'Selfie Elbow'- A Public Health Problem among Mobile Users

Abstract

Introduction: While taking a selfie picture, a person is in a position in which the arm is fully extended or sometimes a little bent and maintained until the picture of choice is adjusted in the camera frame. One Person must have a firm grip on phone to hold it and hit click. When the process is repeated for a few photos, it causes repetitive strain injury, resulting in various signs, including pain in the elbow joint, which has now been named 'selfie elbow.' Doctors assume that as many as 25% of cell phone users in Kolkata are suffering from this problem (selfie-elbow). Although a selfie is generally seen as an expression of self to others, the American Psychiatric Association (APA) has officially confirmed that taking 'selfies' is seen as a mental disorder and has been given the term 'selfitis.' Selfie elbow is a condition due to overuse injury caused by extending and twisting one's arm for too many phone selfies. Like tennis elbow or golfer's elbow, an addiction to selfie-taking and clicking too many can cause pain in your primary picture-snapping elbow and may affect the upper limb, elbow, and shoulder muscles – which leads to degradation in function. Joints involved in the process of selfie-taking are the shoulder joint, the elbow joint, and the wrist joint, all of which help the hand attain a perfect frame for the picture. However, most of the strain is referred to the elbow, because the person extends (or sometimes bends) the elbow in an extremely strained position during the selfie. Selfie elbow is more of an abnormal and repetitive loading of muscles around the elbow, leading to microruptures, and resulting in inflammation and pain; this ultimately heals with scarring, but causes recurrent pain. As stated, it is a form of repetitive stress injury, similar to carpal tunnel syndrome (or the compression of the median nerve in the wrist, usually due to overuse of the hand) and tendonitis (which occurs when the tendon becomes inflamed).

Full text

'SELFIE ELBOW'- A PUBLIC HEALTH PROBLEM AMONG
MOBILE USERS
Affiliation
1. Assistant Professor, Department of Human Anatomy, B.P. Koirala
Institute of Health Sciences, Dharan, Nepal
2. Assistant Professor, Department of Anatomy, Chitwan Medical
College, Chitwan, Nepal
3. Lecturer, Department of Anatomy, Devdaha Medical College and
Research Institute, Rupandehi, Nepal
A R T I C L E I N F O
Article History
© Authors retain copyright and grant the journal right of first
publication with the work simultaneously licensed under
Creative Commons Attribution License CC - BY 4.0 that allows
others to share the work with an acknowledgment of the
work's authorship and initial publication in this journal.
Received : 5 September, 2018
Accepted : 23 April, 2019
Published : 30 April, 2019
Citation
Khanal L, Khan GA, Pandeya A. 'selfie Elbow'- A Public Health Problem
Among Mobile Users. BJHS 2019;4(1)8: 675-679
* Corresponding Author
Dr Laxman Khanal
Assistant Professor
Department of Human Anatomy
B.P. Koirala Institute of Health Science, Dharan, Nepal
Email ID : laxman.khanal.bpkihs@gmail.com
Orcid ID: https://orcid.org/0000-0002-1304-0103
ABSTRACT
While taking a selfie picture, a person is in a posion in which
the arm is fully extended or somemes a lile bent and
maintained unl the picture of choice is adjusted in the
camera frame. One Person must have a firm grip on phone to
hold it and hit click. When the process is repeated for a few
photos, it causes repeve strain injury, resulng in various
signs, including pain in the elbow joint, which has now been
named 'selfie elbow.' Doctors assume that as many as 25% of
cellphone users in Kolkata are suffering from this problem
(selfie-elbow).
Although a selfie is generally seen as an expression of self to
others, the American Psychiatric Associaon (APA) has
officially confirmed that taking 'selfies' is seen as a mental
disorder and has been given the term 'selfis.' Selfie elbow is
a condion due to overuse injury caused by extending and
twisng one's arm for too many phone selfies. Like tennis
elbow or golfer's elbow, an addicon to selfie-taking and
clicking too many can cause pain in your primary picture-
snapping elbow and may affect the upper limb, elbow, and
shoulder muscles – which leads to degradaon in funcon.
Joints involved in the process of selfie-taking are the
shoulder joint, the elbow joint, and the wrist joint, all of
which help the hand aain a perfect frame for the picture.
However, most of the strain is referred to the elbow, because
the person extends (or somemes bends) the elbow in an
extremely strained posion during the selfie. Selfie elbow is
more of an abnormal and repeve loading of muscles
around the elbow, leading to microruptures, and resulng in
inflammaon and pain; this ulmately heals with scarring,
but causes recurrent pain. As stated, it is a form of repeve
stress injury, similar to carpal tunnel syndrome (or the
compression of the median nerve in the wrist, usually due to
overuse of the hand) and tendonis (which occurs when the
tendon becomes inflamed).
