Cervical Erector Spinae Research Articles

Effect of loupe and microscope on dentists’ neck and shoulder muscle workload during crown preparation

Although there is consensus among dentists that visual aids not only improve vision but also help improve posture, evidence is scarce. This study aimed to evaluate the effect of visual aids (loupe and microscope) on the muscle workload of dentists during crown preparation on dentiform first molars in each quadrant of a phantom head, considering dentists’ muscles, patients’ tooth positions and surfaces. Six right-handed dentists from a single tertiary hospital participated. Surface electromyography device recorded the muscle workload of the bilateral upper trapezius, sternocleidomastoid, cervical erector spinae, and anterior deltoid during crown preparation. The results showed significantly lower workload in all examined muscles when using a microscope compared to the naked eye (p < 0.05), whereas the loupe showed reduced workload in some specific muscles. The muscle with the highest workload for all visual aids was the cervical erector spinae, followed by the upper trapezius. When analyzed by tooth surface, while the loupe did not significantly reduce overall workload compared to the naked eye for each surface, the microscope significantly reduced workload for most surfaces (p < 0.05). Therefore, during crown preparation, the workload of the studied muscles can successfully be reduced with the use of a loupe or microscope.

Gender differences in neck muscle activity during near-maximum forward head flexion while using smartphones with varied postures

Women frequently express heightened neck discomfort even though they exhibit smaller neck flexion (NF) during smartphone use. Differences in natural posture while using smartphones may result in varying muscle activation patterns between genders. However, no study focused on this issue. This study investigated the influence of gender on neck muscle activity and NF when using smartphones, ranging from slight (20°) to nearly maximal forward head flexion, across different postures. We analyzed smartphone usage patterns in 16 men and 16 women and examined these behaviors across different scenarios: standing, supported sitting, and unsupported sitting, at 20°, 30°, 40°, and the maximum head angles. During data collection, muscle activity was measured, expressed as a percentage of the maximum voluntary contraction (%MVC), in the cervical erector spinae (CES) and upper trapezius (UTZ), along with NF. Results show significant influences of gender, head angle, and posture on all measures, with notable interactions among these variables. Women displayed higher muscle activities in CES and UTZ, yet exhibited lesser NF, while using smartphones in both standing (12.3%MVC, 10.7% MVC, and 69.0°, respectively) and unsupported sitting (10.8%MVC, 12.3%MVC, and 71.8°, respectively) compared to men (standing: 9.5%MVC, 8.8%MVC, and 76.1°; unsupported sitting: 9.7%MVC, 10.8%MVC, and 76.1°). This study provides a potential rationale for gender-related disparities in injury outcomes, emphasizing that women experience higher neck and shoulder discomfort level, despite their smaller NF during smartphone use, as found in previous research. Additionally, the cervical flexion-relaxation phenomenon may occur when the head angle exceeded 40°. The near-maximum head angle during smartphone use might induce the cervical flexion-relaxation phenomenon, potentially aggravating neck issues. We recommend limiting smartphone usage postures that exceed the near-maximum head angle, as they are commonly adopted by individuals in the daily smartphone activities.

The analgesic effect of ultrasound-guided cervical erector spinae block in arthroscopic shoulder surgery: a randomized controlled clinical trial

