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4 Technology Overuse Injuries You Should Know
Brian Hamzavi, MD | November 13, 2020
| Contributor Information
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Left: Image of computer posture stress points from Andwall2 (left). Right: Ideal computer posture from Onlinetyping.org. Both via Wikimedia Commons.
4 Technology Overuse Injuries You Should Know
Brian Hamzavi, MD | November 13, 2020 | Contributor Information
Technology overuse injuries are almost inevitable in the modern age. Long hours on the computer for work followed by hours of scrolling through social media news feeds on mobile devices can put stress on the body. This effect has been magnified particularly in year 2020 by the coronavirus disease 2019 (COVID-19) global pandemic, during which quarantines have led to even greater technology use. Since technology is not going away any time soon, it is important to recognize the following four overuse injuries so that they can be effectively treated.
Image from Wikipedia | Fredler Brave.
4 Technology Overuse Injuries You Should Know
Brian Hamzavi, MD | November 13, 2020 | Contributor Information
Cervical Pain Syndrome
Cervical pain syndrome (CPS) refers to diverse conditions caused by changes in the cervical spine and the surrounding soft tissue, primarily accompanied by pain.[1] Contributing factors include prolonged sitting in a non-ergonomic posture, with the neck in a flexed position.[2] Examples of such positions including typing on a laptop while seated in bed, or looking down while texting on a mobile device (shown). Because of the extended propensity of these positions to flexion over time, the load effect created by the weight of the head and the strain of the neck muscles will eventually lead to degeneration of the cervical vertebrae and discs, loss of lordosis, and kyphosis.[3]
Image from Wikimedia Commons | Stillwaterising.
4 Technology Overuse Injuries You Should Know
Brian Hamzavi, MD | November 13, 2020 | Contributor Information
The most common presentation of CPS is pain and spasm of the neck muscles that may extend to the back of the head and into the shoulder and scapular areas.[1,2] Headaches and upper extremity numbness and tingling may or may not accompany the pain. Radiographic findings are often consistent with a loss of the normal lordotic curve of the spine.[3] Further imaging studies such as magnetic resonance imaging (MRI) may reveal degenerative changes within the spine (shown).
Treatment for CPS involves a variety of modalities aimed at alleviating symptoms and correcting the offending posture.[1,2] Pharmacologic management with analgesics, anti-inflammatory agents, or muscle relaxants are a good initial intervention. Formal physical therapy that focuses on strength and range-of-motion exercises have been shown to be beneficial. For those who sit for extended periods at work, an ergonomic workstation evaluation by human resources personnel may be helpful in preventing further aggravation of the pain.
Images from Unsplash | Thomas Lefebvre @imthebear (left) and Wikimedia Commons | BruceBlaus (right).
4 Technology Overuse Injuries You Should Know
Brian Hamzavi, MD | November 13, 2020 | Contributor Information
Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is one of the most common causes of workplace disability and absenteeism in the United States; at least 1 in 10 people develop this syndrome or suffer from symptoms of this disorder.[1] CTS results from compression of the median nerve as it passes through the carpal canal from the wrist to the hand (shown).[1] Extended use of a keyboard, computer mouse, or mobile phone may contribute to worsening symptoms. Indeed, "selfie wrist" has emerged as a form of CTS in the digital age, in which injury, including fracture, can occur from repeated wrist flexion due to using mobile devices to take photographs of oneself.[4,5]
Patients with CTS most commonly complain of pain with or without numbness and tingling in the hand, specifically the thumb and adjacent two fingers.[1] Weakness of the muscles at the base of the thumb may develop with chronic median nerve compression.
Images from Wikimedia Commons | CSG-Info (left) and Flickr | Birdies100 (CC by SA 2.0) (right).
4 Technology Overuse Injuries You Should Know
Brian Hamzavi, MD | November 13, 2020 | Contributor Information
Diagnosis of CTS is generally made on the basis of the clinical history, physical examination and, possibly, electromyography (EMG) or a nerve conduction study. EMG or a nerve conduction study aid in identifying the exact site of nerve compression to facilitate release of the nerve if surgery is planned.[1]
Conservative management includes immobilization, local application of corticosteroids, and avoidance of chronic, repeated trauma.[1] A supported hand position while typing may also be beneficial. In severe cases of CTS, surgical release of the retinaculum may be warranted.
Image from Wikimedia Commons | Helar Lukats.
4 Technology Overuse Injuries You Should Know
Brian Hamzavi, MD | November 13, 2020 | Contributor Information
De Quervain Tenosynovitis
De Quervain tenosynovitis (DTS), also known as smartphone-induced tendinitis, is an overuse injury that results in inflammation of one or two tendons on the thumb side of the wrist.[6,7] Pain and swelling may develop from continuous use of a mobile phone in the form of texting or from holding the device itself.
