fbpx

Arm/Hand Numbness From Gaming

1-HP.org > Gaming Pain Archive > Arm/Hand Numbness From Gaming

Arm/Hand Numbness From Gaming

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome From Gaming
  • Thoracic Outlet Syndrome is a condition near the neck and shoulder involving compression of nerves or blood vessels resulting in pain and/or decreased sensation, coordination, and strength 
  • There are three different types of thoracic outlet syndrome all with different presentations and symptoms. 
  • A common type of thoracic outlet syndrome is compression of the brachial plexus which innervates (supplies) specific muscles in the arm and hand. Nerves are responsible for providing muscles with necessary strength, coordination, sensation, and ultimately function which is hugely important in gaming

Thoracic Outlet Syndrome (TOS) is a condition that affects the nerves or blood vessels within a small area located near the neck and shoulder. These are important structures which branch out to the entire arm and hands. Typically the space of the thoracic outlet is large enough to allow the nerves and blood vessels to pass through just fine, but when certain muscles become tight or space becomes narrowed then the nerves and blood vessels can be compressed as they pass between the clavicle and the first rib. The space can become tight as a result of poor posture/ergonomics, traumatic injury, or failure to stretch/strengthen necessary muscles. 

These compressed nerves happen at the brachial plexus which is the network of nerves that come off of the spinal cord and travel down the neck, shoulder, chest region down into the arm and hand which it innervates (supplies muscles). Symptoms include numbness, tingling, pain, and weakness in your arms and hands. Many people are familiar with other forms of nerve compression conditions such as carpal tunnel or cubital tunnel, but TOS is another condition which should be well understood as this can often mimic other nerve compressions. The key difference between these nerve compressions is where the entrapment location is which is critical for understanding the cause and how to go about fixing it. 

It is also important to know the three types of TOS that are possible. The first and most common is neurogenic TOS, neuro meaning “relating to nerves or the nervous system”. This is when compression occurs at the brachial plexus. Secondly, there is venous TOS which is compression of the blood vessels as they return blood back to the heart from the arm. Lastly, there is arterial TOS which is very similar to venous TOS as it is compression of the blood vessels, but now with the blood traveling from the heart to the arm. Arterial TOS is the least common of the 3 types. The name “Thoracic Outlet Syndrome” comes from the anatomical location of the opening between your neck and chest..

 

“An analogy that can be used to think of nerves is like a water hose. When someone steps on the hose there may be a little water sputtering out which can be like the tingling often first experienced with mild compression at the chest/neck region. If someone comes along and steps on the hose with all their weight then the water flow may stop. Similarly, if the chest or muscles in the neck are tight then they may significantly compress the nerves resulting in numbness, pain, or decreased strength. If there is no water coming from the hose to feed the plants then the plants will begin to die after months, similar to how our muscles can start to atrophy (die/weaken) if they are not getting proper innervation (supply) from the nerve.”

 

Brachial Plexus

Radial Nerve: The radial nerve divides into two branches: the superficial branch and the deep branch. The superficial branch provides innervation to the dorsal side of the thumb, Index, middle, and the radial half of the ring finger just proximal to the IP joints as well as a small portion of the volar side of the thumb where it gives sensation. The deep branch or posterior interosseous nerve (PIN) is a motor branch which gives input to the supinator muscle as well as extensors of the wrist and digits. 

Median Nerve: Provides innervation to the thumb, index finger, middle finger, and the radial half of the ring finger on the volar side as well as the dorsal aspect of the same fingers discussed, but only distal to the proximal interphalangeal joint (PIP).

Ulnar Nerve: Provides innervation to the small finger and ulnar side of the ring finger both on the volar and dorsal side

Gamers are likely to experience pain, tingling, numbness throughout the arm along with weakness and poor coordination. Individuals may find their arms to be heavy at times doing activities at or above shoulder height such as driving or participating in various hobbies or overhead sports such as baseball, basketball, volleyball, weightlifting, etc. Gamers may find it challenging gripping and moving a mouse or a controller because of their decreased sensation. Finger dexterity is likely to be reduced which is likely to decrease performance and alter the gameplay of the individual. Individuals may also experience discomfort at night when sleeping due to sleep positioning with the arms overhead or laying on a shoulder and causing increased pressure. It may be hard to distinguish where specifically this pain or altered sensation is because it may not always follow the same pattern or nerve involvement as it would with carpal tunnel or cubital tunnel syndrome. Because these symptoms can mimic other forms of nerve compression it is important to write down or be mindful when symptoms are exacerbated and what potentially was a trigger for these symptoms. For example, Carpal tunnel or cubital tunnel symptoms may occur at night while sleeping for those who sleep with wrists or elbows bent. 


