Dr. Steven H. Goldberg answers your questions about symptoms and myths related to common activities such as texting, typing and playing video games and whether they cause hand pain.
Question: Is extensive texting or video game play likely to cause wrist or hand symptoms?
Several studies have examined this question, and there is some limited evidence that higher amounts of texting or video game play may cause some hand/wrist discomfort. However, this should not be considered a “medical condition.” The obvious “cure” is to reduce the activity and thus avoid the need to see a healthcare provider. With some good old-fashioned common sense, I think each person should be able to adjust their activities to keep symptoms at a minimal or absent level. “Everything in moderation, even moderation.” — Oscar Wilde
However, if someone develops sustained symptoms that are concerning to them, whether it is from texting or another possibly unknown cause, then a medical evaluation would be appropriate. One study of 117 students compared clinical and ultrasound findings of thumb joints in young adults, with and without thumb pain, associated with text messaging. Tenderness was most common in the joint where the thumb meets the hand, followed by the wrist joint at the base of the thumb, and lastly at the joint closest to the fingernail. Ultrasound detected fluid only in the joint where the thumb meets the hand in patients with thumb pain. Ultrasound did not detect fluid in other joints and did not detect this fluid in patients who were pain-free.
A U.S. study found that 75% of children use game consoles or computers. In this study, female gender, longer playing duration and younger age all correlated with increased wrist and finger pain. In a different study, the type of device, such as a touchscreen compared to buttons, had different amounts of thumb movement and muscle activity. More pronounced differences in thumb flexion were found in the group with shorter hands, and differences in muscle activity were seen in the group with longer hands. Thus, hand size and type of device could have some effect on pain development. However, a population-based study of 791 adolescents in Brazil concluded that, despite the frequent use of computer and video games among adolescents, these devices were not associated with the presence of pain. A separate study, also completed in Brazil, found that neck posture, neck pain, and texting were not associated with one another.
Question: Can mobile and other electronic devices be used to decrease pain or anxiety?
Mobile and technologic devices can reduce pain, anxiety and heartrate and offer an engaging activity that is a welcome distraction from painful procedures or events. The gate-keeper theory suggests the brain may only give attention to a certain amount of sensory stimuli. So, when you focus your senses on a game, video or other interactive app, pain can be “forgotten” or “blocked out.”
In a systematic review of 15 studies with 1,962 patients, the severity of pain decreased in most studies where patients were using a pain reduction app on a mobile device compared with patients not using an app. Other measures, such as “worst pain” or “quality of life” showed improvements in patients using an app. Playing games on a mobile device can distract children and results in only 1 of 6 children reporting pain during venipuncture, which is equivalent to distraction by a trained nurse.
Another interesting use of new technology is vibrating gloves that have shown reduced hand pain in women with osteoarthritis (53.5%).
Question: Can video games make my surgeon better?
Video games have been suggested to improve eye-hand coordination, spatial recognition, dexterity, and rapid decision-making. A study on a virtual reality laparoscopic surgery simulator involved randomizing students to two groups, one who gamed on the Nintendo Wii®️ and one who did not use the gaming system. The gaming system group had improvements in accuracy with eye-hand coordination, speed, decreased hand motion and improved economy of movement, and they overall consistently outperformed the control group in 18 measures compared with the control group’s improvement in 6. Another study demonstrated virtual reality games can improve training, automation and surgical motor skills; expert surgeons had equal skill on games using either hand, whereas trainees had more difficulty with their non-dominant hand. People with manual dexterity skills used in video games may perform better initially in a surgical simulation game situation, but this advantage is short-lived and can be overcome with practice.
Question: Does computer keyboard or mouse use cause upper extremity pain?
Answer: It is not likely that keyboard use causes this pain. Patients are more likely to self-report pain based on the amount they type on a keyboard, but when computer use is monitored with software, the correlation between pain and amount of work disappears. There is some limited evidence that people who use a mouse over 30 hours/week may develop forearm pain.
One study that analyzed typing speed did not correlate keyboard use with upper extremity pain. One study looked at number of keystrokes and mouse clicks, length of the average activity period, and micro-pauses; this study found keyboard and mouse use did not influence reports of acute or prolonged neck or shoulder pain. A large Scandinavian study of 6,943 computer users found 10% of workers reported elbow, forearm, or wrist-hand pain during the 12 months the study started. Computer usage was monitored by a program installed on their computers. The workers were then followed for one year, and the study determined pain was not influenced by mouse or keyboard work (time, speed, micropause, and average activity periods), or ergonomic workplace conditions, but the keyboard times were rated as very low. They found a predictor of persistent arm pain was pain in other areas.
Question: Does computer or mouse use cause carpal tunnel syndrome (CTS)?
Answer: It is not likely that computer keyboard use increases the likelihood of developing CTS. There is some limited evidence that mouse use over 20 hours per week may increase incidence of CTS.
One study analyzed a group of 21 patients who were given computer mouse activities using a standard mouse, a vertical mouse, a gel mouse pad, or a gliding palm support. Carpal tunnel pressure increased over baseline while operating a computer mouse, and the pressure remained elevated even when using the other ergonomic options. So, patients should choose whichever work set-up feels more comfortable, but the study was not designed to comment on whether the mouse use actually causes CTS.
Question: Even if evidence is limited for keyboard- and mouse-related pain, is there something that can be done if I get pain at work?
Mouse and trackball devices come in different sizes and shapes. It is recommend to try several different brands or styles to find one that is most comfortable. During use of the mouse, the wrist should be extended less than 30 degrees. Sensitivity to motion can be set on the computer so that smaller movements result in more cursor movement. Less overall hand/mouse movement could reduce repetitive stress. Dragging and dropping when there is pressure applied to a button while moving the mouse side to side results in higher carpal tunnel pressure than clicking alone. Thus, computer activities that minimize dragging and dropping can be beneficial.
Some studies suggest there may be ergonomic stressors with typing/mousing technique, keyboard height, inadequate seating and lack of breaks. Improvement in symptoms occurred in 89% following medical/ergonomic intervention, so it may be helpful to find out of your workplace would permit you to undergo an ergonomic assessment.
There are a variety of things that may improve symptoms, including:
- Alternative keyboard designs
- Different computer mouse shapes
- Wrist supports
- Keyboard support systems
- On-the-job exercise programs
- Taking time for breaks
- Workstation redesign (standing vs. sitting, keyboard height, chair height with/without arms)
- Ergonomics training
- Restricting continuous time spent on one activity
In general, employees in jobs that require highly repetitive and forceful gripping or lifting may be more likely to benefit from job rotation (when the type of activity changes frequently). The same activity may be stressful for one person, but not another. Although none of the studies conclusively show the above interventions would result in prevention of carpal tunnel syndrome or pain syndromes, the above suggestions are low-risk, reasonably-priced options to try to minimize symptoms.
Steven H. Goldberg, MD is Board Certified in Orthopaedic Surgery and is a Fellowship Trained Hand and Microvascular Surgeon with The Subspecialty Certificate in Surgery of the Hand. He has been a member of the American Society for Surgery of the Hand since 2010 and serves as Advisor for the ASSH to the American Medical Association CPT Editorial Panel. He is a member of the Physician Coding and Reimbursement and Public Education Committees. He is interested in Clinical Informatics and is involved in multiple research projects, some of which involve Raynaud’s and vascular disorders. He currently practices at Geisinger Medical Center in Danville and Bloomsburg, Pennsylvania.