Texting thumb, trigger finger, and other smartphone-related injuries

As a physician who has worked a long time in the emergency department, I would like to share with you a case study of a patient that I encountered during my work. She feels numbness on the inside of her thumb, there was a slight weakness in her grip when she grabbed things and aching in the palm of her hand. She also sporadically had another problem, her middle finger got stuck when it bent, and the ring and forefinger were a bit swollen.

I'll tell you the diagnosis in a moment, but let me tell you first that I was so well acquainted with this patient, that it made me wonder, in fact, how I could not have expected such injuries to appear.

For a decade, I used my smartphone to produce extensive reports highlighting a variety of emergency medicine conditions, and then showed them to a large group of doctors every week, with the goal of capturing the most important topics and trends in the field. Our field, and then came the pandemic, which took my phone use to amazing new levels.

I started following the most important scientists on Twitter, immersed myself in reading scientific literature dealing with the “Covid-19” disease, ordered goods and services via the Internet, watched the latest news developments, corresponded with my friends, wrote e-mails, and wrote extensively Notes, I wrote detailed letters, and of course I kept writing those long medical reports, I'd slide my fingers across the screen to scroll, I'd highlight bits of text, I'd bold, copy, paste, format, all on a one-handed mobile phone. , albeit in a clumsy way.

As you might have guessed, the patient is me, whose dominant hand suffered a crushing defeat. The swelling in my index and middle fingers—the two fingers I use to swipe to scroll on the phone screen—affects my ability to fully clench my fist. In addition, The index finger gets stuck a bit when bent, and sometimes it stays stuck in the bent position and then straightens out with a crackling sound.

So the result: technology 1, user 0.

"You're not alone in your struggles," Jeffrey Stone, an upper-limb surgeon at the Florida Orthopedic Institute, tells me he's been exposed to these injuries from texting, working on a computer, playing video games, and recording for a long time. Doctors have information on the internet, surgeons use surgical tools like spacers or tweezers, etc. But, he adds, "now everyone has these injuries, because they're constantly switching between phones, tablets, computers, and they can't stop clicking on screens." and keyboards".

"Texting thumb," also known as "smartphone thumb," may not be an official medical diagnosis, but it is a real, albeit somewhat vaguely defined, phenomenon that results from overuse and consequent inflammation, trigger thumb (or Trigger finger) - which some health service providers have begun to associate with phone users who keep dragging their fingers in order to browse on the phone screen and write text messages - is another real phenomenon. The phenomena we suffer from here - and my use of the plural is intentional - belong to A broader category is repetitive stress injuries, which may affect any part of the body when called upon to do the same thing over and over again.

When I tell someone they have texting thumb, says Stone, that's how I tell them that they're overdoing themselves in a particular activity. How much time do you spend texting?

John Erickson, a hand and upper extremity surgeon at Raleigh Hand-to-Shoulder Center, told me that “from an ergonomics perspective, cell phones are not designed with hands and wrists in mind.” For his part, Stone says smartphone users “are struggling with Thumb marathons every day.” Since the joints of the hand are so small, the pressure on them is enormous, and he adds that one pound of pressure on the tip of the thumb is equivalent to 12 to 14 pounds of pressure at the base of the thumb joint.

In this regard, David Bozyntka, chair of the Department of Hand Surgery at the University of Pennsylvania, comments: “I see the texting thumb as a type of repetitive stress injury.” Experts believe that typing text messages too quickly and keeping the hands in clumsy and uncomfortable positions Fingers stretching to reach distant letter keys all contribute to the problem, along with other factors that make an individual vulnerable to these injuries.

Trigger finger occurs when the flexor tendon becomes thickened and inflamed within a narrow pathway, or sheath, sometimes causing the finger to get stuck when bent. screen to zoom in or out of text and images, or after extensive use of fingers and thumbs, it all sounds familiar, right?

