Help for the typing wounded: Handheld dependency a pain in the thumb

Kent Willyard, MD, a family physician in Newport News, Va., remembers the day a particular patient -- a lawyer -- came to see him, complaining of pain and stiffness in both of his thumbs. Though overuse injuries are common enough in Dr. Willyard's practice, the cause in this case was a new one. "He said he thought he'd been using his BlackBerry too much."

This was Dr. Willyard's first brush with a syndrome the media has dubbed "BlackBerry thumb," an overuse injury from employment of handheld electronic devices that depend on the operator's thumb dexterity. Increasingly, cases are being seen in physicians' offices, primarily because the devices are becoming more popular. According to Gartner Inc., a research and advisory firm, 510,000 BlackBerries -- wireless e-mail devices operated with both thumbs -- were sold in the second quarter of 2004, a sharp jump from only 131,100 in the second quarter of 2003.

"[BlackBerries] have become a common tool, but they have very tiny keyboards. It's not a normal way to use your thumb," said Stuart Hirsch, MD, clinical assistant professor of orthopedics at St. Joseph's Hospital and Medical Center in Paterson, N.J., who has treated several patients with this specific ailment. "It can lead to an overuse syndrome and repetitive strain."

The uptick in interest led the American Society of Hand Therapists to issue in January a consumer education alert warning that heavy use of handhelds such as BlackBerries and iPods can lead to carpal tunnel syndrome and related conditions. "These devices are immensely popular and they are getting smaller with even more features, which encourage heavy, extended use," said ASHT president Donna Breger Stanton. "More of the population could suffer hand ailments unless they learn to take preventive measures."

The society suggested several strategies for safer use, and physicians praised the warning.

"It makes perfectly good sense," said Alvin B. Lin, MD, a family physician from Las Vegas who has conducted handheld device use seminars at American Academy of Family Physicians meetings. "These devices are really made for convenience, but are not made with ergonomics as a major issue."

What to do when you see it

Successful treatment, in some ways, is simple and similar to the approach taken for any overuse injury. Many physicians, for instance, have already had experience with "Nintendo thumb," which emerged in the 1990s, or "Atari finger," which was common in the 1980s.

Anti-inflammatories or some kind of splint are often a first step. But there is also a behavioral component that can introduce complexity. Patients can be less than keen to break away from their tools or toys, although this separation is often the most crucial part of healing. BlackBerries, in particular, have been referred to as "crackberries" because of their addictive quality.

Of course alternatives do exist.

"Patients could use another digit," said Alfred Tallia, MD, MPH, chair of family medicine at the Robert Wood Johnson Medical School in New Jersey. "Or consider picking up the phone and talking to the person. There are alternatives to these electronic devices that we should make use of. We lived without them for a long time and got along just fine."

Figuring out that the handheld device is the cause of a patient's pain may also be challenging because, unlike Dr. Willyard's patient, many of the typing wounded may not recognize or acknowledge the root cause.

"If they can give an accurate history, physicians will be able to identify the cause, and patients will be able to change their behavior," said Dr. Hirsch. "But patients may not connect pain in the thumb to using a BlackBerry."

Meanwhile, the patient could also potentially be a physician because handheld devices are increasingly popular in the health care setting. Several surveys have estimated that approximately 40% of physicians have some kind of handheld device.

But many say the way most physicians use these devices puts them in a lower risk category.

"It's a great tool, but just like any other instrument, we have to be careful," said Marcy Zwelling-Aamot, MD, an internist in Los Alamitos, Calif., who owns a BlackBerry. "But, mostly [doctors] are in the office, and we use it as an ancillary tool. Traveling people use it as a major tool, and I would expect them to be more at risk."

BlackBerry's maker, Research in Motion Limited, declined comment for this story.