Back Side Wrist Pain From Repetitive Strain

Expert Opinion

• One of the most commonly injured areas in gaming and other repetitive hand use, such as typing and mouse work, due to the stress and strain put on the wrist/finger extensors.
• Fox Fingers is irritation of one or multiple tendons that cross the wrist and lead to the tips of the fingers.
• These muscles/tendons are responsible for lifting up the finger and wrist each time a new button or key is pressed or action is completed.

What Does This Diagnosis Mean

Fox fingers is a condition that affects one or multiple tendons stemming from two muscles in your forearm, wrist, and fingers. When you type, click a mouse, play video games, play an instrument, or use your wrist and fingers a lot in other ways, these tendons can get irritated and swollen, causing pain. These tendons allow each person to lift their fingers which is necessary to click/push buttons, keys or screens.

The name "Fox fingers" comes from gaming: it is common in Melee players who main Fox. It 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!). The same tendons lift the fingers in fast typing and playing the piano, so heavy use there can strain them too. This name is also interchangeable with Extensor digitorum communis (EDC) / Indicis proprius (EIP) tendinopathy. This diagnosis is vastly different from carpal tunnel syndrome.

Common Things You Might Feel

People with this condition are likely to begin experiencing pain and discomfort during the activity (gaming, typing, mouse work, playing an instrument) and a sore, achy, or stiff feeling after. Weakness is also likely to be present with lifting and moving the mouse as well as lifting the finger off the screen/mouse/keys. 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.

Disclaimer: 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.

How Does It Happen?

High APM gaming, fast typing and other quick finger work raise the risk because of the repetitive strain in lifting up (extending) the finger. Each time the mouse is clicked or a key is pressed, these muscles/tendons are being used. For other games like Smash, players may notice discomfort after frequently playing Melee which uses the fingers at high rates of speed and often does not allow for rest breaks mid game. Long typing sessions or instrument practice without breaks can load the fingers the same way.

How to Fix It / Recover / What Can You Do?

1. Identify the issue (early detection…do NOT push into or through pain).
2. Rest the wrist/fingers (a few days reducing workload, but continue moving the wrist, fingers, elbow).
   • Splinting: Rarely recommended as relatively restrictive, but if necessary look for a "resting hand splint."
3. Massage in times of pain/discomfort.
4. Use heat/ice (hot/cold packs, warm water soak). Be cautious using ice over nerves.
5. Initiate isometric exercises: a good starting exercise to regain/maintain strength while limiting pain.
6. Stretching: helpful throughout the range of motion.
7. Isotonic strengthening: improve strength and endurance to decrease pain and prevent recurrence.

Diagnosis specific tip: Consider using voice-to-text for long school/work duties to save the muscles/tendons additional workload. Spring-loaded scissors may also be indicated for jobs/school requiring 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 page.

Science Behind The Injury

Specifically, this diagnosis is looking at two muscles which end up diverging into 5 total tendons 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.

Tendons responsible:

• Extensor Digitorum: Extends the MCP, PIP, and DIP joints of all fingers aside from the thumb (digits 2 to 5). Originates at the lateral epicondyle of the humerus and diverges near the wrist into 4 separate tendons attaching to the dorsal aspect of the middle and distal phalanges of digits 2 to 5.
• Extensor Indicis: Primarily extends the MCP, PIP, and DIP joints of the index finger (digit 2). Assists in index finger abduction and forearm supination. Originates at the ulna and interosseous membrane.

Both muscles also help in extending the wrist.

Differential Diagnosis

• Ganglion Cyst: A fluid-filled sac that grows from the lining of our joints; often needs to be removed.
• Intersection Syndrome: Mimics Gamers Thumb (De Quervain's) as well as Fox Fingers; presents higher up on the back of the forearm roughly 4 to 6 cm from the wrist crease.

Preventative Approach

There are 3 main factors to first focus on, plus secondary factors.

1. Strengthening exercises: Build a foundational base for the tendon/muscle.
2. Intermittent stretching (during and after gaming, typing or practice sessions).
3. Proper warm-up: Promotes blood flow and lubricates stiff joints.

Additional: Ergonomics/positioning; rest breaks (every 45 to 60 minutes); massage; ice; heat; relative rest; Sleep/Nutrition/Mental health.

When to see a doctor first

See a doctor before starting if you have any of these:

• Constant numbness that doesn't change with activity
• Worsening weakness
• Visible muscle wasting
• Major swelling or color change
• A recent injury or fall
• Fever
• Severe, unrelenting pain
• Symptoms that wake you every night

Seek urgent care for emergencies.

Frequently asked questions

Why does the back of my wrist hurt when I type or game?

Every time you lift a finger to press the next key or button, the finger extensor tendons on the back of the wrist do the work. In long typing sessions, fast gaming or piano playing, these tendons can fall behind and get sore. Holding your fingers lifted high above the keys adds more load.

Is a bump on the back of my wrist a ganglion cyst?

The back of the wrist is the most common place for a ganglion cyst. It is a smooth, fluid-filled lump that can change size over time. Many are harmless and need no treatment, but any new lump should be checked by a doctor to confirm what it is.

What is intersection syndrome?

Intersection syndrome is irritation where two groups of wrist and thumb tendons cross on the back of the forearm, a few inches above the wrist. It can cause pain, swelling and a creaking feeling when you move the wrist. It is often linked to rowing, lifting and other repeated wrist motion.

Can voice typing help back side wrist pain?

Yes, it can lower hand load on busy days. Using voice typing for long emails, papers or chats gives the finger extensors a break while you keep working. It works best as a short-term tool while you build strength, not as a permanent replacement for typing.

Should I stretch the back of my wrist?

Gentle stretches that bend the wrist and curl the fingers can ease tightness during breaks. Stretching alone rarely fixes tendon pain, since these tendons usually need more strength and endurance. Use stretches as a break tool, and add graded strengthening for lasting change.

See all questions

References

• McGee C and Ho K (2021) Tendinopathies in Video Gaming and Esports. Front. Sports Act. Living 3:689371.
• 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.
• 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.