KEYWORDS
Elbow Joint, overuse injuries, inflammaon, carpal tunnel
syndrome, tendonis.
MRA 1
DOI: hp://dx.doi.org/10.3126/bjhs.v4i1.23952
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1* 2 3
Khanal L , Khan GA , Pandeya A
Khanal L et al
ISSN: 2542-2758 (Print) 2542-2804 (Online)
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Vol.4/No.1/Issue 8/ Jan - April, 2019
HIGHLIGHTS
· The American Psychiatric Associaon (APA) has officially confirmed
the taking selfies as a mental disorder and named it 'selfis'.
· Selfie elbow' is a condion of overuse injury and micro-trauma of the
muscles and tendons at elbow caused by twisng and extending the
arm for taking too many selfies photos.
· During the period from 2014 to 2016, 52 deaths were recorded
globally of which 25 cases belonged to India.
· Use of icepacks, muscle exercise, medicaons, and use of selfie scks
for reducing the stress are suggested by experts for the management
of 'selfie elbow'.

INTRODUCTION
It is very difficult to say whether the newer technologies for
example mobile phones are boon or bane. It has become an
indispensable tool in the hands of young generaon. It has
replaced a watch, calendar, calculator, camera, radio, phone
1,2
book etc. Selfies are popular, and not just popular among
3
our youth, but popular across all generaons! Merriam-
Webster diconary defines selfie as 'an image of oneself
taken by oneself using a digital camera especially for posng
4
on social networks'. The term 'selfie' appear in paper or
th
electronic medium first me on 13 of September 2002 in an
Australian internet forum by an Australian person (Nathan
Hope). Oxford English Corpus, which is an archive of electronically
stored structured set of texts, collected millions of words
each month. This database was analysed by Oxford English
Diconary (OED) in daily basis to track new and emerging
words. On the basis of stascal analysis the OED declared
5
the word of the year 2013 as 'selfie'.
Selfie photographs like all photograph are posted online to
6
express and to convey a parcular impression of oneself.
Due to this reason, selfies are very popular nowadays.
Millions of selfies are becoming a new medium for self-
expression and self-representaon through various social
7
media to keep themselves in other people's minds. People
1
became crazy in taking selfies and got into problems. During
the period from 2014 to 2016, 52 deaths were recorded
8,12
globally of which 25 cases belonged to India. Even though
taking selfies is taken as a way of expression of oneself to
others, the American Psychiatric Associaon (APA) has
officially confirmed the taking selfies as a mental disorder
and named it 'selfis'. It defines 'selfis' as an obsessive
compulsive desire to take one's photos and post those on
social media as a way of geng compensaon of lack of self-
13-,14
esteem and gap in inmacy.
This smartphone obsession has already lead to variety of
well-documented tech injuries like text claw, iPad hand,
muscle problems, osteoarthris and even tendinis of the
15-17 18
thumbs. “Selfie elbow” is the latest one among them.
Selfie elbow is a condion of overuse injury caused by
twisng and extending the arm for taking too many selfies
photos. Repeve overuse, stretching and awkward
posioning resulted in microtrauma or connuous stress of
19
the muscles and tendons at the elbow. Muscles and
tendons work to keep the muscle aached to the bone as
20
well as help extend and stabilize the wrist. Like in the tennis
elbow or golfer's elbow, mulple selfies taking and clicking
may cause pain in the primary picture snapping elbow and it
may further affect shoulder muscles which may lead to
21
compromise in normal funcons. Even in people who do
not have habit of being involved in sport like tennis or golf
requiring repeve use of extended arm and jerks on the
elbow, are found to have pain and other similar symptoms of
22
sport related injuries. This latest tech injury is named as
23
selfie elbow. Experts of 'shoulder surgery department'
claims that there is always a possibility of injury to joints like
21
elbow by incorrect stretching of the tendons. One case of
an American journalist, HodaKotb, was found to be reported
for her affecon of selfies, but the high prevalence of taking
selfies suggest that there are many more undiagnosed cases
23
in different part of world. Doctors in Kolkata (India) were
puzzled when more numbers of youngster visit them with
the complaint of elbow pain, later it was revealed that those
youngsters were involved in taking too many selfies for
uploading in social media. Doctors assumed that around
25% of cellphone users in Kolkata are suffering from 'selfie
24
elbow'. Since taking selfies is a new fad, the experts suggest
that the number of paents will rise in near future. Though
normal gaming, chang or texng on cellphone may lead to
similar condion, taking selfies could hasten the injury since
the process of taking selfies involve raising the arm in
24
abnormal way for longer period of me.
