Nintendo Thumb
   HOME

TheInfoList



OR:

Nintendo thumb, also known as gamer's thumb and similar names, is a form of
repetitive strain injury A repetitive strain injury (RSI) is an injury to part of the musculoskeletal or nervous system caused by repetitive use, vibrations, compression or long periods in a fixed position. Other common names include repetitive stress injury, repetitiv ...
(RSI) caused by excessive playing of
video game A video game or computer game is an electronic game that involves interaction with a user interface or input device (such as a joystick, game controller, controller, computer keyboard, keyboard, or motion sensing device) to generate visual fe ...
s with the traditional Nintendo controller. This injury mainly occurs due to repeated thumb movements while playing video games. The symptoms can include
blister A blister is a small pocket of body fluid (lymph, serum, plasma, blood, or pus) within the upper layers of the skin, usually caused by forceful rubbing (friction), burning, freezing, chemical exposure or infection. Most blisters are filled ...
ing,
paraesthesia Paresthesia is a sensation of the skin that may feel like numbness (''hypoesthesia''), tingling, pricking, chilling, or burning. It can be temporary or chronic and has many possible underlying causes. Paresthesia is usually painless and can oc ...
(a tingling or a burning feeling in the skin), as well as swelling of the
thumb The thumb is the first digit of the hand, next to the index finger. When a person is standing in the medical anatomical position (where the palm is facing to the front), the thumb is the outermost digit. The Medical Latin English noun for thumb ...
s, though any
finger A finger is a prominent digit (anatomy), digit on the forelimbs of most tetrapod vertebrate animals, especially those with prehensile extremities (i.e. hands) such as humans and other primates. Most tetrapods have five digits (dactyly, pentadact ...
can be affected. This can lead to stress on
tendon A tendon or sinew is a tough band of fibrous connective tissue, dense fibrous connective tissue that connects skeletal muscle, muscle to bone. It sends the mechanical forces of muscle contraction to the skeletal system, while withstanding tensi ...
s,
nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons). Nerves have historically been considered the basic units of the peripheral nervous system. A nerve provides a common pathway for the Electrochemistry, electrochemical nerv ...
s, and
ligament A ligament is a type of fibrous connective tissue in the body that connects bones to other bones. It also connects flight feathers to bones, in dinosaurs and birds. All 30,000 species of amniotes (land animals with internal bones) have liga ...
s in the hands, and further onto
lateral epicondylitis Tennis elbow, also known as lateral epicondylitis is an enthesopathy (attachment point disease) of the origin of the extensor carpi radialis brevis on the lateral epicondyle.  It causes pain and tenderness over the bony part of the Lateral epic ...
("tennis elbow"),
tendinitis Tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder ( rotator cuff tendinitis, biceps tendinitis), elbow ( tenn ...
(severe swelling of the tendon),
bursitis Bursitis is the inflammation of one or more bursae (synovial sacs) of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae (bu ...
(inflammation of the fluid-filled sac around joints), and
carpal tunnel syndrome Carpal tunnel syndrome (CTS) is a nerve compression syndrome associated with the collected signs and symptoms of Pathophysiology of nerve entrapment#Compression, compression of the median nerve at the carpal tunnel in the wrist. Carpal tunn ...
(compression of the median nerve at the wrist). Similar injuries can occur with other gaming systems, such as PlayStation thumb from playing
Sony is a Japanese multinational conglomerate (company), conglomerate headquartered at Sony City in Minato, Tokyo, Japan. The Sony Group encompasses various businesses, including Sony Corporation (electronics), Sony Semiconductor Solutions (i ...
PlayStation is a video gaming brand owned and produced by Sony Interactive Entertainment (SIE), a division of Japanese conglomerate Sony. Its flagship products consists of a series of home video game consoles produced under the brand; it also consists ...
. The general recommendation for the treatment is to rest and stop the repetitive motion of the affected finger (usually the thumb). In more severe and painful cases, using NSAIDs is also recommended. Other less localized injuries in the shoulder, knee, and
Achilles tendon The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcane ...
have also been noted to arise from playing the
Nintendo Wii The Wii ( ) is a home video game console developed and marketed by Nintendo. It was released on November 19, 2006, in North America, and in December 2006 for most other regions of the world. It is Nintendo's fifth major home game console, ...
. Some of the symptoms can be associated with the
De Quervain syndrome De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted by their tendon sheath in the wrist. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painf ...
(degeneration of tendons that control the movement of the thumb).


