Article  On a national scale14, the rate of ownership of smartphones in 2011 was estimated to 22% for the 12–17 year-olds, 35% for the 18–24 year-olds and 30% for the 25–39 year-olds. Bone Enlarged external occipital protuberance External occipital protuberance Head Human Posture Skull. The secondary objective was to assess the presence of EOP enlargement in ancient skulls from two young individuals (XVIth century France and Ptolemaic Egypt). Secondly, since the work was performed retrospectively on anonymized CT datasets, it was not possible to assess directly the individual use of smartphones of patients. This finding has been sensationalized as being caused by prolonged phone, tablet, or computer use. Article  Anonymized head Computerized Tomography (CT) examinations from patients aged 18-30 in 2011 (n = 205) or 2019 (n = 240), were reviewed to assess the type of EOP and to measure its volume in case of enlargement. Thus, a dedicated scientific study with a more precise evaluation of EOP size and shape, and including data from different times seemed necessary. However, further studies are needed to fully understand the innate and/or environmental factors that could lead to a major EOP enlargement in certain patients, without forgetting that this finding is very rarely symptomatic. Thus, further studies with a robust design enabling an adjustment of EOP size with confounding factors are needed to draw more robust conclusions on the impact of environment on EOP changes. BMJ Case Reports bcr-2017–220506, https://doi.org/10.1136/bcr-2017-220506 (2017). Therefore, further analyses are needed to better understand the potential changes in EOP size over time. 5). Anonymized head Computerized Tomography (CT) examinations from young patients aged from 18 to 30 years, who were referred to the Division for an acute event between January and June, 2011, and between January and June, 2019, were retrospectively analyzed. Previous studies4,7,10 relied on only one or two linear measurements to define EOP enlargement. The second analysis was performed on a dry skull (Laboratory of Anatomy, Lille University, Lille, France) from a skeleton excavated in 1989 in the vault of a Middle-Ages convent from the Dominican Order established in the XIIIth century (Valenciennes, France). The entheses: histology, pathology, and pathophysiology. J Craniofac Surg 23, 1873–1874 (2012). This study aims to analyze finely the changes in prevalence and size of EOP enlargement in millennials, throughout the smartphone era (2011 – 2019). Before getting too deep into the logistics of the study design and statistical analysis, it is worth pointing out that half of the individuals in the 18-30 age group were asymptomatic while the rest had mild musculoskeletal pain not relating to the EOP. DDS Thesis, Lille University (2015). Panel c. shows EOP measurement (1.87 cm3) which corresponds to the 85th percentile of 2019 values for young women with EOP enlargement. As a retrospective study, causation cannot be inferred. Many electronics are only a couple of decades old at best, so younger populations are more likely to have spent more time using them than older populations which could affect the data. Measurement data are provided as Supplementary Information files. These findings suggest that EOP enlargement was already present and frequent at the beginning of the last decade, and probably even long before. The anonymized head CT examinations were reviewed retrospectively by two readers: a senior musculoskeletal radiologist and a radiology resident specializing in musculoskeletal imaging. The size was expressed as a volume in cm3 (Fig. performed data acquisition and measurements. Varghese, E., Samson, R. S., Kumbargere, S. N. & Pothen, M. Occipital spur: understanding a normal yet symptomatic variant from orthodontic diagnostic lateral cephalogram. R masses. Enlarged External Occipital Protuberance in young French individuals’ head CT: stability in prevalence, size and type between 2011 and 2019. Noticed this for a year. Shahar, D. & Sayers, M. G. L. Prominent exostosis projecting from the occipital squama more substantial and prevalent in young adult than older age groups. The choice to work on head CT examinations rather than cervical spine CT examinations was driven partly by this reason, because the dataset could have been biased in the latter, with an over-representation of patient with cervical symptoms that could have altered the generalization of our description. In particular, he has a keen interest in pain science, tendinopathy, and rehabilitation. Marshall, R. C., Abela, C. & Eccles, S. Painful exostosis of the external occipital protuberance. All authors reviewed the manuscript. EOP enlargement was also already present in ancient skulls from young individuals, with measurements within today’s upper ranges. On an individual scale, it is noticeable that few cases from both 2011 and 2019 datasets were clear outliers (Fig. External Occipital Protuberance (EOP) enlargement has been recently reported to increase in young adults, with a putative link with postural factors such … The prevalence of enlarged external occipital protuberance in young adults. This study specifically focuses on millennials aged 18-30 and the potential rapidly evolving impact on modern life on this population, since they were the principal age group for whom concerns were raised10. The skull underwent a dedicated CT for the purpose of this study. However, this approach does not take the shape of the EOP into account, which can be highly variable between individuals. On a population scale, prevalence and volume of enlarged EOP (“occipital spur”) in millennials remained stable between 2011 and 2019, although the use of smartphones has risen drastically in the meantime. 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