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The advent of personal digital assistants (PDAs) has been a boon to many in the business and medical worlds, but with the blessings has come a curse for some — a painful, chronic hand injury known as “PDA thumb” or “BlackBerry thumb.

Use of hand-held PDAs can be a pain in the thumb

July 1, 2005

Use of hand-held PDAs can be a pain in the thumb

Go easy on rollerball to avoid injury

The advent of personal digital assistants (PDAs) has been a boon to many in the business and medical worlds, but with the blessings has come a curse for some — a painful, chronic hand injury known as “PDA thumb” or “BlackBerry thumb.”

The injury is just like any other repetitive motion injury that arises when a muscle or joint is used over and over again in a way that causes irritation and overuse, according to Kimberly Mezera, MD, assistant professor of orthopedic surgery and chief of hand and upper extremity service at UT Southwestern Medical Center at Dallas. “We saw the same thing in the 1980s with Atari and Nintendo games; when new advances come along, you see things come along with them that you don’t always expect,” she says.

Users of the hand-held devices, which are used for messaging, scheduling, and data retrieval, may notice aching and some stiffness in the thumb base that may travel into the palm and the wrist. “It’s still early but we think we may start seeing people with thumb tendonitis complaints,” says Mezera, who explains that the repeated scrolling motion made by the thumbs on the devices’ rollerballs causes a repetitive motion by the first and second joints of the thumb.

“You have the potential to develop irritation and overuse of the thumb tendon, tendonitis, or trigger thumb, where the tendon locks up and can be painful at the site and also down to the wrist and forearm.”

As with other repetitive motion injuries, PDA thumb is best treated early on with rest, Mezera says. “It’s just a typical overuse syndrome, a little bit of an abnormal use of the thumb in a manner it’s not used to doing,” she explains.

Orthopedists point out that the thumb is designed for gripping, not for the dexterous motion demanded by the PDA. “I have had colleagues mention that their thumbs got sore when they were using their PDA a lot,” says Mezera. “The first thing I’d suggest is to rest it, decrease the time spent using it.” (See box for suggested proper use of PDAs, below.)

Proper Use of Hand-Held Personal Digital Assistants (PDAs)
  • Use a neutral grip when holding the device. A neutral grip is when the wrist is straight, not bent in either direction, and not strong or weak. It will allow for wrist motion in a plane where more motion is available in the wrist.
  • Take a break every hour or switch to another activity. Overuse of repetitive motions, such as pressing buttons, can cause tendonitis of the elbow or lead to carpal tunnel syndrome (tendon or nerve irritation).
  • If possible, place pillows in your lap and rest arms on pillows. This will allow you to keep your head in a more upright position and therefore decrease neck strain. The pillows will help support the arms so they do not have to be held up in the air.
  • Sit in an appropriate chair. This would be a chair that allows you to comfortably put your feet on the floor and also provides good back support.
  • Switch hands frequently. This will allow the one hand to rest and reduce fatigue.
  • Frequently focus on a distant object (away from the screen) to help reduce eye fatigue.

Source: American Society of Hand Therapists, Chicago.

She says adjusting the way the thumb is used, decreasing the demands on the thumb, and taking anti-inflammatories for pain also should be tried. Depending on the severity and persistence of the pain, a visit to a physician for additional evaluation is in order, according to Mezera. Splints and cortisone injections can provide relief; in very serious cases, surgical repair might be indicated.

An Internet search for the term “PDA thumb” yields information on the potential injury as well as a wide variety of splint or glovelike bandages, but orthopedic experts say these might make the problem worse, not better. Ergonomic disorders, of which repetitive motion injury is one, are the fastest-growing category of occupational illnesses. “Thumbs aren’t made for constantly moving up and down on the scroll on a BlackBerry,” says Mezera. “It’s a small movement, but it could lead to bigger problems.”

“Handheld electronics may require prolonged grips, repetitive motion on small buttons, and awkward wrist movements,” points out Donna Breger Stanton, MA, OTR/L, CHT, FAOTA, president of the American Society of Hand Therapists in Chicago. “These devices are immensely popular, and they are getting smaller with even more features, which encourages heavy, extended use.”

A potential epidemic?

Mezera says despite the popularity of its name, PDA thumb is not threatening to become an epidemic. In fact, for many practitioners, it’s a condition they have read about in the literature but have not yet seen. The publicity prompted the American Society of Hand Therapists to issue a consumer education alert warning earlier this year that cautioned that repetitive use of hand-helds such as BlackBerries and iPods can lead to carpal tunnel syndrome and related conditions.

Because patients might not associate the new pain in their hands or wrists with their PDA use, physicians should take a careful history to elicit the information. “It’s the latest toy to come along,” says Mezera. “My only advice would be to use it wisely.”

For more information, contact:

  • Kimberly Mezera, MD, Assistant Professor of Orthopedic Surgery and Chief of Hand and Upper Extremity Service; UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390. Phone: (214) 648-3065.
  • Donna Breger Stanton, MA, OTR/L, CHT, FAOTA, Assistant Professor, Occupational Therapy, Samuel Merritt College, Oakland, CA. E-mail: dbreger@samuelmerritt.edu.