BackgroundErector spinae plane block (ESPB) is a novel fascial plane block technique that can provide effective perioperative analgesia for thoracic, abdominal and lumbar surgeries. However, the effect of cervical ESPB on postoperative analgesia after arthroscopic shoulder surgery is unknown. The aim of this study is to investigate the analgesic effect and safety of ultrasound-guided cervical ESPB in arthroscopic shoulder surgery.MethodsSeventy patients undergoing arthroscopy shoulder surgery were randomly assigned to one of two groups: ESPB group (n = 35) or control group (n = 35). Patients in the ESPB group received an ultrasound-guided ESPB at the C7 level with 30 mL of 0.25% ropivacaine 30 min before induction of general anesthesia, whereas patients in the control group received no block. The primary outcome measures were the static visual analogue scale (VAS) pain scores at 4, 12, and 24 h after surgery. Secondary outcomes included heart rate (HR) and mean arterial pressure (MAP) before anesthesia (t1), 5 min after anesthesia (t2), 10 min after skin incision (t3), and 10 min after extubation (t4); intraoperative remifentanil consumption; the Bruggrmann comfort scale (BCS) score, quality of recovery-15 (QoR-15) scale score and the number of patients who required rescue analgesia 24 h after surgery; and adverse events.ResultsThe static VAS scores at 4, 12 and 24 h after surgery were significantly lower in the ESPB group than those in the control group (2.17 ± 0.71 vs. 3.14 ± 1.19, 1.77 ± 0.77 vs. 2.63 ± 0.84, 0.74 ± 0.66 vs. 1.14 ± 0.88, all P < 0.05). There were no significant differences in HR or MAP at any time point during the perioperative period between the two groups (all P > 0.05). The intraoperative consumption of remifentanil was significantly less in the ESPB group compared to the control group (P < 0.05). The scores of BCS and QoR-15 scale were higher in the ESPB group 24 h after surgery than those in the control group (P < 0.05). Compared to the control group, fewer patients in the ESPB group required rescue analgesia 24 h after surgery (P < 0.05). No serious complications occurred in either group.ConclusionsUltrasound-guided cervical ESPB can provide effective postoperative analgesia following arthroscopic shoulder surgery, resulting in a better postoperative recovery with fewer complications.Trial registrationChictr.org.cn identifier ChiCTR2300070731 (Date of registry: 21/04/2023, prospectively registered).

Investigating cervical flexion-relaxation ratio in subjects with cervical lateral spinal stenosis compared with asymptomatic controls: A case control study

IntroductionThe cervical flexion-relaxation ratio (FRR) is known as a quantitative measure of the ability of the cervical extensor muscles to relax during the full flexion of the cervical spine. Compared with subjects suffering from non-specific neck pain, the changes occurring in the pattern of the neck muscles' functions in cases with cervical spinal stenosis are not yet well understood. Therefore, this study aimed to compare cervical FRR in subjects with cervical lateral spinal stenosis and asymptomatic controls. MethodsIn total, 25 subjects with cervical lateral spinal stenosis (aged 44.7 ± 10.4) and 25 asymptomatic individuals (aged 44.3 ± 10.8) were included in this study. These participants performed full-neck flexion, and at the same time, the electrical activity of the cervical erector spinae (CES) muscles was recorded bilaterally. Cervical FRR was further calculated by analyzing the electromyographic data recorded for each muscle. ResultsThe mean cervical FRR was significantly lower (P = 0.015) and the FRR asymmetry (ΔFRR) was significantly higher (P = 0.003) in the patients than asymptomatic controls. In addition, the cervical FRR of the involved side was significantly lower in the subjects with cervical pain compared with that in the non-involved one (P = 0.004). There was also a significant difference in the cervical extension (CE) angle between both study groups (P < 0.001), while the cervical flexion (CF) angle was not different (P = 0.25). ConclusionAccording to the study results, FRR and its asymmetry in the subjects with cervical lateral spinal stenosis were significantly different from that in asymptomatic controls and the CE angle declined in these subjects.

Evaluation of cranio-cervical muscle activity in adolescents with different malocclusions: a pilot surface emg study

Aims: This study aimed to investigate potential differences in cranio-cervical muscular activation among adolescents with different types of malocclusion. Methods: This study involved thirty-two adolescents aged 10-15 years, categorized into three groups based on Angle. Angle Class I/control group (n=10), Angle Class II (n=12), and Angle Class III (n=10). Surface electromyography (EMG) was utilized to evaluate the activation levels of the Masseter, Temporalis Anterior, Cervical Erector Spinae, Sternocleidomastoid, and Upper Trapezius muscles. Measurements were obtained during mandibular rest, maximum clenching, and chewing tasks. Results: The surface EMG activity of the Upper Trapezius muscle exhibited significant elevation in participants with Class III malocclusions relative to the other groups (p&lt;0.05). While cranio-cervical muscle activities tended to be higher in the groups of Angle Class II and Class III in comparison to the Angle Class I, these differences did not achieve statistical significance, with the exception of the Upper Trapezius muscle (p&gt;0.05). Conclusion: These findings indicate a link between malocclusion types and modified muscle activation patterns in the cranio-cervical region, specifically involving the Upper Trapezius muscle. Insights into cranio-cervical muscle activity can enhance the comprehensive evaluation of malocclusion effects and provide valuable guidance for orthodontic and rehabilitation interventions.

