Gamer’s Thumb Pain

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GAMER'S THUMB PAIN

Thumb Bind Tendinopathy | De Quervian’s Tenosynovitis | Gamers Thumb

Expert Opinion

One of the most commonly injured areas in gaming due to the stress and strain put on the thumb in combination with moving the wrist
Thumb bind tendinopathy is irritation of the 2 tendon sheaths that cross the wrist and lead to the thumb
These tendons are responsible for moving the mouse to the left and lifting up the thumb

Thumb bind tendinopathy is a condition that affects the tendons in your wrist and thumb. Tendons are like little ropes that connect your muscles to your bones, and these particular tendons help you move your thumb. When you play games or use your thumb and wrist a lot, these tendons can get irritated and swollen, causing pain.

This diagnosis is termed thumb bind tendinopathy, but may also go by “falcon thumb” due to the frequent occurrence in Smash players who use the thumb to hit the A, X, Y, and C joystick on a GameCube controller. This name is also interchangeable with De Quervain’s tenosynovitis, 1st dorsal compartment tenosynovitis, or gamers thumb. 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.

Common Things You Might Feel?

Individuals may experience pain and tenderness in the area indicated above. Weakness is also likely to be present with gripping and moving a mouse or pinching to open that new pack of pokemon cards or bag of beef jerky. Gamers are likely to begin experiencing warmth or mild pain while playing, but more of the pain is likely to come following play. This area then may feel sore or achy well after use with general stiffness most often reported even into the next day.

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.

Quick Test

*FINKELSTEIN TEST

Perform this quick test* shown here to screen for this diagnosis. If there is a sharp pain experienced on the thumb side of the wrist then this may indicate a you have this condition.

How Does It Happen to Gamers?

Gamers use their thumb and wrist 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. Each form of gaming utilizes these specific tendons as they allow us to hold on to the input device and move the thumb to tap buttons or move a joystick. If you want to learn more about some of the anatomy and science, check out the sections below!

Mobile Gaming

Holding screen for prolonged periods of time and using thumb to tap/text

Console Gaming

Manipulating the joystick, hitting buttons, and holding a controller for prolonged periods of time

Computer Gaming

Frequently moving the wrist/mouse left and right

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

How to fix it / Recover / What can you do? Strategies to manage symptoms?

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 complete when gaming wrist pain in this area occurs.

Identify the issue (One of the most important factors is early detection…do NOT push into or through pain)
Rest the thumb and wrist (Few days of reducing the workload, but be sure to continue gently moving the thumb)
- Splinting: This may be one way for individuals to rest the irritated tendons. It is important for a gamer to use a “forearm based thumb spica” splint as this is the best splint to rest/relax the overused tendons.
- This should be used as minimally as possible, but may be necessary for very painful acute symptom management.
Massage in times of pain/discomfort
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
Initiate isometric exercises **
- A good starting exercise to regain/maintain strength while limiting further pain or irritation
Stretching **
- Helpful in reducing pain throughout the entire range of motion
Isotonic strengthening **
- Necessary to improve strength and endurance to decrease pain while playing and prevent future injury from returning
Therapy/Medical Professional
- Trained individual on rehab and prevention of injuries and how to fix wrist pain from gaming
- Modalities (A variety of modalities may be used throughout therapy sessions to help speed recovery)

*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 here**

Science Behind The Injury

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 2 tendons (connect muscle to bone) and the sheaths that cover them. Through repetitive use and inadequate amounts of rest, the tendons themselves are constantly rubbing and experience excess friction. This friction leads to a pain response to warn the body of damage and overuse so that individuals will stop the aggravating activity.

Tendons responsible (highlighted in the yellow):

Extensor pollicis brevis: extension of your thumb
- Ex: Lifting the thumb up to hit a button.
Abductor pollicis longus: abduction of your thumb
- Ex: Moving the thumb from X to C stick

The muscles involved move the thumb like this (also known as thumb extension / abduction):

When gamers move their thumb a lot in this direction it can lead to increased strain on the tendon which leads to the symptoms.

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 other hobbies can also further stress these tendons and can be important to thoroughly evaluate as well.

Differential Diagnosis:

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.

Preventative Approach

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.

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)
Intermittent stretching (During and after gaming sessions)
Proper warm-up (Promotes blood flow to the muscles/tendons and lubricates stiff joints)

Additional

1. 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 (Pun intended) 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 palm 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)

References

Benites-Zapata, V. A., Jiménez-Torres, V. E., & Ayala-Roldán, M. P. (2021). Problematic smartphone use is associated with de Quervain’s tenosynovitis symptomatology among young adults. Musculoskeletal science & practice, 53, 102356. https://doi.org/10.1016/j.msksp.2021.102356
Ilyas, Asif M. MD; Ast, Michael MD; Schaffer, Alyssa A. MD; Thoder, Joseph MD. de Quervain Tenosynovitis of the Wrist. Journal of the American Academy of Orthopaedic Surgeons 15(12):p 757-764, December 2007.
Huisstede BMA, Coert JH, Fridén J, Hoogvliet P. Consensus on a Multidisciplinary Treatment Guideline for de Quervain Disease: Results From the European HANDGUIDE Study. Physical Therapy. 2014 Aug;94(8):1095-1110.
Ma, T., Song, L., Ning, S. et al. Relationship between the incidence of de Quervain’s disease among teenagers and mobile gaming. International Orthopaedics (SICOT) 43, 2587–2592 (2019). https://doi.org/10.1007/s00264-019-04389-9
Morgan, S. D., Sivakumar, B. S., An, V. G., Sevao, J., & Graham, D. J. (2020). A Review of De Quervain’s Stenosing Tenovaginitis in the Context of Smartphone Use. The journal of hand surgery Asian-Pacific volume, 25(2), 133–136. https://doi.org/10.1142/S2424835520300029