ABSTRACT
Background:
This study aimed to demonstrate the association between smartphone use and De Quervain’s syndrome in Saudi Arabian teenagers, as well as to establish the length of phone use among these patients in order to evaluate whether it was connected to the emergence of De Quervain’s tenosynovitis.
Methodology:
This cross-sectional observational study was conducted among teenagers in Saudi Arabia studying in public and private schools. Most of the inquiries were closed-ended and sought information regarding the students’ use of various mobile phone sizes, regular text messaging, discomfort in the wrist or thumb, swelling or a snapping sound over the thumb, and limitations or pain aggravation when handling various objects.
Results:
The total number of teenagers that participated in the study was 200; 111 (55.5%) of them were males, while the remaining 89 (44.5%) were females. Out of 200 participants, 135 (67.5%) tested positive for Finkelstein disease; of these, 21 (15.5%) used smartphones for under 4 hours, 53 (39.2%) used smartphones for 5–7 hours, and 21 (15.5%) used smartphones more than 10 hours with P value of 0.008, which is significant and hence concluded that duration of using mobile phones had impact on De Quervain’s disease.
Conclusion:
In conclusion, Finkelstein’s sign, a marker that De Quervain’s illness is widespread, was present in 67.5% of the patients. Current findings suggest that De Quervain cannot be completely ruled out because of this population’s propensity to develop it.
KEYWORDS: De Quervain’s disease, Saudi Arabia, smartphones, teenagers
INTRODUCTION
De Quervain’s disease is a common cause of wrist pain, mainly affecting adults. It is characterized by inflammation of the extensor pollicis brevis and abductor pollicis longus tendons and thickening of their synovial sheath.[1] Based on the findings of the physical examination and history, De Quervain’s tenosynovitis is diagnosed. When the wrist deviates ulnarly, the pain worsens by tucking the thumb between the other fingers, known as a favorable Finkelstein’s sign.[2]
The functionality and reach of smartphone technology have rapidly increased over the past 20 years.[3] De Quervain’s tenosynovitis is closely associated with smartphone use, texting, playing video games, and other activities.[4] In a recent cross-sectional study, it was discovered that there is a direct correlation between extensive smartphone use and hand pain among medical students at King Abdulaziz University (KAU) in Jeddah.[5] Studies on the relationship between smartphone addiction and other musculoskeletal problems, as well as the potential for developing De Quervain’s tenosynovitis due to phone use, have been conducted.[6]
Repetitive wrist motion can cause De Quervain’s tenosynovitis, as is well known, but other risk variables, such as age and sex, can also play a role in the onset of this condition. A study that examined the effect of age on the ailment found that women in their thirties to sixties experience the highest prevalence of De Quervain’s tenosynovitis among all age groups.[7] A 2016 study investigated the relationship between De Quervain’s tenosynovitis and the dominant hand as opposed to the non-dominant hand using the Disabilities of Arm, Shoulder, and Hand scores. It shows that hand dominance had no impact on how the issue arose.[8] This study aimed to demonstrate the association between smartphone use and De Quervain’s syndrome in Saudi Arabian teenagers as well as the prevalence of the disorder in both sexes.
METHODOLOGY
This cross-sectional observational study was conducted among teenagers in Saudi Arabia studying in public and private schools. Three hundred eighty-four teenagers were chosen as the target sample size using the standard method for estimating sample size based on prevalence.
The prevalence was set at 50% because no appropriate statistics were available. With a 95% confidence level, the bound of error of 5% was chosen. The intended sample size of children was unmet, so a sample of 200 teens was used instead.
Most of the inquiries were closed-ended and sought information regarding the students’ use of various mobile phone sizes, regular text messaging, discomfort in the wrist or thumb, swelling or a snapping sound over the thumb, and limitations or pain aggravation when handling various objects. In addition to the questionnaire, the Numerical Pain Rating Scale was used to observe the severity of the pain.[2] The Finkelstein test was used to determine whether De Quervain’s tenosynovitis was present.
For the Finkelstein test, the participants were instructed to tuck their thumbs between their fingers to make a fist. While maintaining forearm stability, the examiner passively deviated the wrist. When the affected side was substantially more tender than the unaffected side, it was considered a positive test for pain at the radial wrist over the Abductor pollicis longus and Extensor pollicis brevis tendons.
RESULTS
The average age of the participants was 16.63 ± 1.59 years. The gender distribution included 89 males (44.5%) and 111 females (55.5%). Regarding education, 135 participants (67.5%) were in school, 50 participants (25%) were in college, and 15 participants (7.5%) were in university. In terms of dominant hand, 27 participants (13.5%) were left-handed, 165 participants (82.5%) were right-handed, and 8 participants (4%) used both hands equally.
Most teenagers use their right hand as the dominant hand to operate their cell phones. With a P value of 0.0001, which is highly significant, it was discovered that the NPRS score acquired throughout the test was higher in the right dominant hand than the non-dominant hand. In contrast to their non-dominant hand, people using mobile phones with their left dominant hand reported higher pain on the NPRS. When we compared the mean score of NPRS Right and NPRS Left among the left dominance group, we did not find a significant connection with a P value of 1.00 as we did in the right dominant group [Table 1].
Table 1.
