Pinky Side Wrist Pain From Gaming

Expert Opinion

• One of the most commonly injured areas in gaming due to the stress and strain put on this muscle for PC gamers.
• Flick Wrist Syndrome is irritation of one tendon that crosses the wrist and allows for a key movement towards the small finger in PC gamers.
• This muscle/tendon is responsible for the flicking motion many PC gamers utilize when playing a variety of games.

What Does This Diagnosis Mean

Flick Wrist Syndrome is a condition that affects one muscle/tendon in your forearm and wrist. When you play video games or use your wrist this tendon can get irritated and swollen, causing pain. This tendon in particular allows someone to move their wrist towards the pinky side (ulnar deviation).

This diagnosis is termed "Flick Wrist Syndrome" due to the frequent occurrence in PC gamers playing FPS games such as Valorant or CS:GO who are required to flick their wrist during certain engagements to snap on to other players. This name is also interchangeable with Extensor carpi ulnaris tendinopathy, mouse wrist tendinopathy, and snapping wrist. This diagnosis is vastly different from carpal tunnel syndrome.

Common Things You Might Feel

Gamers are likely to begin experiencing pain and discomfort while playing and a sore, achy, or stiff feeling after. Weakness is likely to be present with lifting and moving the mouse as well as feeling "off" while aiming. Some may report feeling a clicking/popping feeling on the pinky side of the wrist when turning the palm up (supination) which may indicate the tendon is subluxing. Pain may be worse with activities such as playing the piano, picking up cards or game pieces, or using a hammer/screwdriver to build a new gaming desk.

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 to Gamers?

Gamers playing on PC are at an increased risk because of the repetitive strain in wrist motion required. Each time the mouse is moved towards the pinky side using the wrist, this muscle/tendon is being used. For PC gamers playing on a high DPI, the wrist will be where the majority of motion comes from which in turn makes them more susceptible to this injury. Additionally, players are playing at high rates of speed which often does not allow for rest breaks mid game.

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: A standard wrist splint with the thumb free will restrict the irritated muscles/tendons. Others may benefit from a "Bullseye brace" or "Wrist Widget." For individuals who experience snapping or subluxation of the ECU tendon, a muenster splint may be indicated to limit forearm rotation.
3. Massage in times of pain/discomfort.
4. Utilize 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 exercise tip: Utilize free weights and/or an EZ bar when performing bicep curls to limit the fixed palm-up (supination) motion or stress on the wrist.

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 one muscle which helps move the wrist and mouse towards the pinky side during gaming. The pain will be noticeable at the wrist crease on the pinky side and may be exacerbated by frequent forearm rotation which makes the tendon more prone to becoming pinched between the two forearm bones as the subsheath becomes damaged.

Tendon responsible:

• Extensor Carpi Ulnaris (ECU) — Responsible for wrist extension (lifting) and ulnar deviation (bending towards your pinky). Originates at the lateral epicondyle of the humerus and inserts on the back of the small finger (dorsal base of the fifth metacarpal).

Differential Diagnosis

• TFCC Tear — The triangular fibrocartilage complex (ligaments and cartilage on the pinky/ulnar side of the wrist) acts as a stabilizer. In young individuals this is most likely injured through trauma, but can develop from chronic degeneration and overuse.
• Ganglion Cyst — A fluid-filled sac that grows from the lining of our joints; often needs to be removed.
• Intersection Syndrome — Mimics Flick Wrist Syndrome; presents higher up on the back of the forearm roughly 4–6 cm from the wrist crease and more toward the thumb side.

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 sessions).
3. Proper warm-up — Promotes blood flow and lubricates stiff joints.

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

References

• Campbell, D., Campbell, R., O'Connor, P., & Hawkes, R. (2013). Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management. British journal of sports medicine, 47(17), 1105–1111.
• McGee C and Ho K (2021) Tendinopathies in Video Gaming and Esports. Front. Sports Act. Living 3:689371.
• 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.
• Zarro M, Goel R, Bickhart N, May CC, Abzug JM. Extensor Carpi Ulnaris Tendinopathy in Athletes: A Review of the Conservative and Rehabilitative Options. HAND. 2022.