gamers thumb anatomy

Gamer's thumb: a looming injury for console gamers

A condition known as De Quervain’s syndrome, this is an inflammatory condition of the sheaths that surround the tendons of the thumb. Due to its prevalence in console gaming, this condition has been called “gamer’s thumb.”

What is gamer’s thumb?

Gamer’s thumb is tenosynovitis of the tendons of the thumb. Specifically, gamer’s thumb affects the tendons of the extensor pollicis brevis and abductor pollicis longus muscles. These muscles pull the thumb away from the hand and palm.

In console gaming, these motions are primarily involved in thumb stick movements. This condition has also recently been identified with greater prevalence due to text messaging on mobile devices. These muscles/tendons are less commonly strained in PC gaming.

Pertinent anatomy

It’s important to know some basic anatomy of the thumb to understand this condition.

To begin, the tendon sheaths affected in gamer’s thumb surround tendons that attach from your forearm to your thumb. If you open your hand wide, you can see the tendons pop up on the thumb side of your wrist:

  • Extensor pollicis brevis: extension of your thumb (as in opening your hand wide)
  • Abductor pollicis longus: abduction of your thumb (pulling away from your palm)
Gamer's thumb in gamers
The extensor pollicis brevis and abductor pollicis longus tendons and sheaths

Tendons and tendon sheaths

Tendons are bands of fascia that transmit force from muscle to bone. They are continuous with the muscles and bones to which they are attached.

In some areas of your body, tendons may run through anatomical tunnels made of other types of tissue. In other instances, tendons navigate areas of the body with bony projections. In either case, the tendon may be at risk for greater levels of friction.

Your body’s protective mechanism for this potential increase in friction is a sheath, or a protecting layer of tissue with synovial fluid (lubrication for joints and tendons) that surrounds the tendon. The synovial sheath effectively decreases friction by allowing a smooth gliding of the tendon in these areas.

Tendon sheaths are found most commonly in the hands and feet. The extensor pollicis brevis and abductor pollicis longus tendons have this protective sheath.

Pathophysiology

This injury is in the category of tenosynovitis:

  • Teno-: identifying the involvement of a tendon
  • Synov-: identifying the involvement of the tendon’s synovial sheath
  • -itis: identifying that this is an inflammatory condition
tendon sheath inflammation
Tenosynovitis: inflammation of the sheath surrounding a tendon

It is an inflammatory overuse injury; however, it is not an inflammation of the tendons. Rather, it is an inflammation of the sheath that surrounds the tendons.

De Quervain’s tenosynovitis may be caused by direct trauma; however, the absence of trauma indicates a true overuse syndrome. In other words, excessive activation of the thumb muscles & tendons may lead to inflammation of the tendon sheaths and cause symptoms.

In other overuse strain injuries such as mouse elbow, the issue is an imbalance in muscle activity. In overuse tenosynovitis, the issue is actually excessive, high volume activity.

Signs & symptoms

If you’re affected by gamer’s thumb, you’re likely to experience the following symptoms:

  • Pain: most often, you will experience pain on the thumb side of your forearm and wrist
  • Weakness: gripping may feel weak; however your perceived weakness is more likely due to pain rather than true muscle weakness

Other common findings may include:

  • More pronounced symptoms when extending your abducting your thumb (pulling your thumb away from your hand)
  • Bending your wrist to the pinky side of your hand may also increase pain
  • Worsening symptoms after periods of activity (playing video games or texting)
  • Relief or improvement of symptoms after periods of rest
thumb pain
Most often, you will experience pain on the thumb side of your forearm and wrist

Note: gamer’s thumb is inflammatory in nature. Inflammation is categorized by pain with accompanying swelling, redness, and heat (feeling warm to the touch). These symptoms may appear, but they should be mild.

If you have a fever, or if you notice moderate-to-severe swelling and significant redness and heat, you may be experiencing another, more serious issue. Consult your doctor if you experience these symptoms.

Finkelstein’s test

Finkelstein’s test is an orthopedic maneuver to aid in the diagnosis of gamer’s thumb. To perform this test, the patient grips their thumb in the palm of their hand. With the thumb gripped in the palm, the patient bends their wrist to the pinky side of their hand.