Regional analgesia using ultrasound-guided intermediate cervical plexus block versus cervical erector spinae block for anterior cervical spine surgery: a randomized trial.

Regional analgesia techniques are crucial for pain management after cervical spine surgeries. Anesthesiologists strive to select the most effective and least hazardous regional analgesia technique for the cervical region. Our hypothesis is that an intermediate cervical plexus (IC) block can provide adequate postoperative analgesia compared to a cervical erector spinae (ES) block in patients undergoing anterior cervical spine surgery. In this double-blind prospective trial, 58 patients were randomly assigned into two equal groups prior to the administration of general anesthesia. Patients in the IC group (n = 29) underwent ultrasound-guided bilateral intermediate cervical plexus block with 15ml of bupivacaine 0.25% administered to each side. The ES group (n = 29) underwent ultrasound-guided bilateral cervical erector spinae plane blocks with 15ml of 0.25% bupivacaine administered to each side at the C6 level. The primary outcome was to record the time to the first call for rescue analgesia (nalbuphine), and the secondary outcomes were to measure the performance time, the onset of the sensory block, the intraoperative fentanyl consumption, postoperative pain intensity using VAS, the postoperative total nalbuphine consumption, and postoperative complications such as nausea, vomiting, hypotension, and bradycardia. The performance and onset of sensory block times were significantly shorter in the IC group compared to the ES group. The time to first call for nalbuphine was significantly shorter in the IC group (7.31 ± 1.34h) compared to the ES group (11.10 ± 1.82h). The mean postoperative VAS scores were comparable between the two groups at the measured time points, except at 8h, where it was significantly higher in the IC group, and at 12h, where it was significantly higher in the ES group. The total nalbuphine consumption was significantly higher in the IC group (33.1 ± 10.13mg) compared to the ES group (22.76 ± 8.62mg). For patients undergoing anterior cervical spine surgery, the intermediate cervical plexus block does not provide better postoperative regional analgesia compared to the cervical erector spinae block. Performance time and onset time were shorter in the IC group, whereas nalbuphine consumption was lower in the ES group. The trial was registered at clinicaltrials.gov. (NCT05577559, and the date of registration: 13-10-2022).

Effects of a posture correction feedback system on neck and trunk posture and muscle activity during computer work

BackgroundComputer work often involves prolonged periods of static sitting, which can result in incorrect posture and increase the risk of developing musculoskeletal disorders and associated pain. The incidence of neck pain among computer workers is increasing due to the association with incorrect posture. To solve the problem accurately, it is necessary to correct the incorrect posture. ObjectiveThis study investigated how the angle and muscle activity of the upper body changed when a posture correction feedback (PCF) system was applied during computer work. MethodsFifteen healthy, young adults participated in this study that was conducted in two sessions of 16 min each: the first without feedback and the second with feedback. Neck and trunk angle changes of the participants, as well as cervical erector spinae, upper trapezius, and thoracic erector spinae muscle activation, were measured during computer work. Kinematic and kinetic data were analyzed using a two-way repeated analysis of variance. ResultsNeck and trunk flexion were reduced with the feedback system. Muscle activation of the cervical erector spinae significantly increased over time with computer use and decreased with feedback system use (p < 0.05). ConclusionOur study demonstrates the PCF system may be an effective tool for alleviating postural stress in the neck and trunk in an office setting. Relevance to industryThe PCF system can assist computer workers in improving posture. This demonstrates ergonomic benefits and does not interfere with computer work, making it suitable for use in a real work environment. This can help prevent musculoskeletal disorders and associated pain resulting from prolonged computer work.

The effects of dual screen layout on neck-shoulder muscle activity and head-neck posture variability during computer tasks.

