As a longtime emergency department physician, I have a case study I’d like to share with you. The patient’s right thumb knuckle is inflamed, swollen and often painful, especially toward the end of the day, and the inside part is a little numb. Her grip is slightly weakened, and her palm aches. Her middle finger intermittently has a new “catch” to it when bent. The second and third fingers are slightly swollen. I’ll get to the diagnosis in just a moment. For now, let me just say that this is a patient I know quite well—so well, in fact, that I’m not sure how I didn’t see this coming. For a decade, I have used my smartphone to hammer out voluminous emergency medicine reports that highlight various medical conditions, which I then share with a broad array of doctors each week, the better to stay on top of important trends and topics in our field. Then came the pandemic, which ratcheted up my phone game to staggering new levels. I followed top scientists on Twitter, pored over COVID-19 literature, ordered goods and services, caught up with breaking news, messaged friends, wrote e-mails, composed longer notes and full letters, and of course produced those long reports. I swiped up, highlighted, bolded, copied, pasted, collated—all of it on a mobile device that fits in one hand, albeit awkwardly. So yes, the patient is me. And yes, my dominant hand has taken a beating. Swelling in my index and long fingers—my swiping fingers—is affecting my ability to fully close my fist. Additionally, my long finger is catching some when I bend it. It becomes stuck sometimes when bent and then straightens with a snap. Score: Technology 1, User 0. “You are not alone,” Jeffrey Stone assures me. Stone, an upper extremity surgeon at the Florida Orthopedic Institute, says he has long seen these injuries from texting, computer work, gaming, doctors recording information online, surgeons holding retractors or forceps, and so on. “But now it’s everybody,” he says, “because people are constantly between their phones, [electronic] pads and computers. They’re constantly banging away.” “Texting thumb,” which you may also hear called “smartphone thumb,” may not be an official medical diagnosis. But it is a real phenomenon, if somewhat ill-defined, and stems from overuse and subsequent inflammation. Trigger thumb (or trigger finger), which some providers are beginning to associate with phone users who constantly swipe and text, is another real thing. We are dwelling here within the broader category of repetitive stress injuries, which may occur in any body part being asked to do the same thing repeatedly. And when I say “we,” I mean it. “Texting thumb is a way for me to say to somebody, ‘It appears to me that you’re doing too much of this,’” says Stone. “It’s a garbage can all-inclusive term to say, ‘It appears that the biggest culprit to this continuing to be a problem for you—and continuing to inhibit your life—is the amount of time you’re spending texting.’” As John Erickson, a hand and upper extremity surgeon at the Raleigh Hand to Shoulder Center, tells me, “Ergonomically, smartphones weren’t designed with the hands and wrists in mind.” Stone says smartphone users are “running marathons with their thumbs every day,” and because the joints are very small in your hands, the amount of force transmitted is tremendous. Stone says that one pound of pressure at the tip of the thumb can translate to about 12 to 14 pounds of pressure at the base of the thumb joint. “I consider texting thumb as more of a repetitive stress injury,” says David Bozentka, chief of hand surgery at the University of Pennsylvania. High-velocity texting, hands held in awkward positions, fingers stretched to reach faraway keys—all of these contribute to the problem alongside other predisposing factors, experts say. Trigger finger occurs when the flexor tendon becomes thickened and inflamed inside a narrow tunnel, or sheath, sometimes causing the finger to be stuck in a bent position. It is often seen in people who use their hands for repetitive movements, such as frequent gripping or pinching, or after forceful use of the fingers and thumb. Sound familiar? In my own case, I’ve developed inflammation and mild arthritis in my right thumb metacarpal joint, which my doctor and I suspect was exacerbated by excessive smartphone use. The pain and the degenerative arthritic changes are present only in my right (texting) thumb, which is significantly larger than my left thumb. The pain resolves completely at night after resting it, but recurs the next day when I resume pecking and swiping—and I do resume. Multiple studies have shown the cumulative effects of smartphone use on the musculoskeletal system, with up to two thirds of mobile device users in one study having such complaints, associated with the frequency of making phone calls, texting and gaming. Another study found the highest prevalence of complaints in the upper neck, back, and wrists and hands. Let’s face it: our hands weren’t really made for all of this. Experts describe another painful tendonitis at the thumb base called “gamer’s thumb” or De Quervain’s disease. It seems to be associated with frequent texting on smartphones or gaming, among other causes, though more research is needed. At a more anatomical level, ultrasound studies have shown thickening and changes in thumb tendons of frequent texters—and the thickness paralleled the numbers of messages per day. “And there’s other smartphone overuse injuries that we see,” says Brandon Donnelly, a hand