The following information is provided for general educational purposes only and should not be considered medical advice. It is not intended to replace consultation with a qualified healthcare professional. If you have specific concerns or questions about your health or medical condition, please seek the guidance of a licensed physician or another qualified medical practitioner. Any reliance you place on the information provided is solely at your own risk. In no event will the author or 1HP be liable for any loss or damage arising from using this information. Always consult with a healthcare professional before starting or changing any medical treatment or regimen.

Perform this quick test for yourself (Roos Test):

 

Instructions:

The patient is to open and close the hands slowly over a 3-minute period

Normal Response: Some minimal discomfort and fatigue

Positive test: Reproduction of symptoms occurs such as numbness/tingling or pain

Gamers are at risk for this injury due to the long durations we play. Gamers or office workers spend a significant portion of the time sitting which may lead to poor posture over time resulting in tightness of the neck and chest. Gamers oftentimes take minimal rest breaks because they are so engaged and locked in and don’t always think to put their body first. Pain and discomfort is something that can be reduced from distractions and gaming is a good distractor which makes it hard for gamers to know when to stop due to pain/discomfort. 

Thoracic outlet syndrome in gaming occurs as players sit in a slumped posture resulting in forward head posture with tight pec muscles (chest), scalenes, sternocleidomastoid, and levator scapulae. When the core is weak and players fail to move and take rest breaks then they may begin to rely on external supports like the armrest and desk. In this rounded shoulder position the space in the thoracic outlet becomes compressed which is how poor posture/ergonomics in gaming can result in this diagnosis.

Check out the video linked here for a video explanation about what thoracic outlet syndrome is and how to help it

Returning from this injury takes a concerted effort, but can be done without much time away from the game. Below are a few steps that individuals need to understand and take when discomfort in this area occurs. 

  1. Identify the issue 
    • Oftentimes TOS can be challenging to identify due to the variety of differential diagnosis possible. Be sure to track symptom location and what makes it better or worse to better help a practitioner identify the route cause
  2. Stretching
    • Frequently stretching tight muscles is important to help loosen these over time to decrease compression on the nerves and blood vessels
    • Helpful in decreasing tightness and stiffness throughout the chest and neck
      • Scalenes Stretch
      • Doorway Chest stretch
      • 1st Rib Mobilization (Equipment: Belt, towel, purse/satchel strap)
  3. Ergonomics
    • Evaluating one’s ergonomic setup to ensure that the chair, desk, and armrest height is optimal to allow the shoulders and elbow to be both supported but relaxed
      • A secondary effect to a poor ergonomic setup could be poor posture
  4. Posture
    • Poor posture could mean increase pressure on the nerves or blood vessels
      • Likely due to lack of core strength and endurance
  5. Exercise
    • Strengthening the core and back muscles can often counteract the effects which prolonged sitting has on an individual
      • Scapular Squeezes (Equipment: Resistance band Band)
      • Resistance Band Rows
      • Chin Tucks
      • Wall slides (Emphasize scapular movement)
  6. Nerve Glides
    • To restore mobility between the nerve and the surrounding tissues
  7. Massage
    • A great way do decrease muscle tightness and increase blood flow to the muscles, tendons, and nerves
  8. Sleeping
    • Sleep can be significantly impacted due to the positioning individuals find themselves in. It is suggested to sleep flat on the back or on the unaffected side if possible.
    • Completing a Cyriax Release maneuver may be helpful prior to bed in order to unload the neurovascular structures.
      • Though symptoms will be produced, this position should be held for 30 minutes if possible
      • Generally this is not comfortable, but the goal is to help the individual sleep better at night by maximizing blood flow just prior to bed
      • It is important in this case to let the tingling happen and once the tingling has subsided then you can stop (~15-30 min). Over a few weeks this may no longer be necessary. 
  9. Breathing Exercises
    • Diaphragmatic breathing can be great to incorporate into one’s day in order to decrease stress/anxiety, but also to retrain the body in proper breathing with less chest or accessory breathing required.
  10. Utilize heat (Hot packs)
    • Prior to gaming sessions, stretches, or massage to decrease tightness in the neck and shoulders
  11. Rest breaks
    • It is best to incorporate breaks in gameplay to complete some of these recommended strategies and get out of a prolonged static position

 

*Surgery is seldom required in order to effectively treat for neurogenic TOS, but may be indicated for arterial or venous TOS

The diagnosis was explained in short above, but for those wanting to know and learn more this is for you. 