Selfie thumb, a condition associated with extended selfie-taking posture, occurs from repetitive stress injury to the same tendons as that of DTS and presents with pain at similar locations.[6] The size of the mobile device relative to the user's hand may also play a role in the development of DTS. Some smartphones have become larger than their predecessors, with bigger displays, which may lead to more occurrence of tenosynovitis.[7]
Brian Hamzavi, MD | November 13, 2020 | Contributor Information
Diagnosis of DTS is based on the patient's history and physical examination. Several tests may be used to aid in the diagnosis, with the Finkelstein, Eichhoff, and WHAT (wrist hyperflexion and abduction of the thumb) tests principally used.[6] In the Finkelstein test, a sudden downward jerk of the thumb produces pain at the radial styloid area; in the Eichhoff test, pain at the same location is produced from movement of the wrist toward the ulnar side while the thumb is clenched within the fingers.[6]
Conservative treatment of DTS begins with rest and modification of the repetitive activity, administering anti-inflammatory medication and, possibly, use of a thumb spica splint.[8] A corticosteroid injection may be helpful when conservative treatment fails. In chronic cases, surgical release of the tendon sheath (shown) may be indicated.[8]
Image from Pixabay | Dariusz Sankowski.
4 Technology Overuse Injuries You Should Know
Brian Hamzavi, MD | November 13, 2020 | Contributor Information
Trigger Finger or Trigger Thumb
Stenosing tenosynovitis (or "triggering") of the fingers or thumb results from thickening of the flexor tendon sheath or nodular thickening of the flexor tendon itself.[10] In adults, the digits are most often triggered; in the pediatric population, the thumb is predominantly affected.[11]
In regions where people may spend a significant amount of time playing video games and using mobile phones for texting, trigger finger or trigger thumb is known as "texting tendonitis" or "Game-Boy thumb."[10] Increasing use of mobile phones and games consoles may contribute to a growing prevalence of this condition.
Patients typically experience pain and difficulty straightening the affected digit(s).[10,11] The pain may also be accompanied by a snapping or catching sensation, which may or may not result in the finger being locked in the flexed position.[11]
Left and center images from Hazani R, Whitney RD, Redstone J, Chowdhry S, Wilhelmi BJ. Eplasty. 2010;10:e57. [Open access.] PMID: 20862293; PMCID: PMC2941186. Right image from Wikimedia Commons | JoJoEMC.
4 Technology Overuse Injuries You Should Know
Brian Hamzavi, MD | November 13, 2020 | Contributor Information
Diagnosis of stenosing tenosynovitis is based on the history and physical examination. Clinical findings often include tenderness over the A1 pulley (left and center images) and catching of the tendon with flexion and extension of the digit.[11] There may or may not be a palpable nodule.
Initial management often involves activity modification, splinting, and corticosteroid injections directed into the tendon sheath.[11] If no resolution is seen with conservative treatment, surgical release and debridement of the A1 pulley may be warranted (right image).
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Overuse injuries, otherwise known as cumulative trauma disorders, are described as tissue damage that results from repetitive demand over the course of time.Medscape Drugs #38; Diseases, Jul 2020
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Contributor Information
Author
Brian Hamzavi, MD
Orthopaedic Sports Medicine Surgeon
Melbourne, Florida
Disclosure: Brian Hamzavi, MD, has disclosed no relevant financial relationships.
Editor
Olivia Wong, DO
Section Editor Medscape Drugs & Diseases New York, New York
Disclosure: Olivia Wong, DO, has disclosed no relevant financial relationships.
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References
Tiric-Campara M, Krupic F, Biscevic M, et al. Occupational overuse syndrome (technological diseases): carpal tunnel syndrome, a mouse shoulder, cervical pain syndrome. Acta Inform Med. 2014 Oct;22(5):333-40. PMID: 25568584
Karic-Skrijelj M, Talic A, Masic I, Vavra-Hadziahmetovic N, Pandza H, Suljic-Mehmedika E. Cervical pain syndrome as consequence of computer use in daily practice. Acta Inform Med. 2008;16(1):25-8. PMID: 24109153
Öğrenci A, Koban O, Yaman O, Dalbayrak S, Yılmaz M. The effect of technological devices on cervical lordosis. Open Access Maced J Med Sci. 2018 Mar 3;6(3):467-71. PMID: 29610602
Lyona RF, Kelly JC, Murphy CG. The selfie wrist - selfie induced trauma. Ir Med J. 2017 Jun 9;110(6):589. PMID: 28952679
Dharmshaktu GS. "Selfie test": The proposal of a new clinical test for diagnosing De Quervain's tenosynovitis at primary care level. J Family Med Prim Care. 2020 Apr 30;9(4):2139-40. PMID: 32670985
Iwata K. Smartphone-induced tendinitis: a case report. J Family Med Prim Care. 2019 May;8(5):1784-5. PMID: 31198758
Satteson E, Tannan SC. De Quervain tenosynovitis. Updated: December 16, 2019. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK442005/. Accessed November 11, 2020.
Ali M, Asim M, Danish SH, Ahmad F, Iqbal A, Hasan SD. Frequency of De Quervain's tenosynovitis and its association with SMS texting. Muscles Ligaments Tendons J. 2014;4(1):74-8. PMID: 24932451
Ifeacho SN, Brar R. Stenosing tenosynovitis (trigger finger and trigger thumb). Ann R Coll Surg Engl. 2007;89(3):326-7. PMCID: PMC1964730.
Johnson JD, Gaspar MP, Shin EK. Stenosing tenosynovitis due to excessive texting in an adolescent girl: a case report. J Hand Microsurg. 2016 Apr;8(1):45-8. PMID: 27616827
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