Larger dual screens have been widely used during office work and their biomechanical exposure should be explored. To investigate the biomechanical effect of two dual screen layouts on neck-shoulder muscle activity and the variability of head-neck posture in computer users. A preliminary study of the user-preferred dual screen angles was carried out in V-shaped and L-shaped layouts. Twenty healthy participants aged 19 to 26 years were recruited and assigned to perform reading, typing, and searching tasks for 30 minutes in both workstation layouts. Electromyography was measured at bilateral cervical erector spinae (CES), sternocleidomastoid (SCM), and upper trapezius (UT). The head-neck lateral bending, rotation, and flexion angles were recorded. The visual analog scale (VAS) was used to evaluate visual strain. The muscle activity at the left UT and right CES sites when using the V-shaped layout was significantly higher than the L-shaped. There were significant differences in head-neck rotation and flexion angles between the two layouts in reading and typing tasks. In the searching task, there was no significant difference in the head-neck rotation and flexion angles between the two layouts. The visual strain score was significantly higher in the V-shaped layout. The CES and UT muscles displayed higher levels of activation while using the V-shaped layout in comparison to the L-shaped layout. The head-neck rotation and flexion angles differed due to varied types of work when using V-shaped and L-shaped layouts.

Dual erector spinae plane block for complex traumas of upper and lower limb: an opioid reduction strategy—a case series

BackgroundPatients with polytrauma (fractures of the humerus and the femur) require concurrent operative fixation. Pain originating from multiple operative sites leads to increasing doses of opioid-based analgesia, which has detrimental effects in the form of longer hospital stays, higher costs, and increased mortality.Case presentationIn twelve patients with humerus and femur fractures, a cervical erector spinae plane block (ESPB) at the level of T1 and a lumbar ESPB at the level of L2 were administered with a catheter and continuous infusion technique for postoperative analgesia. None of these patients required opioids in the postoperative period. The catheters were removed after 48 h.ConclusionsA dual ESPB can be used successfully in patients with multiple injuries by appropriately selecting the level of intervention, and opioid-sparing analgesia can be effectively delivered to these patients.

Neck and shoulder strains under various head flexing positions while standing and sitting with and without back support for male and female smartphone users

This study recruited 30 young participants (15 men and 15 women) to examine the smartphone usage patterns in three postures (standing, supported sitting, and unsupported sitting) and at five head angle (HA) positions (0°-40°). Cervical erector spinae (CES) and upper trapezius (UTZ) muscle activity, neck flexion (NF), gaze angle (GA), viewing distance (VD), and discomfort scores were collected. Results showed that HA and posture almost affected all responses, while CES muscle activity, NF, and VD differed between sexes. Strain in the neck and shoulder region increased with HA increase. Particularly, when the HA exceeded 20°, the discomfort scores considerably increased. Unsupported sitting should be avoided during smartphone use because of relatively poor responses in all variables. However, both standing and supported sitting have their respective benefits. Sex-related differences were typically observed in the standing position, with women tending to have lower NF but higher CES muscle activity compared with men. Practitioner summary: Although smartphones have become daily necessities, the overall quantitative neck and shoulder strain of using smartphones in different postures is rarely evaluated. We suggest that maintaining the HA within 20° is recommended because of relatively low load on the neck and shoulders. An unsupported sitting should be avoided during smartphone use.

A Flight Helmet-Attached Force Gauge for Measuring Isometric Neck Muscle Strength.

INTRODUCTION: Fighter pilots must withstand high Gz-forces that can damage the cervical spine. Strength of the cervical musculature is of vital importance when it comes to preventing these G-induced neck injuries. However, there is very little evidence on valid neck muscle strength measurement methods for fighter pilots. The aim of this study was to examine the validity of a commercial force gauge attached to a pilot's helmet for measuring isometric neck muscle strength.METHODS: A total of 10 subjects performed maximal isometric cervical flexion, extension, and lateral flexion with the helmet-attached gauge and with a weight stack machine, which was used as a reference. Electromyography (EMG) activities were recorded from the right and left sternocleidomastoids and cervical erector spinae muscles during all measurements. Paired t-tests, Pearson correlation coefficient, and Wilcoxon's test were used to analyze the data.RESULTS: Difference of mean force values between the devices was statistically significant in all directions. Pearson correlation coefficient varied between 0.73 and 0.89 and it was highest in cervical flexion. EMG activities were significantly different only in the left CES during flexion.DISCUSSION: The helmet-attached gauge is a valid tool for measuring isometric neck muscle strength and is best used as a means to compare individual differences in strength levels or to track the progress of strength development.Nyländen P, Virmavirta M, Sovelius R, Kyröläinen H, Honkanen T. A flight helmet-attached force gauge for measuring isometric neck muscle strength. Aerosp Med Hum Perform. 2023; 94(6):480-484.

