Virginia Hixson’s article on Ergonomics for Text Messaging  previously posted provides information on research and ergonomic solutions for discomfort associated with Repetitive Strain Injury (RSI) and one specific RSI injury called De Quervain’s Tenosynovitis  . RSI and De Quervain’s has been increasingly identified with discomfort associated with excessive text messaging on handheld devices  in adults, teens and children (Partin, C, ND; Ashurst, Turco, Lieb, 2010; Narain, 2006). I found it described in numerous ways including Blackberry Thumb, Nintendo Thumb/Nintendonitis, Teenage Texting Tendonitis (Sadler, 2012) or Texting Thumb (Amadio. n.d.; ).

So what exactly are the symptoms and causes RSI or De Quervain’s Tenosynovitis related to use of mobile devices? Here is some basic information I found on Mayo Clinic website:

Symptoms of De Quervain’s tenosynovitis according to Mayo Clinic include:

• Pain near the base of your thumb
• Swelling near the base of your thumb
• Difficulty moving your thumb and wrist when you’re doing activities that involve grasping or pinching
• A “sticking” or “stop-and-go” sensation in your thumb when trying to move it

If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

Other symptoms identified with RSI with texting can include (Partin, C., n.d.):

• Stiffness
• Cramping
• Numbness
• Fatigue
• Swelling
• Symptoms can start intermittantly and worsen with activity

Causes:

Chronic overuse of your wrist is commonly associated with de Quervain’s tenosynovitis.

When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons normally glide unhampered through the small tunnel that connects them to the base of the thumb. If you repeat a particular motion day after day, it may irritate the sheath around the two tendons, causing thickening that restricts the movement of the tendons. Other causes of de Quervain’s tenosynovitis include:

• Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons
• Inflammatory arthritis, such as rheumatoid arthritis

Habitual texting certainly can contribute to the condition and also has been found in texting teens (Sadler, 2012)

Interventions

Virginia Hixson’s article has a number of ergonomic suggestions in her article Ergonomics for Text Messaging.  Massachusetts Institute of Technology also provides four keys to RSI intervention  listed below with additional online interventions included for “text thumb” or Blackberry Thumb” including Mayo Clinic’s Life Style and Home Remedies. Suggestions of handheld apps are included in Techniques for possible hands free or key input reduction.

1. Position – Watch your hand position when you text

• Keep your wrists in neutral when texting
• Rest your arms on a table or surface whenever possible to reduce the need to bend your neck for long periods of time
• Don’t hunch over when texting as it also has been shown to contribute to neck, shoulder and back problems (University of Gothenburg, 2009)
• Wear a brace or splint if suggested by your doctor.

2. Pacing  – Limit the amount and length of time you text

• Reduce the time you spend texting
• Take a break if you are texting for a long time
• If you are doing a lot of texting use a keyboard you can attach to your handheld device

retrieved from: http://www.miamivalleyhospital.org/uploadedFiles/mvh/Health_Information/v26i1_text.pdf

3. Technique – Being mindful of how you are texting can be helpful

• Position your hands for better alignment with wrists held at neutral position.
• Avoid moving your hands and wrists the same way repeatedly, vary your activity
• Use of a stylus might also offer a different position and movement when texting
• Take special note of any activity that causes pain, swelling or numbness in your thumb and wrist, try to avoid it, and share that information with your doctor.
• Utilize apps available for voice recognition, abbreviation expansion or word completion to reduce key input associated with texting:
  • Dragon Dictation  (free) for iOS
  • Dragon – (free) voice recognition for Android
  • Flex T9 (free) for Android
  • Siri on iOS – (free) on iPad 3 and iPhone 4S
  • Skyvi (free Siri) for Android
  • SwiftKey Keyboard for Android  – (1.99) Offers sliding your finger over the keyboard to type and predict typed words.
  • A.I.Keyboard Plus – (3.99) Word completion app for Android.
  • ZenTap Pro – (1.99) Word completion for iPhone
  • Brevity – (.99) Word completion/ auto expansion for iPhone

4. Exercise – There are recommended gentle stretching exercises to help relieve the symptoms of text thumb. Consult a physician if the symptoms increase.

