Health Matrix: How to Avoid Smartphone Injury (And Is It Real?)
Ever felt a pain in your finger, wrist or hand after using your phone too much? Well, it could be a sign of an increasing type of injury caused by smartphones.
But what’s the scientific consensus on the risks of phones - and how best to avoid, and treat, these conditions?
For our Health Matrix - when a second opinion just isn’t enough - we’ve brought together three top medical professionals to discuss:
The risks and types of injuries caused by phone use
The warning signs you should look out for
Tips to avoid injury
For the headlines of their findings - and to watch video clips of exercises if you’re feeling any pains - read our shorter feature.
Meanwhile, here’s the deep dive with our trio of experts…
PAUL GIRARD
Certified hand physiotherapist, Okanagan Hand & Upper Limb Rehab
DR SANJEEV KAKAR
Orthopedic Surgeon, Mayo Clinic, Minnesota
DR NEAL CHEN
Chief, Hand & Arm Center, Massachusetts General Hospital - and Assoc Prof of Orthopaedic Surgery at Harvard Medical School
In a word: can using your smartphone cause arthritis or damage to your hands?
PAUL GIRARD: Yes. But in more words than one, differently, than you might think. Please read on for the full story before you panic. I do not believe smartphone use causes irreversible damage to hands.
DR NEAL CHEN: No. The good news is that the forces used to hold or use a smartphone are unlikely to lead to clinically significant damage to the hands.
DR SANJEEV KAKAR: Smart phone overuse can lead to conditions called tendonitis (which is inflammation of the tendons, that are like the ropes that move your fingers). There hasn’t been a direct correlation between use of your thumbs for texting and thumb arthritis although we do know that the force between your thumb and index finger tips is magnified 12 fold at the base of your thumb. In theory, repetitive increased use of your thumbs may alter the forces across the joint at the base of your thumb. That could lead to earlier wear-and-tear of the lining of the joint that can lead to pain and loss of mobility of the thumb base joint.
What evidence is there that people’s hands are already being damaged by smartphones? What have you seen yourself in patients?
PAUL GIRARD, PT: There is scant evidence on this smartphone topic specifically. Most information is anecdotal, and the studies that exist are small. But we do have relevant historical research regarding other hand/wrist/elbow problems that we can correlate to smartphone issues.
The overuse of a smartphone typically places the wrist/thumbs in sustained, and often ‘unnatural,’ positions. This is similar to other tasks and jobs humans have found themselves occupied with over our modern history. Logically, some of the problematic outcomes are therefore similar.
I have seen tendinosis-type symptoms in patients who overuse their smartphones. Basically, this is an inflammatory response from these ‘puppet string’ tissues being held in awkward postures and overused. This is NOT irreversible damage – it’s just your tendons telling you to back off. I have never seen or heard of anyone getting arthritis from using a smartphone. Arthritis involves the joints, and here the issues surrounding pain instead concern the soft tissues being overused and sustained in positions not conducive to the smooth pain-free ‘gliding’ they normally allow. Furthermore, smartphone use does not cause carpal tunnel syndrome. Carpal tunnel syndrome is a neuropathy concerning blood flow to the median nerve located under the palm-side of the wrist.
DR NEAL CHEN: Occasionally, patients have conditions that can be exacerbated by smartphone use, but it is not the smartphone that is causal. Very rarely, a patient will get tendinitis that is directly related to excessive cell phone use.
DR SANJEEV KAKAR: I’ve seen many patients, from young to old, who have presented with these overuse tendonitis syndromes like DeQuervain tenosynovitis which is inflammation of the tendons that run on the side of your thumb. These patients may have swelling in the wrist adjacent to this area with exquisite pain and tenderness over the thumb side of the wrist that prevents them from doing simple activities such as lifting or twisting.
What conditions are people at risk of?
PAUL GIRARD: By far the most problematic condition is tendinosis, or swelling in the tendon/sheath structures of a digit. Almost exclusively in smartphone overuse, this occurs on the outside of the thumb. Continued bulldozing through this pain without rest may lead to a diagnosis of De Quervain tenosynovitis. Again, this is not a newly discovered issue specific to smartphone use. Dr. DeQuervain documented this problem over one hundred years ago. It is a thickening/swelling of the first dorsal extensor compartment at the thumb-side of the wrist. Another general term for this issue is tendonitis. A person could also develop tendinosis in other finger tendons or at the elbow, too.
On a more holistic view, there is a very real risk of systemic health problems from smartphone use. This owing to the fact that people are exercising, sleeping and meaningfully interacting in decreased amounts because instead they are distracted or addicted to these devices.
DR NEAL CHEN: Conditions that can be exacerbated include: 1) arthritis at the base of the thumb (Commonly known as: CMC arthritis or basal joint arthritis), 2) DeQuervain’s tenosynovitis which is a tendinitis of a group of tendons on the wrist, 3) Compression of the nerves of the wrist (like Carpal tunnel syndrome or Cubital tunnel syndrome)
What sort of particular phone use and posture should people avoid? (Is it worse when lying down holding the phone in the air, for example. Are short bursts OK?)