Evaluation of surface electromyography of selected neck muscles during the whiplash mechanism in aware and unaware conditions due to safe punching in kickboxing

BackgroundKickboxing is considered as a combat sport in progress, in which injuries are frequent and significant, and close injury monitoring is highly recommended. Sports injuries to the head and neck are estimated to cause 70% deaths and 20% permanent disabilities although they are much less common than those to the limbs. Whiplash mechanism involves the rapid extension (opening) and flexion (bending) of neck. The purpose of the current study was to investigate the electromyographic activity of selected muscles in the whiplash mechanism in aware and unaware conditions of the safe punching in kickboxing so that we can design special exercises.MethodIn the present study, 24 male kickboxing athletes aged 18–40 years were selected based on a purposive sampling method. The surface electromyography (EMG) signals of muscles were recorded with and without awareness of safe punching by using a nine-channel wireless EMG device. Additionally, a nine-channel 3D inertial measurement unit (IMU, wireless,) was utilized to determine the acceleration, kinematics, and angular velocity of the subjects’ head. The statistical dependent t-test was applied to compare the EMG activity of each muscle, as well as its participation ratio.ResultsThe results of statistical analysis represented a significant increase in the EMG activity of sternocleidomastoid (p = 0.001), upper trapezius (p = 0.001) and cervical erector spinae muscles (p = 0.001), as well as the neck extension and flexion angles between the athletes aware (open eyes) and unaware (closed eyes) of the safe punching.ConclusionIn this study, the EMG activity of the sternocleidomastoid, upper trapezius, and cervical erector spine muscles in the aware condition was significantly different from the activity under unaware condition. In fact, the intended muscles exhibited significantly different behaviors in preventing extension and flexion in the two conditions.

목 굴곡 각도에 따른 스마트폰 사용이 목세움근과 위등세모근의 근피로도에 미치는 영향

This study investigated the effect of smartphone use by smartphone users" various angles on neck fatigue after using smartphone. Fifteen participants playing the game tasks for 20 min and Neck muscle fatigue was measured by extension the neck for 30 seconds in a supine position before and after using the smartphone at various neck flexion angles. At each neck flexion angle, there was no difference in the degree of muscle fatigue of the Upper Trapezius(UT) when extension of the neck between groups and within the group at both before and after using the smartphone. In the Cervical Erector Spinae(CES), there was no difference in fatigue at each neck flexion angle, but the difference in muscle fatigue within the groups was confirmed that the left side had more muscle fatigue after using the smartphone than before using the smartphone at a 45° flexion angle. In conclusion, smartphone users should be instructed not to adopt a neck flexion angle of 45° during smartphone use, as there is a link between these neck flexion angle ranges and increased CES muscle fatigue. Practitioner summary: This study proved that we should try to avoid a 45° neck flexion angle when using a smartphone.

Investigation of Flexion-Relaxation Ratio Symmetry in Subjects with and without Non-Specific Chronic Neck Pain