surgeon with Pontchartrain Orthopedics and Sports Medicine in Metairie, La. “‘Text claw,’ or pain and cramping in the fingers, is one along with carpal tunnel and ‘cell phone elbow,’ which is caused by prolonged bending. Users may bend their wrist or elbow while watching the latest viral video, streaming television and scrolling through social media content,” Donnelly says. Experts agree that more research is needed to better understand and detail technology’s role in all of these conditions. “I advise people to at least put their phone on the table when they can,” says Stone. “The mere act of holding it involves gripping it with your thumb and small finger, so your intrinsic muscles are straining and your palm hurts.” As you’ve no doubt noticed, they’re making many smartphones bigger, not smaller. That’s an issue, especially for someone with smaller hands. Smartphone addiction has been increasing worldwide, particularly among young adults, and those age groups are not immune from injury. “It’s not like an epidemic, but it’s certainly a steady flow of these kinds of patients coming in,” says Erickson. Most cases of texting thumb can be treated conservatively by simply resting the thumb. Given the trend toward more phone use, that’s easier said than done. Still, Erickson says, “The most obvious thing is activity modification.” Try some of these measures to give your thumb a break: Use your index finger or different fingers to text and swipe. Employ voice recognition software on devices when possible. Use a desktop or laptop when composing longer notes. Limit gaming time. Consider anti-inflammatory medication, if not contraindicated. For the overwhelming majority of high-tech sufferers, such conservative actions should do the trick. Erickson says that if things aren’t improving in a few weeks, one should seek medical attention. That may mean a thumb brace or splint, oral or topical nonsteroidal medications, hand therapy, referral to occupational therapy, and perhaps a cortisone shot. In my case, I’m hoping that a recent steroid injection will reduce the inflammation and swelling in my trigger finger. My hand surgeon estimates that the treatment is effective in roughly 70 percent of cases. Occasionally, surgery is necessary for recalcitrant conditions. Physician awareness will be important going forward. We sometimes diagnose conditions and treat patients without fully considering the cause—which, in this case, is nearly completely reversible once corrective measures are taken. I suspect we underdiagnose smartphone use as at least an important contributor to various repetitive stress injuries. In 20 years in the ER, I can tell you this etiology for various musculoskeletal complaints never crossed my mind. I simply didn’t know. I do now. More broadly, it’s probably wise for all of us to spend a little more time unplugged. (Guilty as charged, over here.) Take a walk. Pocket your phone. And give your tweeting digits the break they deserve.
I’ll get to the diagnosis in just a moment. For now, let me just say that this is a patient I know quite well—so well, in fact, that I’m not sure how I didn’t see this coming.
For a decade, I have used my smartphone to hammer out voluminous emergency medicine reports that highlight various medical conditions, which I then share with a broad array of doctors each week, the better to stay on top of important trends and topics in our field. Then came the pandemic, which ratcheted up my phone game to staggering new levels.
I followed top scientists on Twitter, pored over COVID-19 literature, ordered goods and services, caught up with breaking news, messaged friends, wrote e-mails, composed longer notes and full letters, and of course produced those long reports. I swiped up, highlighted, bolded, copied, pasted, collated—all of it on a mobile device that fits in one hand, albeit awkwardly.
So yes, the patient is me. And yes, my dominant hand has taken a beating. Swelling in my index and long fingers—my swiping fingers—is affecting my ability to fully close my fist. Additionally, my long finger is catching some when I bend it. It becomes stuck sometimes when bent and then straightens with a snap.
Score: Technology 1, User 0.
“You are not alone,” Jeffrey Stone assures me. Stone, an upper extremity surgeon at the Florida Orthopedic Institute, says he has long seen these injuries from texting, computer work, gaming, doctors recording information online, surgeons holding retractors or forceps, and so on. “But now it’s everybody,” he says, “because people are constantly between their phones, [electronic] pads and computers. They’re constantly banging away.”
“Texting thumb,” which you may also hear called “smartphone thumb,” may not be an official medical diagnosis. But it is a real phenomenon, if somewhat ill-defined, and stems from overuse and subsequent inflammation. Trigger thumb (or trigger finger), which some providers are beginning to associate with phone users who constantly swipe and text, is another real thing. We are dwelling here within the broader category of repetitive stress injuries, which may occur in any body part being asked to do the same thing repeatedly. And when I say “we,” I mean it.
“Texting thumb is a way for me to say to somebody, ‘It appears to me that you’re doing too much of this,’” says Stone. “It’s a garbage can all-inclusive term to say, ‘It appears that the biggest culprit to this continuing to be a problem for you—and continuing to inhibit your life—is the amount of time you’re spending texting.’”