Specifically, this diagnosis is looking at compression or irritation of the brachial plexus nerves, subclavian artery, or subclavian vein as they pass through the narrow space between the collarbone (clavicle) and the first rib, known as the thoracic outlet. This compression can result from various factors such as anatomical variations, traumatic injury, or abnormal tightness of surrounding muscles (scalene muscles and the pectoralis minor). The compression of these vital structures can lead to symptoms such as pain, numbness, tingling, and weakness in the shoulders, arms, and hands, ultimately affecting the functionality of the upper extremities.

Due to the complexity of the diagnosis it can be hard to identify which type of TOS is present or even identifying TOS as a diagnosis in the first place. There are many different clinical tests that may be performed. Through having knowledge of one’s anatomy there can be a better understanding as to what is occurring and how various treatments or exercises are used to address reported symptoms. 

Nerve Responsible: 

  • Brachial Plexus: The brachial plexus is a network of nerves that originates from the spinal cord in the neck and extends into the armpit. It is responsible for providing motor and sensory innervation to the shoulders, arms, and hands, facilitating various movements and transmitting sensory information from the upper extremities to the central nervous system. This is what becomes compressed in neurogenic TOS.

 

Relevant Structures

  • Pectoralis Minor
    • This muscle attaches at the scapula (shoulder blade) where it passes over the brachial plexus and blood vessels to insert on ribs 3-5.
    • This muscle helps with stability and mobility of the scapula. Also assists in respiration in breathing as an accessory muscle.
  • Scalenes
    • A group of 3 muscles (anterior, middle, and posterior scalenes) located in the side neck region. These muscles attach at various points on the vertebrae where it passes over the brachial plexus and blood vessels to insert on the first two ribs.
    • This muscle helps with stability and mobility of the neck. Also assists in respiration in breathing as an accessory muscle.
  • 1st Rib and clavicle 
    • Forms the space for which blood vessels and nerves travel through
  • Subclavian vein 
    • A large blood vessel that returns blood from your arm and sends it back toward your heart. Pressure on this vein prevents blood from leaving your arm, leading to swelling and heaviness.
    • This artery lies between the clavicle and first rib.
    • This is what becomes compressed in venous TOS.
  • Subclavian artery
    • A large blood vessel that supplies blood to your arm. When pressure is put on this artery there will be reduced blood flow to your arm, hand and fingers resulting in numbness, tingling or pain, as well as skin that feels cool to the touch
    • This artery lies between the clavicle and first rib.
    • This is what becomes compressed in arterial TOS.

It should also be known that gaming is not the only activity to bring on this condition and certainly other lifestyle factors play a role. School, work, and hobbies are also important to thoroughly evaluate as well for the potential it has on inducing or exacerbating this condition.

  

  • Upper Crossed Syndrome
    • Upper crossed syndrome is a postural condition characterized by muscle imbalances in the upper body, typically resulting from prolonged poor posture. It involves tight and overactive muscles in the neck and shoulder region, such as the upper trapezius pectoralis, and levator scapulae, as well as weak and lengthened muscles in the front of the chest and the back of the neck, such as the rhomboids and deep cervical flexors.

 

  • Carpal Tunnel Syndrome
    • Carpal Tunnel Syndrome (CTS) is a condition that affects the median nerve in your wrist. The carpal tunnel is a narrow passageway in the wrist through which this nerve and several tendons travel from your forearm to your hand. The median nerve controls sensation and movement in the thumb and first three fingers of your hand. TOS can be mistaken for carpal tunnel by some as they both result in numbness/tingling and discomfort, but differ in several ways. Click the link here to learn more about this diagnosis.

 

  • Cubital Tunnel Syndrome
    • Cubital Tunnel Syndrome is a condition that affects the ulnar nerve in your arm. The cubital tunnel is a narrow passageway in the elbow where the nerve passes and is most notably known as the “funny bone”. The ulnar nerve controls sensation and movement in the small and pinky side of the ring finger in your hand. TOS can be mistaken for Cubital Tunnel Syndrome by some as they both result in numbness/tingling and discomfort, but differ in several ways. Click the link here to learn more about this diagnosis.