Introduction: Neuromuscular imbalance between right and left sides of Cervical Erector Spinae (CES) muscles can induce pain by applying the asymmetric loads on the spine incorrectly. This study evaluated the symmetry of the right and left cervical flexion-relaxation ratio (FRR) in patients with Non-Specific Chronic Neck Pain (NSCNP) and healthy subjects.We aimed to investigate the symmetry of FRR on the right and left sides of the CES muscles in individuals with and without NSCNP.Materials and Methods: A total of 25 patients with NSCNP and 25 healthy subjects participated in this study. The surface electromyography activity of CES muscles during four phases of flexion and extension tasks were measured and recorded. Unilateral FRR in the right and left sides of CES muscles was calculated and compared in each group.Results: Only in NSCNP patients, FRR in the right CES muscle was significantly higher than that in the left one (P&lt;0.05). Also, FRR for bilateral CES muscles was significantly higher in healthy subjects than in NSCNP patients (P&lt;0.001).Conclusion: The study results indicated a greater FRR asymmetry in CES muscles in NSCNP patients than in healthy subjects. This asymmetry is probably due to the dominance of the limb. Moreover, asymmetric FRR as a kind of neuromuscular imbalance may cause pain due to imposing asymmetric loads on spine structures.

Pain and electromyography reduction cause of sitting upright posture, frequent break, eye rest and self-stretching during smartphone usage.

Prolonged use of the smartphone causes neck and shoulder pain. However, no study has yet evaluated the effects of sitting upright, combined with frequent breaks, eye rest and self-stretching on pain and EMG during smartphone use. The purpose of the study was to compare pain and muscle activity between the control group (rest only) and the intervention group (rest combined with correct posture, eye rest and self-stretching) in smartphone use for 41.30 minutes. Forty-four healthy females aged 18-25 years old were recruited and randomly divided into two groups. The body pain chart and Visual Analog Scale (VAS) were used to evaluate pain. Electromyography (EMG) was used to measure muscle activity of Cervical Erector Spinae (CES) and Upper Trapezius (UT) muscles. The results showed that overall pain and neck pain in the control group increased significantly after smartphone use for 20 min and continually increased to 41.30 minutes (p < 0.05). Overall pain and neck pain in the intervention group was significantly lesser than control group after smartphone use for 41.30 minutes (p < 0.05). In the control group, EMG of CES at 41.30 minute was significantly higher than that of at 0 min (p < 0.05). There was no significant difference in EMG of UT between the two groups. Conclusion smartphone user in the interventional group reported less pain when compared to control group after Smartphone use for 41.30 minutes. Therefore, the user aged 18-25 years should have a rest combined with correct posture, eye rest and self-stretching to prevent neck pain during prolonged smartphone use.

Bilateral ultrasound-guided continuous cervical erector spinae plane block in suboccipital craniotomy.

Bilateral ultrasound-guided continuous cervical erector spinae plane block in suboccipital craniotomy.

Differences in neck muscle activity according to lying positions using a smartphone.

Due to the extended use of smartphones, people spend a lot of time on these devices while lying down. The purpose of the present study was to compare the differences in neck muscle activity of participants while they watched videos on a smartphone in four different lying positions (supine (SUP), prone on elbows (PE), side lying (SIDE), and 45∘ head turn while side lying (45-SIDE)). Twenty-three healthy volunteers (22.4 ± 1.7 years) were enrolled in this study. We assessed the activities of their right and left sternocleidomastoid (SCM), anterior scalene, cervical erector spinae (CES), and upper trapezius (UT) muscles while they watched videos on a smartphone in four different lying positions. The right and left SCM and CES had significantly different muscle activities depending on the lying positions. The SCM activity had a significantly greater asymmetry in the 45-SIDE position, while the CES activity had a significantly greater asymmetry in the SIDE and 45-SIDE positions. Moreover, the UT activity had a significantly greater asymmetry in the SUP, PE, and SIDE positions. Neck muscle activity and asymmetry were the lowest in the SUP position relative to the other positions. Therefore, lying down in the SUP position may minimize neck muscle activation while using a smartphone.

The relationship between visual impairments and activity of the neck/shoulder muscles among surgeons during simulated surgical tasks.