PAUL GIRARD: Whenever the hand(s) are kept in a static wrist position with concurrent busy digit use for extended periods of time there is a risk of a loading imbalance. It is time and intensity-dependent. So, yes, short bursts are generally tolerated no matter the position you are in. I believe changing postures fairly frequently is a good idea to help avoid tendonosis.
DR NEAL CHEN: Holding the phone to your ear with your elbow in full flexion for long periods of time can push on the nerve at your elbow that can bother your nerves. In addition, if you can avoid holding the phone in your hand and instead have it supported by the table, that is preferable.
DR SANJEEV KAKAR: I think short bursts are OK. Anything where you’re overdoing it and spending hours repeatedly texting without a break isn’t healthy. This would apply to all types of smart phones.
What are the warning signs - where would you feel them?
PAUL GIRARD: This is a bit of a loaded question. Different people have different thresholds to pain, and I always keep in mind and educate patients that pain and tissue damage are not the same thing. So that is my caveat. That said, pain onset where there was none before is a danger signal. Typically, people feel pain on the ‘thumb side’ of the wrist. Regardless, if you have any onset of pain, you should change postures or give your wrists/thumbs/digits a rest. Significantly, the pain usually abates with a week or two of avoiding the excessive provoking activity.
DR NEAL CHEN MD: If you start getting pain in the base of the thumb, you may be exacerbating your thumb arthritis. If you have pain when you are moving your fingers or thumb, you may be developing a tendinitis. If you get tingling and numbness that awakens you at night, it may be a sign that you are getting nerve compression
DR SANJEEV KAKAR: It depends on what the problem is. DeQuervain’s tenosynovitis is pain and swelling on your wrist on the same side as your thumb. I’ve seen patients hold their phones in odd positions for a prolonged period of time where the wrist is flexed and they develop carpal tunnel-like symptoms which is numbness and tingling in the thumb, index, long and half of your ring finger. The symptoms may get better at first by shaking the hand but over time, symptoms can progress to happening at night, driving, holding a phone etc. They can also lose fine co-ordination like doing their shirt buttons or muscle mass by their thumb in advanced cases.
What exercises can people do to counteract problems from building up?
PAUL GIRARD: Great question. For those readers not completely ensconced in the digital world (and somewhat facetiously) - just put the phone down. On a very serious note, we all need to be aware of what keeps our soft tissues healthy. The answer is fairly frequent moderately aerobic exercises such as walking, hiking, riding a bike or swimming. Do that at least three times a week for half an hour and don’t take your phone with you! Generally, specific hand and digit tendon-focused exercises for strengthening or stretching are not research-supported. Remember, it’s not a problem of weakness or stiffness, but rather a problem of overuse (and the fact that generally we in our modern society aren’t moving the bigger muscle groups and challenging our aerobic systems nearly enough). So avoiding a sedentary lifestyle where we are in frequent ‘unnatural’ static positions with our wrists/digits is a fantastic way to counteract tendonosis. I might compare the issue to sleep deprivation: there is no way to ‘build-up’ a tolerance to it. You need to rest these structures if the tendons/sheaths are swollen and painful. For the small percentage of people who go on to a more persistent problem like DeQuervain tenosynovitis, they likely benefit from splinting, anti-inflammatory medication or corticosteroid injection to relieve the issue. Certainly, there are many snake oil salespeople and con artist practitioners pedalling miracle ‘cures’ – I work hard to educate my clients that this stuff falls under the “buyer beware” category. That is a constant battle – ironically, the smartphone allows a constant barrage of this garbage.
DR NEAL CHEN MD: It is not clear that exercises are beneficial for these particular problems. If you start getting symptoms that you think are associated with smartphone work, try to use the phone less.
DR SANJEEV KAKAR: There are things you can do to try and mitigate some of these problems:
Decrease usage time (rather than constantly checking your phone, set up some ground rules e.g. check your phone for 5-10 minutes every 2 hours)
Alternate fingers when texting or using your phone
Use of voice-activated software for dictation
Use of hands-free device
Pay attention to your posture
How do you use your phone?
PAUL GIRARD: According to my kids, like an idiot. I’m 49 years old. Sometimes I hold it in one hand, sometimes in both. Sometimes I use one thumb or two for texting, and sometimes I use one index finger. I never use the phone while lying down. I do often use voice software instead of typing. And, of course, I don’t use it anywhere near the intensity that many other young people do. On a bright note, I have never had a problematic symptom in my wrists/digits from smartphone use.
DR NEAL CHEN MD: I use my phone about 1 hour a day and try to use the dictation in composing emails or texts whenever possible. I avoid using the phone while driving and use Bluetooth if I have to communicate.
DR SANJEEV KAKAR: I text with my index finger and not my thumb. I check my phone every 2 hours. I use hands-free options like phone voice-activated software.
Are there are links, studies or research you can share?
PAUL GIRARD: Most of the quality research surrounds issues of smartphone addiction and the myriad problems for health that concerns.
DR NEAL CHEN: The biggest risk is actually injuries while using smartphones and car accidents! These are much more worrisome.
>> Exercises from the Mayo Clinic if you’ve got pains in your fingers, wrists or arms
>> Seven gadgets to help you use your phone less