Background

Few case reports of symptoms including stiff and painful joints and limited range of motion in the wrist after frequent
Atari 2600 The Atari 2600 is a home video game console developed and produced by Atari, Inc. Released in September 1977 as the Atari Video Computer System (Atari VCS), it popularized microprocessor-based hardware and games stored on swappable ROM cartridg ...
use were published in the late 1970s and early 1980s. Nintendo thumb specifically was first highlighted after portable handheld
Nintendo is a Japanese Multinational corporation, multinational video game company headquartered in Kyoto. It develops, publishes, and releases both video games and video game consoles. The history of Nintendo began when craftsman Fusajiro Yamauchi ...
games consoles were released in 1989, with reported cases of RSI appearing primarily in children. Later, the controllers for the
Sony is a Japanese multinational conglomerate (company), conglomerate headquartered at Sony City in Minato, Tokyo, Japan. The Sony Group encompasses various businesses, including Sony Corporation (electronics), Sony Semiconductor Solutions (i ...
PlayStation is a video gaming brand owned and produced by Sony Interactive Entertainment (SIE), a division of Japanese conglomerate Sony. Its flagship products consists of a series of home video game consoles produced under the brand; it also consists ...
and
PlayStation 2 The PlayStation 2 (PS2) is a home video game console developed and marketed by Sony Interactive Entertainment, Sony Computer Entertainment. It was first released in Japan on 4 March 2000, in North America on 26 October, in Europe on 24 Novembe ...
were noted as causing the condition. In 1987, an 11-year-old boy reported to the
Children's Hospital of Philadelphia The Children's Hospital of Philadelphia, also known by its acronym CHOP, is a children's hospital in Philadelphia, Pennsylvania. Its primary campus is located in the University City, Philadelphia, University City neighborhood of West Philadelph ...
complaining of his finger being contracted, flexed, and being unable to relax it back to its baseline position. After medical investigation it was determined that this same finger was being used to use the joystick of his video game remote (no mention of the brand) up to around 6 continuous hours on a daily basis. All other fingers that did not use the joystick did not witness this injury, and a general approach of anti-inflammatories and eliminating playing time was used to treat this individual. The first occurrence of the Nintendo thumb condition was published on May 17, 1990 when a 35-year-old woman played a Nintendo video game for the first time. She played it for five hours with no interruptions. The next day, she experienced severe pain in the right thumb (specifically in the extensor tendon), which she had used to press a button on the video game console repeatedly. In January 1991, the condition was termed as "Nintendinitis" by James Casanova, MD, when he evaluated an 8-year-old boy with pain in his thumb. It was found that the pain occurred when the boy flexed his thumb while playing a Nintendo video game, and that he had no history of trauma or disease. A similar effect was seen in adults using alternative controllers such as the Nintendo Wii Remote Controller. However, due to the shape, size, and extended use of game controllers, it can occur in users of any gamepad or
joystick A joystick, sometimes called a flight stick, is an input device consisting of a stick that pivots on a base and reports its angle or direction to the device it is controlling. Also known as the control column, it is the principal control devic ...
. Similar problems have also been observed with the use of
mobile phones A mobile phone or cell phone is a portable telephone that allows users to make and receive calls over a radio frequency link while moving within a designated telephone service area, unlike fixed-location phones ( landline phones). This radio ...
and
text messaging Text messaging, or texting, is the act of composing and sending electronic messages, typically consisting of alphabetic and numeric characters, between two or more users of mobile phones, tablet computers, smartwatches, desktops/laptops, or ...
in particular, called texter's thumb (see
Blackberry thumb De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted by their tendon sheath in the wrist. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painf ...
). Reports of nintendinitis resurfaced after the
Nintendo 64 The (N64) is a home video game console developed and marketed by Nintendo. It was released in Japan on June 23, 1996, in North America on September 29, 1996, and in Europe and Australia on March 1, 1997. As the successor to the Super Nintendo E ...
console came to market in 1997, which contained a joystick that caused similar injuries in the palm named "ulcerative nintendinitis".