Comparison of numerical pain rating scale with dominance of hand among mobile users
| Groups | Mean± | t test | P |
|---|---|---|---|
| Right Hand Dominance | 5.7 | 0.00001 | |
| NPRS Left hand | 2.75±2.57 | ||
| NPRS Right hand | 1.25±1.50 | ||
| Left Hand Dominance | 0.001 | 1 | |
| NPRS Left hand | 2±2 | ||
| NPRS Right hand | 2±2.65 |
When the Finkelstein test and pain experienced while using a mobile phone were analyzed, it was discovered that 120 (60%) participants complained of thumb or wrist pain. Among this group, 101 participants tested positive for the Finkelstein test, whereas 65 positive cases of De Quervain’s tenosynovitis were reported among 80 (40%) participants who did not have any pain while using mobile phones. We observed that 23 (17%) teenagers had no trouble unscrewing the jar lid, while 21 (15.5%) teenagers had mild and 10 (7.4%) had moderate difficulty (P value = 0.043). When it came to keyboard typing, 48 (35.5%) had no difficulty in typing on a keyboard in the past three weeks, compared to 16 (11.8%) mild and 9 (6.6%) moderate cases (P value = 0.04) [Table 2].
Table 2.
Pain and discomfort compared with the Finkelstine test
| Parameters | Total cases n (%) | Finkelstine test | Chi square test | df | P | |
|---|---|---|---|---|---|---|
|
| ||||||
| Positive n=135 | Negative n=65 | |||||
| Pain felt in thumb/wrist during the use of mobile | 3.84 | 1 | 0.02 | |||
| Yes | 120 (60%) | 101 | 19 | |||
| No | 80 (40%) | 65 | 15 | |||
| Thumb movement difficulty | 0.54 | 2 | 0.76 | |||
| Mild difficulty | 45 (22.5%) | 25 | 20 | |||
| Moderate difficulty | 15 (7.5%) | 7 | 8 | |||
| No difficulty | 140 (70%) | 70 | 70 | |||
| Difficulty in pinching last three weeks | 7 | 2 | 0.03 | |||
| No difficulty | 130 (65%) | 65 | 65 | |||
| Mild difficulty | 60 (30%) | 20 | 40 | |||
| Moderate difficulty | 10 (5%) | 2 | 8 | |||
| Difficulty in gripping in last three weeks | 3.94 | 2 | 0.13 | |||
| No difficulty | 113 (56.5%) | 90 | 23 | |||
| Mild difficulty | 62 (31%) | 41 | 21 | |||
| Moderate difficulty | 25 (12.5%) | 18 | 7 | |||
| Difficulty in typing on keyboard in last three weeks | 6.23 | 2 | 0.04 | |||
| No difficulty | 148 (74%) | 48 | 100 | |||
| Mild difficulty | 38 (19%) | 16 | 22 | |||
| Moderate difficulty | 14 (7%) | 9 | 5 | |||
| Difficulty in unscrewing jar lid in past three weeks | 1.85 | 2 | 0.39 | |||
| No difficulty | 101 (50.5%) | 23 | 78 | |||
| Mild difficulty | 67 (33.5%) | 21 | 46 | |||
| Moderate difficulty | 32 (16%) | 10 | 22 | |||
DISCUSSION
The study also revealed that smartphone usage is rising due to smartphones replacing traditional leisure activities. Research conducted in China[9] observed 43.4% of participants suffering from thumb or wrist pain due to using various electronic gadgets. According to a study conducted in 2020 by Bashar Reada et al.,[10] 112 (48%) of the 233 individuals with a positive Finkelstein’s sign claimed that the pain was more severe in the dominant hand. Whereas in the current study, 101 (74.8%) positive cases with severe pain in the thumb and wrist were reported. According to the results of the present study, the dominant hand’s NPRS is higher than the non-dominant hand’s. The current study said that people who pass the Finkelstein test have a strong correlation with mild difficulties performing daily tasks.
In the current study, the frequency of De Quervain’s disease is significantly correlated with the number of texts sent each day. As the number of readers increases, so does the incidence of a positive Finkelstein’s test, rising from 40% in those who send fewer than 50 texts to 64% in those who send 50–100 texts to 45.7% in those who send 100 to 200 texts to 80.9% in those who send more than 200 texts. We contrasted our results with those from related studies. Increased text messaging and a higher incidence of the Finkelstein test were found by Eapan et al.[11] In the current study, 120 (60%) of the 200 teenagers reported having thumb or wrist pain. These numbers are higher than the findings of a survey by Ayman Baabdullah et al.,[5] who discovered that 20.4% of participants experienced thumb/wrist pain. Vicente Aleixandre’s[12] research in Peru in 2020 found a correlation between problematic smartphone use on occasion or frequently and a higher prevalence of DQT symptoms as measured by the Finkelstein test, as well as a correlation between the number of hours per day spent using a smartphone and the prevalence of DQT.[12] Chronic overuse can result in inflammation of the tendons and tendon sheaths, which narrows the first dorsal compartment and restricts the motion of the tendons. This inflammation is brought on by repeated gripping, clutching, or wringing of things. Inflammation and stenosis gradually narrowing, if left untreated, can result in scarring that further restricts thumb motion.[13] Male students in this study had a 6% higher prevalence of De Quervain’s disease than female students, which is not a significant difference. There are differences in the results because although the population is homogeneous, there was some heterogeneity.
CONCLUSION
Using the Finkelstein test, the present study discovered a high correlation between almost every characteristic of cell phone use. Based on several other mobile phone-related factors, the current study provides data on the prevalence of De Quervain’s disease and its relationship to excessive mobile phone use.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The author extends the appreciation to the Deanship of Postgraduate Studies and Scientific Research at Majmaah University for funding this research work through the project number (R-2024-1228). The authors would like to thank the Deanship of Scientific Research at Shaqra University for supporting this work.
Funding Statement
Nil.
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