Minimally Invasive Surgery (MIS) has an impact on surgeons' musculoskeletal and visual systems. However, the relationship between visual symptoms and musculoskeletal problems is not well understood. This study used surface electromyography (sEMG) to examine changes in fatigue of the neck/shoulder muscles among surgeons with visual impairments when performing simulated surgical tasks in 2D and 3D viewing modes. Cross-sectional laboratory study. Changes in median frequency (MDF, an indicator of muscle fatigue) were examined in 17 experienced gynaecologists. Four simulated surgical laparoscopy tasks were performed in 2D and 3D viewing modes. The MDF of three neck/shoulder muscles (cervical erector spinae, [CES], upper trapezii [UT], and anterior deltoids [AD]) were examined bilaterally. Visual parameters (accommodation, convergence, and stereoacuity) were measured prior to commencement. There was a downward shift of MDF from simple to more complex tasks for the right and left CES and AD muscles but not the UT, which was consistent for surgeons with mild accommodation/convergence impairment and/or good stereoacuity. There were significant differences in the level of muscle fatigue of the neck/shoulder muscles according to the severity of visual impairment, muscle side, task and surgical performance level. The results show a relationship between the degree of visual impairments and muscle fatigue of the neck/shoulder muscles among MIS surgeons. These findings have important implications in understanding the concurrence of musculoskeletal problems and visual symptoms.

Effect of Smartphone Addiction on Craniovertebral Angle and Muscle Fatigue of Cervical Erector Spinae and Upper Trapezius

&lt;p&gt;India ranks 3&lt;sup&gt;rd&lt;/sup&gt; in number in the smartphone use. Above 50% of worldwide population uses smartphone. The aim of the study is to find the effect of smartphone addiction on craniovertebral angle and muscle fatigue of Cervical Erector Spinae (CES) and Upper Trapezius (UT). Eighty-six healthy students took an interest in the examination. Subjects were chosen for the study with the assistance of SAS-LV form. Lateral postural assessment was done to measure CVA with the assistance of photography method. Electromyography (EMG) was utilized to compute muscle fatigue of cervical erector spinae and upper trapezius. The co-relation coefficient between addiction and CVA is r = -0.2196, that means as SAS-LV score rises, the CVA decreases. Co-relation between addiction score and mean frequencies of UT and CES by r = 0.03679 and r = -0.04472 respectively, this states that as addiction score increases UT shows fatigue however not CES. Co-relation between CVA and muscle fatigue of CES and UT by r = 0.01816 and r = -0.04472 respectively, that means as CVA increases UT shows fatigue but not CES. There is co-relation between smartphone addiction, CVA and UT and CES fatigue but it is not statistically significant (p&amp;gt;0.05). From the statistics, it is concluded that unnecessary utilization of smartphone decreases the CVA and muscle fatigue starts to set in, in the UT however not in CES. As the CVA decreases upper trapezius shows fatigue however not cervical erector spinae.&lt;/p&gt;

Improving the Breast Surgeon's Ergonomic Workload for Nipple-Sparing Mastectomies Using Exercise and Operating Room Positioning Protocol.

The objective of this study was to examine whether an exercise program and standardized operating room positioning protocol (EOPP) would improve surgeon muscle workload and/or surgeon perception of mental/physical workload for nipple-sparing mastectomy (NSM). This prospective study analyzed muscle workload by EMG of four surgeons performing NSM before and after an EOPP. Surveys were administered assessing surgeon perception of mental/physical workload. EMG data were analyzed using repeated-measures ANOVA, controlling for surgeon, first assistant, duration and difficulty of procedure, left or right side, and sequence of the procedure. A total of 56 NSM cases performed by 3 surgeons were analyzed. One surgeon was excluded because of muscle injury and undergoing active physical therapy during the study period. After implementation of the EOPP, the left (P = 0.005) and right (P = 0.020) upper trapezii muscles had a significant decrease in overall ergonomic workload but there was no significant change in overall ergonomic workload for the bilateral cervical erector spinae, anterior deltoid, and lumbar erector spinae muscle groups. When analyzing muscle group exertion by surgeon, there was significant variability in all muscles except the left cervical erector spinae. Following the EOPP, surgeons reported that the procedures were more physically (P = 0.01) and mentally (P = 0.002) demanding and visualization (P = 0.04) was worse. The breast laterality and sequence did not affect muscle exertion. An EOPP decreased the overall ergonomic workload of one muscle group for surgeons performing NSM but did not impact surgeon perception of mental/physical workload. Further investigation is needed to improve surgeon ergonomics.