 

  • Wartenberg Syndrome
    • Wartenberg Syndrome is compression of the superficial branch of the radial nerve at the wrist/forearm. This will present as pain over the dorsal aspect of the distal forearm (back of the arm near the wrist) and paresthesia (numbness/tingling) throughout the radial nerve distribution of the hand. TOS can be mistaken for Wartenberg syndrome by some as they both result in numbness/tingling and discomfort, but differ in several ways. Click the link here to learn more about this diagnosis.

There are several approaches to take in order to prevent this injury from occurring or coming back. There are 5 main factors to first focus on and address, but it is also important to keep in mind other secondary factors which can be helpful to address.

 

  1. Ergonomics/Posture
    • Poor positioning may lead to tightness between the space in our neck, chest, and shoulders as a forward head posture begins to develop therefore making it more susceptible to compression
  2. Stretching (During and after gaming sessions)
    • Prioritize stretching the neck and chest
  3. Exercise
    • Through increased strength and muscular endurance of the back and core individuals can offset some of the effects of prolonged sitting which can help to open the chest and necks from compression
    • Individuals who exercise frequently are often more confident. Confidence can alter an individual’s posture and how they sit. Those who lack confidence are more likely to sit reserved with their head down and shoulders rounded vs those who are more confident who are likely to sit more upright. 
  4. Mental health
    • There can be stress as a result of playing video games and competing. Stress may result in increased tension or tightness throughout the neck, chest, back, and shoulders which if ignored may exacerbate this condition
    • Those who are stressed/anxious are more likely to have rushed and shallow breathing. This requires the accessories muscles of the chest and neck to help which if not addressed can become tight and exacerbate symptoms 
  5. Breathing
    • Rarely do individuals pay attention to their breathing, but this can be very helpful in preventing chest muscles from becoming tight
    • Practice diaphragmatic breathing in order to rely less on the accessory muscle (Chest and neck muscles) with respiration and breath more efficiently.




Additional 

  1. Rest breaks 
    • Pain/discomfort levels can be reduced through distractions. Gaming is a big distractor, meaning that individuals should take breaks every 45-60 minutes to assess how you are feeling.
    • Creating a schedule that works for you and your game is also recommended. For example, consider taking a 10 minute break after 2 ranked games (~60 minutes) or a short 5 minute break to stretch following 1 ranked game (~30 min). Certain games will vary in duration, but planning ahead and forming a routine will be beneficial in the long run. A general rule of thumb is, the longer you play, the longer the break should be to allow for some recovery.
  2. Massage 
    • A great way to decrease muscle tightness and increase blood flow to the muscles, tendons, and nerves
  3. Heat 
    • Prior to gaming sessions, stretches, or massage to increase blood flow and decrease tightness
  4. Nutrition/sleep
    • Both of which cannot be ignored in one’s overall wellbeing. Those who get poor sleep are likely to be more stressed resulting in increased tension in the shoulders and neck. Those who neglect fueling their body with the right foods and nutrients are more susceptible to fatigue resulting in poor posture.

Garraud T, Pomares G, Daley P, Menu P, Dauty M, Fouasson-Chailloux A. Thoracic Outlet Syndrome in Sport: A Systematic Review. Front Physiol. 2022 Jun 8;13:838014. doi: 10.3389/fphys.2022.838014. PMID: 35755427; PMCID: PMC9214221.

 

Levine NA, Rigby BR. Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations. Healthcare (Basel). 2018 Jun 19;6(2):68. doi: 10.3390/healthcare6020068. PMID: 29921751; PMCID: PMC6023437.

 

Luu D, Seto R, Deoraj K. Exercise rehabilitation for neurogenic thoracic outlet syndrome: a scoping review. J Can Chiropr Assoc. 2022 Apr;66(1):43-60. PMID: 35655698; PMCID: PMC9103635.

Additional 1HP Articles on Thoracic Outlet Syndrome

Can A Gaming Pillow Reduce Pain? Science & Ergonomics of Gaming Pillows

Should Uzi have retired? Thoughts from Esports Health Experts

HEALTHGAMEFAQS#4 – MECHANICAL KEYBOARDs, MOUSE CHOICE, WRIST STRENGTHENING & MORE

Written By: Brett Becker, OTR/L, MS, ACE-CPT