A positive test is one that results in sharp pain along the extensor pollicis brevis and abductor pollicis longus tendons on the thumb side of the wrist and forearm.

finkelstein's test
Example of Finkelstein’s test

Common mechanism(s) of injury

Gamer’s thumb is more common for console gamers due to the use of the thumb sticks. Common risks for console gamers include:

  • Poor hand position
    • Gaming with your wrists held in radial deviation (bending your wrist towards the thumb) increases the friction of the extensor pollicis brevis and abductor pollicis longus tendons underneath the tendon sheath
  • Skipping your warm-up
    • The purpose of a warm-up is to increase blood flow to muscles and to lubricate joints and other structures (i.e. tendon sheath)
    • Gaming without first performing a proper warm-up may allow for increased friction of the extensor pollicis brevis and abductor pollicis longus tendons underneath the tendon sheath
  • Skipping your cool down
    • One important purpose of a cool down is to decrease inflammation
    • Gaming without performing a proper cool down afterwards may allow for chronic inflammation of the tendon sheaths
using controller thumb sticks
Gamer’s thumb is more common for console due to the use of the thumb sticks

Prevention

The most common mechanisms of injury for gamer’s thumb overuse, exacerbated by poor wrist position, and chronic inflammation.

For all hand & wrist injuries, we’ve created a comprehensive injury prevention program. Performing this exercise routine may help reduce your risk for all gamer injuries, including gamer’s thumb.

Hand & wrist position: it is important to keep your wrists neutral! Radial deviation (bending your wrists towards your thumb) increased the risk of developing gamer’s thumb.

Use & overuse:

It is also important to eat an anti-inflammatory diet and/or include anti-inflammatory supplements in your diet to prevent chronic, systemic inflammation that may be a contributing factor.

Rehabilitation

Note: unresolved or improperly treated tenosynovitis injuries will lead to stenosing tenosynovitis, also known as trigger finger. Trigger finger is an irreversible locking of the tendon where you will be unable to extend the finger. This condition requires surgical intervention!

gamers thumb stretches
Proper warm-up and cool down (stretches) may help reduce the risk for gamer’s thumb

To effectively resolve gamer’s thumb, it is important to first identify and correct the initial cause. For example, if you’re not taking breaks, or you’re gaming with your wrists held in radial deviation (bending your wrist towards the thumb), protocols may be ineffective because of the constant exacerbation.

Perform a proper warm-up

First, recognize that a proper warm-up is absolutely essential—not only to prevent pain and injury but also to improve your gaming performance. Our warm-up routine is comprehensive to include all muscles and joints involved in your gaming sessions.

Take breaks while gaming

Do yourself a favor, and take breaks between matches. Additionally, schedule longer (10-minute) breaks intermittently during long hours of gaming.

If you’ve read through our page outlining habits healthy gaming, you’ll know that stretching is important but not until your entire session is over. DO NOT stretch your muscles during these intermittent breaks! To stay loose, repeat some of the exercises and movements in the warm-up. Stretching mid-session may decrease your performance and will not effectively aid in injury prevention.

Make healthy diet choices

Do not underestimate the absolutely invaluable aspect of nutrition. Eating unhealthy foods or consuming unhealthy beverages will simply make your body unhealthy. Check out our page describing our favorite healthy gamer snacks for better snack options during your gaming sessions.

Also, drink plenty of water. Generally, the recommendation for fluid intake is half your body weight (measured in pounds) in fluid ounces per day. So, if you weigh 120lbs, you should drink 60 fl. oz. If you weigh 160lbs, you should drink 80 fl. oz, and so on.

Rest and recovery

We will never tell you to stop gaming. However, your rest and recovery are important. Taking beaks between games and matches is part of that, but your recovery after and between these long sessions is even more important.

Post-session stretching

When you’re done gaming, and you won’t be gaming again until tomorrow or later, it is time to stretch! We have a stretch routine to assist in the prevention of aches, pains, and injuries that gamers may face. Following physical activity, stretching may increase range of motion and release chronic tension in muscles.

The unmatched importance of sleep

In life, there is not one single thing more valuable to your health than your sleep. Please, read our post on sleep to better understand its importance. And, for the sake of your health, schedule and commit to a regular sleep schedule including eight hours of uninterrupted sleep!

Contrast therapy

For treatment of gamer’s thumb, we suggest contrast therapy. Begin with heat on the area for ~10 minutes. Following ~10 minutes of heat, replace it with ice or cold therapy. Contrast therapy will open the blood vessels to help eliminate toxins followed by clamping the blood vessels and preventing excess inflammation.

Anti-inflammatory medication

As chiropractors and providers who are not established as your doctor, we cannot and do not recommend anti-inflammatory medication.

However, if inflammation exists (pain with redness, swelling, and heat), non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen (Aleve), aspirin, or acetaminophen (Tylenol) may be useful.

If you’re interested in taking NSAIDs or any other medication, our official advice is that you must first speak with your doctor.

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Disclaimer

This information is for educational purposes only and is not intended to replace the advice of your doctor. Esports Healthcare disclaims any liability for the decisions you make based on this information.

The information contained on this website does not establish, nor does it imply, doctor-patient relationship. Esports Healthcare does not offer this information for diagnostic purposes. A diagnosis must not be assumed based on the information provided.

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