Biomechanics of the Hand During Handheld Device Use: A Systematic Review
Melinda J Choi, MD, Kyle Y Xu, MD and Kashyap K Tadisina, MD, University of Miami Miller School of Medicine, Miami, FL
Introduction: Cell phone use has become ubiquitous in everyday life. Despite the increased use of handheld devices (HHDs) by adults and children, biomechanical changes of the hand with chronic use of these devices remains relatively unknown. Current studies exist that describe the interaction of hand and forearm muscles, joints, and nerves while using HHDs. The authors performed a systematic review of the effects of HHD use on the biomechanics of the hand to identify potential pertinent surgical anatomical changes.
Methods: A systematic review was performed using PubMed, Embase, Scopus, CINAHL, and Web of Science databases, using search terms related to HHD use and hand biomechanics. Studies examining tablet use were included due to the expanding size of modern cell phones and widespread use in schools and at home.
Results: 1556 studies were screened, with 30 meeting inclusion criteria, including a total of 2269 individuals studied. Studies examined both cell phone (n=26) and tablet (n=5) usage. Kinematics (n=17), muscle (n=13), joints (n=2), nerve (n=5), and tendon (n=2) of the hand were specifically examined. Kinematic and joint studies assessed the position of the thumb carpometacarpal (CMC), metacarpophalangeal (MCP), and interphalangeal (IP) joints while using a HHD. The wrist joint was also examined (n=8). Muscle studies examined either extrinsic only (n=3) or both intrinsic (thenar) and extrinsic muscles (n=10). Nerve studies examined the median nerve, and tendon studies examined flexor pollicis longus (FPL). HHDs can place the thumb in extreme positions of CMC and MCP abduction, MCP and IP flexion, as well as wrist extension and ulnar deviation. Increased muscle activity of the first dorsal interossei (FDI), abductor pollicis longus, and abductor pollicis brevis was demonstrated with HHD use, especially during thumb abduction and flexion. There is evidence of an increase in the cross-sectional area of the median nerve and FPL during cell phone use.
Conclusions: The interaction between the hand and cellular devices is relatively understudied given the prevalence of use. Surgically relevant areas of the hand that are impacted by HHD use include the median nerve, first dorsal extensor compartment tendons, thenar muscles, FDI, and both the CMC and MCP joint of the thumb. Future studies examining long-term effects of HHD use on the hand and wrist with respect to surgical implications are warranted.
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