Treatment and prevention

It is known that movements that are both high in acceleration and in force can lead to injury if performed repeatedly, and this applies to both larger limbs such as legs and arms, as well as smaller ones such as wrist and fingers. Evidence based guidelines for wise use of e-games by children suggest prevention of musculoskeletal injuries via minimization of usage of e-games that require movements that can lead to RSI while at the same time being mindful of the physical position the player is in while engaged in video games. Additionally, preventative measures can include flexion and extension stretches in the wrist at warm-up and throughout gameplay. These examples of preventative approaches become particularly important since evidence shows that increased video game playing time will increase the risk of developing these conditions. In early 2000,
Nintendo of America is a Japanese multinational video game company headquartered in Kyoto. It develops, publishes, and releases both video games and video game consoles. The history of Nintendo began when craftsman Fusajiro Yamauchi founded the company to p ...
provided protective gloves for its users after receiving 90 case-reports regarding hand injuries. Nintendo now also provides messages during gameplay to remind players to take a break. The pain and discomfort resulted from this injury is usually temporary, and the recommended treatment includes holding back on playing video games for several days. The few published case reports of Nintendo thumb did note that symptoms resolved upon stopping video game use. Using
nonsteroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a Indication (medicine), therapeutic drug class which Analgesic, reduces pain, Anti-inflammatory, decreases inflammation, Antipyretic, decreases fever, and Antithrombotic, prevents bl ...
s like
Ibuprofen Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to relieve pain, fever, and inflammation. This includes dysmenorrhea, painful menstrual periods, migraines, and rheumatoid arthritis. It can be taken oral administration, ...
to relieve the inflammation from the RSI is another treatment option.


Other related injuries


Case reports

Although overall video game consoles and remote controllers have moved towards a more
ergonomic Ergonomics, also known as human factors or human factors engineering (HFE), is the application of psychological and physiological principles to the engineering and design of products, processes, and systems. Primary goals of human factors engi ...
approach, Nintendo has faced an increase in injuries with their consoles caused by the Nintendo Wii. This is because of its novel style of play which involves more physical and interactive activity on behalf of the user. After the release of this console in 2006, the first case report belongs to an
Achilles heel An Achilles' heel (or Achilles heel) is a weakness despite overall strength, which can lead to downfall. While the mythological origin refers to a physical vulnerability, idiomatic references to other attributes or qualities that can lead to do ...
injury presented by a 46-year-old man after playing performing a jogging motion requested by the game which led to the rupture of his Achilles tendon. Although the interaction is virtual, the injuries are very real and resemble injuries seen in real-life sports ranging from head to toe. A neck-related injury was first reported in 2009 when a 38-year-old man swung his remote control forcefully enough to send him to the emergency department. This injury required a minor surgery to address due to
physical therapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...
being unable to address the individual's symptoms. Additionally, a 44-year-old woman needed surgery to recover from an unstable knee due to a prior
anterior cruciate ligament The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments (the other being the posterior cruciate ligament) in the human knee. The two ligaments are called "cruciform" ligaments, as they are arranged in a crossed formation. In ...
(ACL) tear while playing Wii Sports that failed physical therapy recovery just 6 months prior. A case report from 2004 that was published in ''
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...
'' described a blister on the thumb caused by repetitive use of a Playstation 2 controller. The writer dubbed the condition "PS2 thumb". While named similarly to Nintendo thumb, the two do not have the same cause. Playstation thumb is caused by friction and affects the skin (though associated symptoms can include pain and stiffness in the hands, shoulders, and neck), while Nintendo thumb is caused by injuries to the tendon.


Different forms of Wii-itis

Wii-itis is the general term that is used for any inflammatory disease or injury due to playing with the Wii console. These injuries are categorized into four major classes:
tendinopathy Tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder ( rotator cuff tendinitis, biceps tendinitis), elbow ( tenn ...
,
bursitis Bursitis is the inflammation of one or more bursae (synovial sacs) of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae (bu ...
(inflammation of fluid filled sacs around joints),
enthesitis Enthesitis is inflammation of the entheses (singular: enthesis), the sites where tendons, ligaments and joint capsules attach to bones. It is a type of enthesopathy, meaning any pathologic condition of the entheses, with or without inflammati ...
("inflammation of sites where tendons and ligaments are attached to the bone"), and epicondylitis (degeneration of the origin of a tendon in the forearm due to overuse of an extensor muscle). Common forms of injuries related to the Wii include:


Wii knee

Wii knee describes knee-related injuries that happen while playing with the Wii console. According to a case report from 2008, a teenager twisted and fell on his knee while playing the Wii which caused a lateral
patella The patella (: patellae or patellas), also known as the kneecap, is a flat, rounded triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint. The patella is found in m ...
dislocation. The treatment for his injury required surgery, and he recovered well. This injury can cause osteochondral fractures, tears in tendons, and meniscal injury.


Wii shoulder

Wii shoulder is soreness and pain in shoulder and upper extremities, often due to playing games like Wii tennis or bowling. A case report of a 22-year-old man who injured his left arm after playing a bowling game on Wii was published in 2008. The injury resulted in pain and swelling.


