Pinky Side Wrist Pain From Gaming
Pinky Side Wrist Pain From Gaming
Flick Wrist Syndrome | Extensor Carpi Ulnaris Tendinopathy | Mouse Wrist Tendinopathy | Snapping Wrist
- 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. lifting up the 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.
Flick Wrist Syndrome is a condition that affects one muscle/tendon in your forearm and wrist. 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 this tendon can get irritated and swollen, causing pain. This tendon in particular is what 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. Players of these games perform frequent actions for prolonged periods of time which can lead to overuse of the extensor carpi ulnaris (ECU) tendon. Through improper positioning, poor conditioning, or inadequate rest this tendon will take the brunt of this and elicit pain. This name “Flick wrist syndrome” is also interchangeable with Extensor carpi ulnaris tendinopathy, mouse wrist tendinopathy, and snapping wrist. 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 below. Weakness is likely to be present with lifting and moving the mouse as well as feeling “off” while aiming. This is likely to decrease performance and alter the gameplay of the individual where movements may be slowed or less precise. 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, using a hammer/screwdriver to build a new gaming desk, etc.
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 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 to limit the overall use. All of this contributes to the overall strain gamers may experience.
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.
- Identify the issue (One of the most important factors is early detection…do NOT push into or through pain)
- 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.
- A splint used for this diagnosis should be a standard wrist splint with the thumb free. This will restrict the irritated muscles/tendons from being used and allow the pain to subside while they heal. Others may benefit from the use of a “Bullseye brace” or “Wrist Widget” to further stabilize the wrist. For certain individuals who experience snapping or subluxation of the ECU tendon a muenster splint may be indicated which limits forearm rotation.
- 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. Be cautious using ice over specific nerves as this may lead to irritation.
- 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
*Surgery is very rarely required in order to effectively treat
Diagnosis specific exercise tip: Utilize free weights and/or EZ bar when performing bicep curls to limit the fixed palm up (supination) motion or stress on the wrist
**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 one muscle which helps to 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. Through repetitive use, inadequate amounts of rest, or improper positioning 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.
Tendon responsible:
- Extensor Carpi Ulnaris (ECU)
- This muscle is responsible for wrist extension (lifting) and ulnar deviation (bending towards your pinky)
- This muscle originates at the lateral epicondyle of the humerus and inserts on the back of the small finger (dorsal base of the fifth metacarpal).
TFCC Tear- The triangular fibrocartilage complex (TFCC) is made up of ligaments and cartilage on the pinky (ulnar) side of the wrist acting as a stabilizer. The TFCC helps attach the forearm bones to the bones in your wrist and provides support in forearm rotation and gripping. In young individuals this is most likely to be injured through trauma, but can still develop from chronic degeneration and overuse.
Ganglion Cyst-A fluid filled sac that grows from the lining of our joints. This can be seen protruding from the back of the wrist and most times needs to be removed. This is important to seek medical advice from a doctor regarding treatment.
Intersection Syndrome-Intersection Syndrome mimics Flick Wrist Syndrome 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 and more toward the thumb side of the wrist. 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.
- 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
- 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)
- 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. )
- Massage
- (Helpful at times whenever pain or tenderness is present)
- Ice
- (Following long bouts of gaming if painful)
- Heat
- (Prior to gaming sessions or stretches)
- 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)
- Sleep/Nutrition/Mental health
- (These underlie all of what is experienced in a day and cannot be ignored in injury prevention)
- 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. https://doi.org/10.1136/bjsports-2013-092835
- McGee C and Ho K (2021) Tendinopathies in Video Gaming and Esports. Front. Sports Act. Living 3:689371. doi: 10.3389/fspor.2021.689371
- 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. https://doi.org/10.1589/jpts.27.57
- 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;0(0). doi:10.1177/15589447221127331
Additional 1HP Articles on Flick Wrist Syndrome
Written By: Brett Becker, OTR/L, MS, ACE-CPT
Expert Opinion
What Does This Diagnosis Mean
Common Things You Might Feel
How Does it Happen to Gamers
How to Fix It
Science Behind the Injury
Preventative Approach
References