In my case, I had mild arthritis and inflammation in the metatarsal joint of my right thumb, which my doctor agreed was exacerbated by excessive smartphone use, and I only feel the pain and degenerative changes from arthritis in my right thumb (which is the finger I use for texting) ), which is much larger than my left thumb, the pain goes away completely at night when I rest my right thumb, but it comes back the next day when I resume tapping and swiping the screen, which I do all the time.

Many studies have shown the cumulative effects of using smartphones on the musculoskeletal system, and one of these studies indicated that up to two-thirds of mobile device users complained of those cumulative effects associated with the frequency of making phone calls, writing text messages, and playing electronic games, and another study found that the greatest prevalence of these pathological symptoms is in the upper neck, back, wrists, and hands.

So we have to face the truth: Our hands weren't built for all this. Experts also point to another type of painful tendinitis at the base of the thumb known as "player's thumb" or De Quervain's synovitis, apparently linked to letter-writing. Texting on smartphones or playing electronic games a lot, in addition to some other causes, although more research is needed. On the anatomical level, ultrasound studies have shown thickening and changes in the tendons of the thumb in those who send text messages a lot. It has been observed that this thickness corresponds to the number of letters written per day.

We're also offered other smartphone-related injuries, like 'texting claw', which involves pain and cramping," says Brandon Donnelly, a hand surgeon at Pontchartrain Orthopedic and Sports Medicine Center in Mitere, Louisiana. Muscle in the fingers, in addition to carpal tunnel syndrome, and the “mobile phone elbow”, resulting from keeping it in the flexion position for long periods, as the user may bend his wrist or elbow while watching the latest popular videos, or series broadcast on the Internet, or while browsing content Social Media”, and experts agree that more research is needed to better characterize and understand the role that technology plays in these pathological conditions.

"I advise people to put their phones on the table whenever possible, because just holding the phone involves holding it with your thumb and pinky fingers, which leads to fatigue of the internal muscles and feeling pain in the palm of the hand," says Stone. You must have noticed that a lot of phones The new smart phone is not smaller in size, but rather larger, and this is a problem, especially for those with small hands.

Smartphone addiction rates are on the rise all over the world, especially among young adults, and those age groups are not immune to these infections.

Most cases of thumb inflammation caused by excessive texting can be treated conservatively by simply resting the thumb, but with the current trend towards increased phone use, sticking to this advice in practice is not easy, however, Ericsson insists that “ The obvious solution is to modify the practice."

Here are some measures you can try to give your thumbs a rest: Use your index finger or other fingers when typing and browsing Add voice recognition software to your devices if possible Use your desktop or laptop when writing longer texts than usual Customize Less time for electronic games, use anti-inflammatory drugs if you have no contraindications to their use.

The vast majority of those who suffer from the disadvantages of advanced technology will find a solution to their problems by following the previous conservative treatment measures, and if the condition does not improve within a few weeks, the patient should seek medical attention, Erickson recommends, in which case the doctor may prescribe you a brace or a splint to immobilize your thumb, or some non-steroidal medication, either topical or given by mouth, and may refer you to a chiropractor or occupational therapist, and may prescribe a cortisone injection, and as for me, I'm hoping the steroid injection I've had recently will reduce the inflammation and swelling They result from the condition of trigger finger, as the effectiveness of this treatment is approximately 70% of cases, according to the hand surgeon who is following my case, however, surgical intervention sometimes becomes necessary to treat intractable cases.

Raising awareness of these conditions among doctors is an important step forward. Sometimes doctors diagnose disease conditions and treat their patients without sufficient attention to the causative factors of the disease, although these factors can be almost completely reversed once corrective measures are taken. types of repetitive stress injuries; In the 20 years I've been in the emergency department, it never occurred to me that this could be the cause of so many musculoskeletal complaints, I didn't know it then, but I do now.

In general, I think it would be best for all of us to spend some time off the Internet (and I'm the first to apply this advice), so let's put our phones in our pockets, take a walk, and give our Tweeting fingers some much-needed rest .