• How to Relieve Blackberry Thumb Video – A video produced by Trish Muse, PT on exercises to relieve text thumb.
  http://www.monkeysee.com/play/7441-how-to-relieve-blackberry-thumb
• Virgin Mobile also offers “Textercises” from Sammy Margo Physiotherapist showing specific exercises to perform to relieve “text thumb”

Summary

There is a lot of information on the web on the subject. Here is one additional article from Advance for PT: “Texting and Hand Health” : http://physical-therapy.advanceweb.com/Features/Articles/Texting-and-Hand-Health.aspx

An increase in RSI has been found in children, teens and adults due to texting. Be mindful of ergonomics when using handheld devices no matter what the age to reduce long term effects of overuse and poor positioning!

Note: The above information is not a substitute for evaluation or treatment from a physician. Consult your physician for prolonged pain or discomfort .

Resources:

Ashurst, Turco, Lieb, 2010., “Tenosynovitis Caused by Texting: An Emerging Disease”. J Am Osteopath Assoc May 1, 2010 vol. 110 no. 5 294-296

Relief-for-texting-thumb. Jefferson Hospital, Aug. 2012. Web. 23 Feb. 2013. <http://www.jeffersonhospital.org/keep-in-touch/august-2012-issue/relief-for-texting-thumb&gt;.

Mayo Clinic. Mayo Clinic, n.d. Web. 23 Feb. 2013. http://www.mayoclinic.com/health/de-quervains-tenosynovitis/DS00692.

Muse, Trish.  How to Relieve Blackberry Thumb. N.p., n.d. Web. 23 Feb. 2013. http://www.monkeysee.com/play/7441-how-to-relieve-blackberry-thumb.

McEvoy, Cheryl. “Texting and Hand Health.” Advance for Physical Therapists. Advance, 10 July 2010. Web. 23 Feb. 2013. <http://physical-therapy.advanceweb.com/Features/Articles/Texting-and-Hand-Health.aspx&gt;.

Narain, Jaya. “Eight-year-old Text Queen Has Repetitive Strain Injury.” Daily Mail.com. Daily Mail, 8 June 2006. Web. 23 Feb. 2013. <http://www.dailymail.co.uk/news/article-389800/Eight-year-old-text-queen-repetitive-strain-injury.html&gt;.

Partin, Christine. (n.d.): n. pag. “Thumb Hurt? Wrist Sore? Hands Tired? Text Messaging May Be to Blame”,. Miami Valley Hospital. Web. 23 Feb. 2013. http://www.miamivalleyhospital.org/uploadedFiles/mvh/Health_Information/v26i1_text.pdf.

“Potential Risks of Computer Games and Text Messaging.” RSI.org. N.p., n.d. Web. 23 Feb. 2013. http://www.rsi.org.uk/pdf/games_and_texting.pdf.

“RSI: What You Absolutely Need to Know.” MIT, n.d. Web. 23 Feb. 2013. http://web.mit.edu/atic/www/rsi/needtoknow.html.

Sadler, Jane. “Teenage Texting Tendonitis.” Health Blog. Dallas News, 12 June 2012. Web. 23 Feb. 2013. <http://healthblog.dallasnews.com/2012/08/win-50000-dollars-and-you-may-get-teenage-texting-tendonitis-as-a-bonus.html/&gt;.

“Virgin Mobile SafeText.” Textercises.” Virgin Mobile, n.d. Web. 23 Feb. 2013. <http://www.practisesafetext.com/&gt;.

University of Gothenburg (2009, June 24). How To Text Message And Avoid Sore Thumbs, Neck And Hands. ScienceDaily. Retrieved February 23, 2013, from http://www.sciencedaily.com­ /releases/2009/06/090623150131.htm

Carol