ANATOMICAL CONSIDERATION
Shoulder joint, elbow joint and wrist joint help the upper
arm to aain a posion for perfect frame for the picture, so
are the joints involved in process of selfie taking. Despite the
involvement of these joints, most of the strain is taken by the
elbow because a person extends and bends a bit the elbow in
an extremely strained state during capturing the selfie. Such
a strained posture of the upper limb is responsible for the
repeve strain and overuse of the structures around the
elbow making it a target joint for selfie elbow. Pain and
discomfort in elbow is thought to be due to inflammaon and
micro-rupture of the tendons passing through the elbow
20
joint due to repeve moon.
Knowledge of funconal anatomy and biomechanics of the
elbow is very important. The elbow joint is a joint between
the lower end of the humerus and upper ends of the radius
and ulna. It is the hinge type of synovial joint. Stability of the
elbow joint is provided by the pulley shaped trochlea of the
humerus and jaw like trochlear notch of the ulna and
25
ligaments. The complexity of the joint is increased by its
connuity with the superior radio-ulnar joint. It includes two
arculaons: the humero-ulnar, between the trochlea of the
humerus and the ulnar trochlear notch, and the humero-
radial, between the capitulum of the humerus and the radial
20
head.
Most of the ligaments are in real sense specialized thickening
of the joint capsule. The elbow joint has six degrees of freedom:
flexion/extension, pronaon/supinaon, and valgus/varus
26
funconal moons. Elbow has mainly medial and lateral
collateral ligaments with former having two parts: anterior
bundle and posterior bundle. Due to slight difference in
origin of ligaments, lateral collateral ligament (LCL) becomes
tense uniformly during elbow flexion and extension, while
medial collateral ligament (MCL) is taut at different posion
during elbow flexion. LCL in general takes its origin from the
lateral epicondyle of the humerus and terminates diffusely
in the annular ligament, while MCL get its origin from the
medial epicondyle and got aached itself to the coronoid
7
and olecranon processes of ulna. The LCL and the anterior
bundle of the MCL originate from points through which the
26
axis of rotaon passes.
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There are seven muscles in the back of the forearm crossing
the elbow joint. Among these, most lateral one is the
extensor carpi radialis brevis (ECRB) which is covered by
19
extensor carpi radialis longus (ECRL). In addion to the
lateral epicondyle, ECRB has its origin from the LCL and
intermuscular septa. The tendon of ECRB inserted on Lateral
side of the dorsal surface of the base of third metacarpal
bone. Study of ECRB by electromyography had shown its
strong acvity at all me during roune funconal acvies,
but the main acon of this muscle is pure wrist extension
7-27
with some degree of radial deviaon.
PATHOPHYSIOLOGY
In precise sense selfie elbow is an abnormal and repeve
loading of muscles around the elbow causing micro-rupture
an d in flamma on of tendo ns lea ding to pain an d
discomfort, which ulmately heals with scarring and might
cause recurrent pain. It is a form of repeve stress injury,
similar to carpal tunnel syndrome (caused by median nerve
compression in the wrist, usually due to overuse of the
hand) and tendonis (occurs when the tendon becomes
23,28
inflamed). Such pathological changes in elbow may
iniate severe pain with minimal stress causing painful
inhibion of muscles resulng in further weakening.
Repeated painful inhibion of muscles may build up stress
through such vicious cycle and lead to severe loss of
29
funcon. Nothing in human evoluon necessitated the
arm to be extended ll your ligaments begin stretching, your
palm to be turned inward, and the thumb to be bent at an
unnatural angle to tap the screen connuously while
24
craning your neck to fit in the frame.
Any abnormal posture is going to put muscles and bones
under stress. Taking selfies involve an unusual arm posion
and repeang the act could be injurious and stressful.
Keeping arm raised for long me to click selfies causes the
elbow muscles under severe strain. Repeang the same
acon eventually makes the elbow muscles under strain and
puts pressure on the bone, leading to inflammaon and
24
severe pain.
Muscle causing the extension and flexion of elbow joints are
mainly originated from the lateral and medial epicondyle of
the humerus respecvely. Tearing of tendon of extensor
carpi radialis brevis (ECRB) lead to lateral epicondylis during
acvies requiring repeve supinaon and pronaon of
26
the forearm with full extension of the elbow joint.
Signs and Symptoms:
Clicking selfies inially starts with fun and me pass, but
gradually it becomes habit and followed by an obsession.
