Back Side Wrist Pain From Gaming

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Back-Side Wrist Pain From Gaming

Fox Fingers | Extensor Digitorum Communis/Indicis Proprius Tendinopathy

Hand Pain From Gaming
Back-Side Wrist Pain From Gaming
  • One of the most commonly injured areas in gaming due to the stress and strain put on the wrist/finger extensors resulting in back side wrist pain from gaming
  • Fox Fingers is irritation of just one or multiple tendons that cross the wrist and leads to the tips of the fingers
  • These muscles/tendons are responsible for lifting up the finger and wrist each time a new button is pressed or action is completed. Whether that is clicking the mouse/keyboard, using your finger to hit a controller trigger, or tapping something on the mobile device

Fox fingers is a condition that affects one or multiple tendons stemming from two muscles in your forearm, wrist, and fingers. Tendons are like little ropes that connect your muscles to your bones, and they help you move specific joints. When you play video games or use your wrist and fingers a lot, these tendons can get irritated and swollen, causing pain. These tendons in particular are what allows each person to lift their fingers which is necessary to click/push buttons or screens. 

This diagnosis is termed “Fox fingers” due to the frequent occurrence in melee players who main Fox. This can also be present in PC gamers who play high actions per minute (APM) games/characters (think Invoker in Dota 2, or rhythm games like Osu!) gamers. In these games players are required to perform frequent actions for prolonged periods of time which can lead to overuse of the finger extensor muscles/tendons. Through improper positioning, poor conditioning, or inadequate rest these tendons will take the brunt of this and elicit pain. This name “Fox fingers” is also interchangeable with Extensor digitorum communis (EDC) / Indicis proprius tendinopathy (EIP). This diagnosis is vastly different from carpal tunnel syndrome as carpal tunnel from gaming is much less common than many know and believe. Discussed below are just a few simple, but effective ways to fix wrist pain from gaming.

Gamers are likely to begin experiencing pain and discomfort while playing and a sore, achey, or stiff feeling after in the area indicated to the right. Weakness is also likely to be present with lifting and moving the mouse as well as lifting the finger off the screen/mouse. This is likely to decrease performance and alter the gameplay of the individual where movements may be slowed or less precise. Pain may be worse with activities such as playing the piano, picking up cards or game pieces, using scissors to open a new package, or throwing a curveball while playing Pokemon Go.


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.

Gamers use their fingers a lot! Gamers are at risk because of the long durations we play. Oftentimes this means we are taking less rest breaks when we are in the zone because we don’t always think to put our body first. Pain 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. Gamers are also at risk because of the specific motions required when playing. Gamers playing high APM games are at an increased risk because of the repetitive strain in lifting up (extending) the finger. Each time the mouse is clicked, these muscles/tendons are being used. For other games like Smash, players may notice discomfort after frequently playing melee which utilizes the fingers at high rates of speed and often does not allow for rest breaks mid game to limit the overall use.

For a short video explanation about how overuse injuries can develop in gamers and how to help them, check out the video linked here:

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 pain in this area occurs. 

  1. Identify the issue (One of the most important factors is early detection…do NOT push into or through pain)
  2. Rest the wrist/fingers (Few days of reducing the workload, but be sure to continue moving the wrist, fingers, elbow)
    • Splinting: This may be one way for individuals to rest the irritated tendon. It is important for a gamer to know that this should be used as minimally as possible, but may be necessary for very painful acute symptom management.
    • Splints for this diagnosis are rarely recommended as it is relatively restrictive, but if necessary then look for a “resting hand splint”.
  3. Massage in times of pain/discomfort
  4. Utilize heat/ice (Hot/cold packs, warm water soak)
    • Heat can be helpful before or during activity. Ice can be helpful following activity in the presence of pain. Be cautious using ice over specific nerves as this may lead to irritation.
  5. Initiate isometric exercises **
    • A good starting exercise to regain/maintain strength while limiting further pain or irritation
  6. Stretching **
    • Helpful in reducing pain throughout the entire range of motion 
  7. Isotonic strengthening **
    • Necessary to improve strength and endurance to decrease pain while playing and prevent future injury from returning

Diagnosis specific tip: Consider utilizing voice to text if performing school or work duties for long periods of time as this will save the muscles/tendons from an additional workload. Spring loaded scissors may also be indicated if at a job or in school which requires a lot of cutting.