Achilles Wii-itis

Based on case reports, Achilles tendon injuries can happen with different degrees of severity while playing Wii. These injuries may include tear or complete rupture of Achilles tendon. The rupture of the tendon will require surgery, while minor tears can be addressed with non-surgical treatments like physical therapy and use of NSAIDs. In 2009, a case report was published describing a 42-year-old woman who tore her left Achilles tendon after stretching her leg on her Wii Fit board.


PlayStation-related injuries


PlayStation thumb

PlayStation thumb is defined, similarly to Nintendo thumb, as a
repetitive strain injury A repetitive strain injury (RSI) is an injury to part of the musculoskeletal or nervous system caused by repetitive use, vibrations, compression or long periods in a fixed position. Other common names include repetitive stress injury, repetitiv ...
(RSI) caused by excessive use of a
PlayStation controller The PlayStation controller is the first gamepad released by Sony Computer Entertainment for its PlayStation home video game console. The original version (model SCPH-1010) was released alongside the PlayStation on 3 December 1994. Design B ...
. This condition includes blistering of the thumbs due to excessive use of pressure and friction with the PlayStation controller during gameplay. There is also hardening of the skin on the thumb ( lichenified hyperkeratotic papules) causing the skin to appear leathery. It can also be accompanied by changes to the nail, such as the nail plate lifting from the skin. Other symptoms include stiffness, swelling, pain, and tingling in the arm joints such as wrists, elbows, and shoulders. The first case of PlayStation thumb was recognized in a letter to an editor in 2004 from a 9-year-old boy. The boy played PlayStation 2 in a rapid manner for about 20 minutes and felt his thumb become numb and a blister formed. After ceasing gameplay for one week, the thumb healed. Several other cases have been published as well. A study involving 120 students in South Africa followed up on the 2004 correspondence and found that 7 of the 17 girls and 8 of the 28 boys who played PlayStation had symptoms of PlayStation Thumb.


PlayStation palmar hidradenitis

Hidradenitis has been diagnosed through an examination to confirm the presence of
neutrophil Neutrophils are a type of phagocytic white blood cell and part of innate immunity. More specifically, they form the most abundant type of granulocytes and make up 40% to 70% of all white blood cells in humans. Their functions vary in differe ...
s (a type of immune cell present during inflammation) in the
eccrine sweat gland Eccrine sweat glands (; from Greek '' ek(s)+krinein'' 'out(wards)/external+ secrete') are the major sweat glands of the human body. Eccrine sweat glands are found in virtually all skin, with the highest density in the palms of the hands, and sol ...
s. Palmar hidradenitis is the inflammation of the palm, primarily in the eccrine sweat glands, causing lesions on the palmar surface of the hands. These lesions develop when people spend prolonged periods of time using their hands to hold and manipulate PlayStation controllers. As of 2021, there have been two reported instances of PlayStation palmar hidradenitis: The first case was in 2009 in a 12-year-old girl. She had painful skin lesions on both palms and nowhere else on her body, and the cause of the condition was sourced to playing PlayStation for several hours per day prior to the lesions forming. After the lesions formed, the girl continued to play PlayStation games, but less intensely than before, which caused the lesions to develop more. The lesions went away completely after stopping playing PlayStation for 10 days. The second case was in 2017 in a 14-year-old boy who had painful palmar nodules after spending prolonged periods of time playing games and using his mobile phone. Similarly to the last case, he had inflammation containing neutrophils in the eccrine sweat glands in his palms. The palmer lesions healed on their own in two weeks after stopping PlayStation gameplay.


See also

* Video game-related health problems *
Blackberry thumb De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted by their tendon sheath in the wrist. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painf ...
*
Tennis elbow Tennis elbow, also known as lateral epicondylitis is an enthesopathy (attachment point disease) of the origin of the extensor carpi radialis brevis on the lateral epicondyle.  It causes pain and tenderness over the bony part of the lateral epi ...
*
Golfer's elbow Golfer's elbow, or medial epicondylitis, is tendinosis (or more precisely enthesopathy) of the medial common flexor tendon on the inside of the elbow. It is similar to tennis elbow, which affects the outside of the elbow at the lateral epicondyl ...


References


Further reading

* * * * * * {{refend
Thumb The thumb is the first digit of the hand, next to the index finger. When a person is standing in the medical anatomical position (where the palm is facing to the front), the thumb is the outermost digit. The Medical Latin English noun for thumb ...
Fingers Inflammations Overuse injuries