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Overreliance on small hand-

held devices may be predis-posing the current generationof electronics addicts to early develop-ment of osteoarthritis and other poten-tially chronic joint conditions such asBlackBerry thumb, some physio-therapists say.

BlackBerry thumb is a repetitivestrain injury that causes tendons at thebase of the thumb to become in amedas a consequence of hyperextensionand awkward positioning, as can occurduring extended use of a BlackBerry or

other smartphone.Injuring a thumb can have a substan-

tial impact because a persons thumbis responsible for 60% of the function-ing of their hand, says Dolores Lang-ford, a registered physiotherapist andcerti ed hand therapist in West Vancou-ver, British Columbia.

The size and weight of hand-heldphones mislead people about the pres-sure the devices require, she says. If youre texting, the pressure at the tip of your thumb is ampli ed twelve timesby the time it gets to the base of yourthumb, so the basal joint has to absorbthat shock with every keystroke.

Youngsters dont phone each otheranymore. Everything is done via text. Ihave a teenage daughter and Im seeingin her friends that they are also startingto complain of pain in their thumbs,Langford adds. Theres just so muchpressure on their little hands that I think that down the line, in 15, 20 years,were going to see some of the reper-

cussions of this.Langford frequently sees patients

with are-ups in the base of theirthumbs who must give up texting for anextended period to reduce pain.

But others appear skeptical thatthere is such a condition as BlackBerrythumb or that it is strictly associatedwith the use of hand-held devices.

As much as it is more commonlyknown as BlackBerry thumb, themajority of people we see dont actuallyget it from using a BlackBerry, which is

a bit odd, says Joseph Federico, a reg-istered physiotherapist who operates aclinic in Ottawa, Ontario.

Its just a fad name for an injury thatalready exists, he says, adding that thecondition has been called mommythumb by some, but that the technicalname is deQuervains tenosynovitis.

Its very common in mothers of tod-dlers because they spread their thumbsaway from the rest of their ngers tocover more surface area when pickingup their children, Federico says. Itsalso seen sometimes in people withhobbies, such as making crafts thatrequire intricate hand work.

NewsCMAJ

Thumbs up and down

2011 Canadian Medical Association or its licensors CMAJ, August 9, 2011, 183(11) E711

Some teenagers who spend hours texting friends every week already have pain in theirthumbs and may one day end up with other health repercussions from the repetitivestrain on their hands, say some physiotherapists and hand therapists.

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One study on whether there is a link between use of hand-held devices andpain indicated that the consequencesoften extend well beyond the thumbalone ( Appl Ergo 2011;42:371-8)

In frequent users of hand-helddevices, severe pain was felt primarily

in the neck, upper back and shoulders,often requiring painkillers and becom-ing quite disabling, says Richard Wells,director the Centre of Research Exper-tise for the Prevention of Muscu-loskeletal Disorders in Waterloo,Ontario. If were creating a lot of 17-year-olds, 19-year-olds who have morechronic shoulder, neck and arm prob-lems, then they got a lifetime of prob-lems ahead of them.

Wells adds that while the studyinvolved only 140 university students,

faculty and administrative staff, thendings suggest that the degree of painrises with the frequency of use of mobile devices for such activities as tex-ting, emailing, Internet browsing, talk-ing on the phone and gaming. Forexample, pain in the right shoulder after4.09 hours of gaming was reported to beas high as 9.42 (out of ten) on a severityindex. It was reported at 8.33 after 3.76hours, indicating that after a period of time, relatively small incrementalincreases in period of usage resulted inhigher levels of severity of pain.

The next step will involve determiningwhether the type and shape of mobiledevices (such as slide phones, ip phonesand touch screens) affects the degree of strain or damage to peoples thumbs.

Until the ndings of such research isconclusive, Wells says, people should

try to minimize the potential damagethat mobile device use can cause by, forexample, resting their arms on a tablewhile using the devices to protect theirshoulders and neck.

Its all about ergonomics, says Fed-erico. If you use the device in a moreergonomically correct way, its going tominimize your risk for injury. Try tokeep your wrist in a more neutral posi-tion so that the wrist is not cocked uptowards you. He also recommendsstretching exercises, such as the Finkel-

stein test point thumb at ceiling andngers forward; place thumb in palm of hand; wrap ngers around thumb; bendwrist toward ground after prolongedperiods of mobile device use.

Thats how physiotherapists actuallydiagnose deQuervains tenosynovitis, headds. If you have pain with that, thenwe say, Oh, thats a positive Finkelsteintest, you have BlackBerry thumb.

Although Federico believes theactual incidence of the disorder as a con-sequence of hand-held device use is rare,that hasnt stopped law rms such as

Roberts Jackson Ltd. in the UnitedKingdom from surmising that employ-ees will soon be seeking legal redress forhaving to use mobile devices, accordingto recent news reports (www.telegraph.co.uk/technology /BlackBerry /8403978

/BlackBerry-thumb-is-new-health-hazard

.html). Employers can expect a seriesof lawsuits from staff claiming compen-sation, the rm believes.

Theres no evidence of similar legalaction in Canada, although the Cana-dian Union of Public Employees says itis now working with the CanadianStandards Association on a generalergonomic standard for hand-helddevice use that is expected to be pub-lished within six to eight months, saysAnthony Pizzino, national director of research, job evaluation and health and

safety for public employees.Although its not expected that the

voluntary standard will cover all mobiledevices, it should introduce a preven-tive framework that allows manufac-tures and workplaces to adopt methodsof recommended usage similar to thosenow advised for computer keyboards,says Pizzino. Were looking at similarprocesses in terms of usage, amount of time that you use and design itself. Erin Walkinshaw, Ottawa, Ont.

CMAJ 2011. DOI:10.1503/cmaj.109-3911

E712 CMAJ, August 9, 2011, 183(11)