in earlier researches using marker based optical motion capture system , goniometry and fluoroscopy. TMI is affecting more and more children and young adult due to excessive text messaging . the objective of the study was to determine the thumb motion and typing forces on keypad of mobile phone during text messaging. (5) The hands are essential for most occupational and daily living activities. Pain and loss of hand movement-related functions decrease the patient's ability toperform manual tasks and diminishes the patient's quality of life. (6)(7)(8) Women are more vulnerable than men to the effects of hand problems on their daily activities. (7) The prevalence of hand pain in the general population varies between 12% and 32% . (7-8) Depending on the definition of the symptoms (severity and duration). The prevalence of hand pain seems to increase with age. (10)(11)(12) The incidence of hand pain was 22% among a group of older adults, and women reported higher incident hand pain than men, with little influence of age on hand pain . (8) Among the other risk factors that may contribute to hand pain are occupational loading and overuse of the hand . (13)(14) The biomechanical factors related to the differential use of the hands and their joints may also play a role in the development of pain, The forces generated by diverse hand activities produce different loads on the finger joints. A biomechanical analysis of finger joint load showed that fine pinch grip resulted in greater loads than power grip.
Previously, we have shown that pain is more common in the right than the left hand, in the thumb, index, and middle fingers comparedwith the little finger, and in the inter phalangeal (IP) joints compared with the metacarpo phalangeal (MCP) joints . (16) Objectives:the purposes of this study was determine if there is effect of prolonged use of smartphone on hand grip strength and pinch strength and the pain related to overusing of phones. This study aimed at students of the University of Hail.
1859 Methodology:-Subjects:-Inclusion criteria:-This study was conducted to120 students from Hail university in KSA participated from various departments aged between 18-27.
Exclusion criteria:-Cases having past history of fracture or intractable disease of hand and general weakness were removed from this study .
Procedure:-Type of handedness determination and the Time from Using smart phones was conducted through questionnaire which consisted of a total 16 question items. Grip and pinch strength was measured with dynamometer (hydraulic hand dynamometer ) , pinch strength was measured using pinch gauge (pinch gauge ) and assesse pain by numeric scale .The subjects were seated with their knee flexed 90° and back rested on chair , shoulder adducted and neutrally rotated, elbow flexed at 90°, forearm in neutral position, and wrist 0-20 flexion. The thenar group of muscle is rested on the handle of hand dynamometer.
For each strength test the scores of three successive trials were recorded for each hand .

Equipments:-
The standard, adjustable-handle dynamometer, reported as the most accurate for measuring grip strength, was used. For standardization, it was set at the second handle position for all subjects. The dynamometer was lightly held around the readout dial by the examiner to prevent inadvertent dropping . The pinch gauge, used to measure key pinch was held by the examiner at the distal end to prevent dropping . Scores were read on the needle side of the red readout marker. The calibration of both instruments was tested periodically during the study.
Data analysis:-SPSS version 16 was used for data analysis. Descriptive data was calculated , The percentage of type of dominant hand , grip and pinch strength for both right and left hand and pain scale.   Discussion:-Readings in correspondence with duration of usage graph -1:-People who have used of smart devices for more than 10 years have a significant decrease in the strength of the grip and pinch both compared to those who use it less. The rate of pain in this group is from 3-5 regarding to numeric rating scale and termed as mild to moderate pain. Followed by groups of 3-4 and 5-6 years which were somewhat similar in readings.

Results:-
The first group from 1-2 years recorded the highest readings, which is the normal range for the strength grip and pinch both .
Related to the kind of Handedness graph -2:in this study show people how right-handedness and grip pinch is more powerful compared to those who have lefthandedness , but can cause a number of R handedness in this study represent 105 and L handedness 15 subject only may helped in the incorrect judgment.
Generally, the dominant side grip strength is more strong than non-dominant side grip strength . (19) There are a dominant side hand have 30% more strong than a non-dominant side hand but normally it is strong about 5-10%. there are a dominant side have 5-7% more strong grip and pinch than a non-dominant side hand in the type of right hand. there are not difference in the type of left hand Be very aware of stiffness, sharp pain or dull ache, numbness or tingling, or poor grip, which may come on after a heavy session on the computer using either the keyboard or the mouse, or when using a pen, or with thumb movements when using a Games Console, or when texting on a mobile phone. (20)(21) Try to take breaks between hand activities, of a few minutes each half-hour or ten minutes each hour. Massage your hands and arms to restore the circulation and refresh the muscles and tendons. Flex your fingers, and stretch your arms out to the side, above your head, then to your sides, keeping your spine straight. This applies at home or at schoolif possible Do warm up exercises the same as when you do before. Gentle exercise can only help.

Conclusion:-
We conclude from this study Increased the duration of using of smart devices reduces the grip and pinch strength .
Strength of Dominant hand is more than that of Non-dominant hand .

Recommendations;-
Checklist for Mobile Using Be aware that by using a mobile phone and holding it in one hand, with that hand in a claw position, and when moving the thumb rapidly over the keypad , puts an enormous strain on tendons in the hand and arm.
In between , massage your hand and thumb, and rotate your hands at the wrists, in clockwise and anticlockwise directions. If it already hurts to text, use the fingers of the other hand or the end of a pen to press the keypad, reduce using your phone, and get medical help. Keep a diary of any aches and pains, and when, and for how long you use the equipment.

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But rememberprevention is better than cureyou only have one body & one life.
For Future Researchers:= Use a larger segment of participants, both males and females and compare between them from different ages. and record the most important differences. And record other combination of differences including examination of various pinches and grasps.
Limitations:-Due to lack of awareness regarding proper physiotherapy techniques which can avoid the repetitive strain injury RSI the number of participants in this study were 120 only .