*Surgery is very rarely required in order to effectively treat

 

**For a comprehensive guide on the exercises discussed, check out the videos on our

Fix Wrist Pain Link

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 two muscles which end up diverging into 5 total tendons (connect muscle to bone) which are responsible for lifting (extending) the fingers. These tendons can feel irritated at various points such as the wrist crease as they run from near the elbow into the tips of the fingers. Through repetitive use, inadequate amounts of rest, or forceful clicking the tendon can experience inflammation which if ignored may lead to structural damage over time. This overuse leads to a pain response to warn the body of damage so that individuals will stop the aggravating activity. 

Tendons responsible:

  • Extensor Digitorum (highlighted in the blue, TOP)
    • The muscle is responsible for extending the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of all the fingers aside from the thumb (digits 2-5).
    • The muscle originates at the lateral epicondyle of the humerus where it diverges near the wrist to form 4 separate tendons which attach to the dorsal aspect of the middle and distal phalanges of digits 2-5.
  • Extensor Indicis (highlighted in the blue, BOTTOM)
    • The muscle is primarily responsible for extending the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of the index finger (digit 2). Additionally this can assist in finger abduction of the index finger and supination of the forearm. 
    • The muscle originates at the ulna and interosseous membrane where it diverges near the wrist to form 4 separate tendons which attach to the medial aspect of the middle and distal phalanges of the index finger (digit 2).

*Both muscles also help in extending the wrist 

Ganglion Cyst-A fluid filled sac that grows from the lining of our joints, often times needs to be removed. This is important to seek medical advice from a doctor regarding treatment.

 

Intersection Syndrome-Intersection Syndrome mimics Gamers Thumb (De Quervain’s Tenosynovitis) as well as Fox Fingers as it is within close proximity to the pain location. Instead with Intersection syndrome, it will present (Proximal to the dorsal wrist crease) higher up on the back of the forearm roughly 4-6 cm from the wrist crease. This is a form of tenosynovitis between 2 sets of tendons intersecting and near the wrist causing friction and pain.

There are several approaches to take in order to prevent this injury from occurring or coming back. There are 3 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. Strengthening exercises (Important for building up a foundational base to allow the tendon/muscle to keep up with the workload they are being asked of)
  2. Intermittent stretching (During and after gaming sessions)
  3. Proper warm-up (Promotes blood flow to the muscles/tendons and lubricates stiff joints)

Additional 

  1. Ergonomics/positioning 
    • (Poor positioning could put the muscles/tendons in a compromised position which forces it to work harder therefore making it more susceptible to injury)
  2. Rest breaks 
    • (Pain 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. Additionally, the break may not need to be the same for each person. If the injury severity is high then it may be better to take more frequent or longer breaks vs someone who has mild stiffness or discomfort where breaks can be more infrequent or shorter in duration)
    • 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 to avoid overuse. A general rule of thumb is, the longer you play, the longer the break should be to allow for some recovery. )
  3. Massage 
    • (Helpful at times whenever pain or tenderness is present)
  4. Ice 
    • (Following long bouts of gaming if painful)
  5. Heat 
    • (Prior to gaming sessions or stretches)
  6. Relative rest 
    • (If tenderness becomes apparent over the back side wrist area shown above then it is best to reduce the time playing or take some added time off)
  7. Sleep/Nutrition/Mental health 
    • (These underlie all of what is experienced in a day and cannot be ignored in injury prevention) 
  • McGee C and Ho K (2021) Tendinopathies in Video Gaming and Esports. Front. Sports Act. Living 3:689371. doi: 10.3389/fspor.2021.689371
  • Hu X, Suresh NL, Xue C and Rymer WZ (2015) Extracting extensor digitorum communis activation patterns using high-density surface electromyography. Front. Physiol. 6:279. doi: 10.3389/fphys.2015.00279
  • Yoo W. G. (2015). Effects of different computer typing speeds on acceleration and peak contact pressure of the fingertips during computer typing. Journal of physical therapy science, 27(1), 57–58. https://doi.org/10.1589/jpts.27.57

Additional 1HP Articles on Fox Fingers

HAND PAIN WITH GAMING? YOU MIGHT BE DEALING WITH THIS!

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