As John Erickson, a hand and upper extremity surgeon at the Raleigh Hand to Shoulder Center, tells me, “Ergonomically, smartphones weren’t designed with the hands and wrists in mind.” Stone says smartphone users are “running marathons with their thumbs every day,” and because the joints are very small in your hands, the amount of force transmitted is tremendous. Stone says that one pound of pressure at the tip of the thumb can translate to about 12 to 14 pounds of pressure at the base of the thumb joint.
“I consider texting thumb as more of a repetitive stress injury,” says David Bozentka, chief of hand surgery at the University of Pennsylvania. High-velocity texting, hands held in awkward positions, fingers stretched to reach faraway keys—all of these contribute to the problem alongside other predisposing factors, experts say.
Trigger finger occurs when the flexor tendon becomes thickened and inflamed inside a narrow tunnel, or sheath, sometimes causing the finger to be stuck in a bent position. It is often seen in people who use their hands for repetitive movements, such as frequent gripping or pinching, or after forceful use of the fingers and thumb. Sound familiar?
In my own case, I’ve developed inflammation and mild arthritis in my right thumb metacarpal joint, which my doctor and I suspect was exacerbated by excessive smartphone use. The pain and the degenerative arthritic changes are present only in my right (texting) thumb, which is significantly larger than my left thumb. The pain resolves completely at night after resting it, but recurs the next day when I resume pecking and swiping—and I do resume.
Multiple studies have shown the cumulative effects of smartphone use on the musculoskeletal system, with up to two thirds of mobile device users in one study having such complaints, associated with the frequency of making phone calls, texting and gaming. Another study found the highest prevalence of complaints in the upper neck, back, and wrists and hands.
Let’s face it: our hands weren’t really made for all of this. Experts describe another painful tendonitis at the thumb base called “gamer’s thumb” or De Quervain’s disease. It seems to be associated with frequent texting on smartphones or gaming, among other causes, though more research is needed. At a more anatomical level, ultrasound studies have shown thickening and changes in thumb tendons of frequent texters—and the thickness paralleled the numbers of messages per day.
“And there’s other smartphone overuse injuries that we see,” says Brandon Donnelly, a hand surgeon with Pontchartrain Orthopedics and Sports Medicine in Metairie, La. “‘Text claw,’ or pain and cramping in the fingers, is one along with carpal tunnel and ‘cell phone elbow,’ which is caused by prolonged bending. Users may bend their wrist or elbow while watching the latest viral video, streaming television and scrolling through social media content,” Donnelly says. Experts agree that more research is needed to better understand and detail technology’s role in all of these conditions.
“I advise people to at least put their phone on the table when they can,” says Stone. “The mere act of holding it involves gripping it with your thumb and small finger, so your intrinsic muscles are straining and your palm hurts.” As you’ve no doubt noticed, they’re making many smartphones bigger, not smaller. That’s an issue, especially for someone with smaller hands.
Smartphone addiction has been increasing worldwide, particularly among young adults, and those age groups are not immune from injury. “It’s not like an epidemic, but it’s certainly a steady flow of these kinds of patients coming in,” says Erickson.
Most cases of texting thumb can be treated conservatively by simply resting the thumb. Given the trend toward more phone use, that’s easier said than done. Still, Erickson says, “The most obvious thing is activity modification.”
Try some of these measures to give your thumb a break: Use your index finger or different fingers to text and swipe. Employ voice recognition software on devices when possible. Use a desktop or laptop when composing longer notes. Limit gaming time. Consider anti-inflammatory medication, if not contraindicated.
For the overwhelming majority of high-tech sufferers, such conservative actions should do the trick. Erickson says that if things aren’t improving in a few weeks, one should seek medical attention. That may mean a thumb brace or splint, oral or topical nonsteroidal medications, hand therapy, referral to occupational therapy, and perhaps a cortisone shot. In my case, I’m hoping that a recent steroid injection will reduce the inflammation and swelling in my trigger finger. My hand surgeon estimates that the treatment is effective in roughly 70 percent of cases. Occasionally, surgery is necessary for recalcitrant conditions.
Physician awareness will be important going forward. We sometimes diagnose conditions and treat patients without fully considering the cause—which, in this case, is nearly completely reversible once corrective measures are taken. I suspect we underdiagnose smartphone use as at least an important contributor to various repetitive stress injuries. In 20 years in the ER, I can tell you this etiology for various musculoskeletal complaints never crossed my mind. I simply didn’t know. I do now.
More broadly, it’s probably wise for all of us to spend a little more time unplugged. (Guilty as charged, over here.) Take a walk. Pocket your phone. And give your tweeting digits the break they deserve.
