Monday, October 24, 2011

Cell-Phone Elbow

Minimize the Perils of Mobile Technology
By now, most people have heard of BlackBerry thumb. Recently, there has been talk of a new repetitive strain injury called “cell-phone elbow.” As technology advances, allowing us to do more tasks on smaller equipment, our bodies often pay the cost. With a growing potential for injuries from tools we rely on, it’s a good time to educate your patients about what they can do to minimize their risk.

Addressing Cell-Phone Elbow
Dr. Peter Evans, director of the Hand and Upper Extremity Center at Cleveland Clinic, recently coined the term “cell-phone elbow” to describe the paresthesias, pain and weakness some people experience from excessive phone use. These symptoms can progress to atrophy, weakness and clawing of the ulnar digits, affecting daily living tasks, as well as typing and writing.

Cell-phone elbow is not a new diagnosis but simply a new name for cubital tunnel syndrome. The two biggest controllable risk factors for cubital tunnel syndrome are prolonged flexion of the elbow at greater than 90 degrees and pressure placed directly on the ulnar nerve as it passes around the underside of the elbow. With technology allowing for full Internet access, social networking and entertainment to be performed from cell phones, more people spend greater time using them. The more time spent staring at that little screen, the longer people keep their elbows bent, which diminishes blood flow to the nerve and results in injury. Compounding the problem is resting on the flexed elbow when using the cell phone at a desk or in a car, which leads to direct nerve compression, in addition to elbow flexion.

Doctors of chiropractic can play a key role in educating patients about the risks of excessive time holding a phone to the ear and looking at a screen. If your patients experience overuse symptoms, it is also important to help them analyze the other activities they do that may contribute to the problem. Sleeping with the elbows bent and habitually crossing the arms, as well as working on a surface that is too high, pinch the nerve and should be addressed.

To eliminate prolonged elbow bending, remind patients to use headsets, which free the hands to take notes or type, eliminating the need to pinch the phone between the ear and shoulder. Simply showing patients what happens to the vertebrae and nerves in this extreme side-bent position is often enough motivation to get them to begin using a headset.

Avoiding Posture Pitfalls
The popularity of texting, combined with the increasing amount of time spent in front of a computer, will very likely contribute to worsening posture. Teens and young adults are particularly at risk. Many people find it challenging to maintain their posture in everyday tasks. When you add staring intently at a small screen for long periods, it is easy to fall into a slouched, head-forward position.

Teach your patients to sit upright with the head over the shoulders while using the phone. If the PDA is to be used for lengthy typing, see if an external keyboard can be used. Resting the forearms on a pillow while texting or typing will also help minimize neck tension by allowing the upper traps to relax. Cue patients to look down with the eyes and gently tuck the chin to maintain a healthier posture.

In addition, make sure the screen is easy to read. Straining to see what is on the screen leads to jutting the chin forward, shifting work from the spine to the muscles to hold the head up. Avoiding use of PDAs while in bright sunlight can help.

While they describe conditions known before recent advances in technology, terms such as “BlackBerry thumb,” “Wii-itis” and “cell-phone elbow” don’t simply give new names to old problems. If these new terms help the public begin to recognize how everyday tasks can place them at risk for injury, maybe our patients will take ownership of their own health, instead of passively expecting others to “fix it.” Our role is to help them move in that direction.

By Chris Sorrells, OTR, CHT, CEAS. Chris Sorrells is the president of, a free online resource for health professionals. He can be reached at

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