Consequences of selfie includes poor performance in the
work field, peer pressure, unwanted stress, unhealthy
30
family relaons, conflicts etc. Also, it may lead to
complicaons such as swelling in elbow followed by pain
and numbness in the elbow joint, cervical spondylis and
30
awkward posture of the body. Some cases were also found
to have their shoulder froze during taking the selfies
24
followed by pain in shoulder joint. A study done among 250
students aged 18 to 25 year had shown that taking selfie was
associated with complicaons like low back pain (30%), head
ache (25%), cervical spondylis (20%), stress (15%) and
30
selfie elbow (10%).
There may be the swelling in the elbow joint more specifically
at the site of origin of extensor group of muscles because
most of the stress in the posion of taking selfie is carried
7
out by the extensor group of muscles. Once the injury of the
tendon and ligament occurred, even minimal amount of
load or strain causes a lot of pain due to already weakened
muscles of the elbow which has not been cured yet, and this
2 2
eventually lead to loss of funcon.
Symptoms of the selfie elbow can be pointed out in following
points:
1. Burning pain around the elbow joint
2. Pain while doing acons at elbow and wrist
3. Limitaon of moon at elbow and wrist joint
4. Sffness in the arm (more commonly in morning)
5. Muscle fagueness
PREVENTION AND MANAGEMENT
According to experts, it is suggested that applying ice packs
and taking some an-inflammatory medicaons may be
29
needed in case of emergency. It may require a physiotherapist
for modalies and muscle stretching and strengthening
exercises if the trouble rises. The experts also suggested the
use of a selfie sck to avoid stress on the muscles and use both
hands alternavely to take selfies which prevents build-up
29
of stress on only one arm muscle group. Using both hands
alternavely is a wise opon. This prevents the overuse of
parcular arm. Since, selfie elbow is very similar to tennis
elbow, both triggered by stress resulng from overuse, resng
24
the arm joints is the first step for the both condions.
Following methods could be applied for the management of
selfie elbow:
1. Rest: give rest to your arm. Since 'selfie elbow' is an
overuse injury, it is the first thing to be done. Avoid
clicking too many selfies. Use a selfie sck or use both
hands while holding your phone during a click, or switch
hands to avoid overuse of one hand.
2. Ice: It works for acute inflammatory symptoms only
when there is a visible and palpable swelling around the
area. Ice is recommended for its analgesic and local
vasoconstricve acon, but for chronic condion and
cases with muscle dysfuncon inflammaon could not
31
respond with icing.
3. Medicaon: non-steroidal an-inflammatory drugs
(NSAIDs) could be used to reduce the inflammaon and
31
pain.
4. Physiotherapy: Perform full range acve movement of
the elbow. Other modalies of exercise like Therapeuc
eccentric exercise (TEE) could be suggested for structural
remodeling of the tendon and to increase the tensile
32
strength of the tendon. TEE may provide neuromuscular
33
adaptaon of both agonist and antagonist muscles.
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Some of the simple exercises are also suggested for the
affected persons are:
a) Wrist flexion and extension stretch: Keeping your
elbow straight, use your unaffected hand to bend
the affected wrist downward, hold this stretch for
30 seconds. Sll keeping your elbow straight, use
your unaffected hand to bend the wrist upward
and hold this stretch for 30 second. Whole acon
3,34,35
should be repeated two mes.
b) Wrist flexion curls: Hold a small free weight with
the affected hand, rest the forearm on a table and
bend the wrist up and down with the palm face up
3,34,35
and repeat the same for ten mes.
c) Puy squeeze: Squeeze puy in hand trying to
keep it round by rotang puy aer each squeeze.
Push fingers through puy to palm each me for
3,34,35
two minutes.
5. Braces and Support: Use of elbow caps to support the
elbow joint while in pain may be useful. Braces should
not be used for longer span of me because braces for
longer me may enhance the muscle weakness and may
22
promote immobility to some extent.
In order to save young generaon from being selfie- addict,
several rem ed ies sh ould b e adop te d which inclu de
behavioral counseling and cognive behavior therapy for
self-movaon and self-control on unnecessary use of social
36
media and giving quality me to family and friends.19, Of
23
course, the cure would be to stop taking so many selfies.
CONCLUSION: STRESS
Taking more selfies makes people self-obsessed with poor
mental health, are mentally disturbed and seen with
condions like mood swings and stress. Taking selfie also
causes physical problem like Selfie elbow.It can be concluded
that taking selfie is fun in one hand with simultaneous
negave impact on human health in the other hand. This
condion can be prevented and cured by administering
various method of remedies discussed.
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