These clinical cases and our current report suggest there are variable presentations for texting-induced tendinopathy. As previously discussed by Gross, the mechanism of tendinitis injury involves stressors that are too high in magnitude, too frequent in repetition, or both.9
Recently, Gustafsson et al used an electrogoniometer and surface electromyography to examine thumb movements and muscular loads, respectively, during mobile phone use.10 They found that young adults with musculoskeletal symptoms had higher thumb movement velocities, fewer pauses in thumb movements, and higher APL activity than those without symptoms. Females showed higher thumb velocities, fewer pauses in thumb movements, and greater muscle activity in the APL and extensor digitorum than males. Those with musculoskeletal symptoms were more likely to sit with the head bent forward, to sit without forearm or back support, and to enter text using only one thumb, compared with those without symptoms.
In another study based on surveys administered to college students, Gold et al found that the number of text messages sent daily from handheld devices was associated with self-reports of neck and shoulder discomfort.11
So how can patients avoid injury?
While these cross-sectional studies of Gustafsson and Gold did not track patients with clinically confirmed tendinitis over time to assess the direct impact of specific interventions, the findings are still helpful. They define important risk factors for developing musculoskeletal symptoms, which translate into prevention recommendations for mobile phone users.
Their findings suggest that mobile phone users should:
- limit the duration of daily texting activity
- learn to text with both hands (ie, thumbs) rather than with one hand alone
- take frequent breaks
- avoid typing too fast
- ensure proper support of forearms and backs while texting
- maintain a comfortable posture, avoiding prolonged periods of slouching with the head bent forward.
Our patient incorporated many of these behavioral modifications (in addition to using the spica splint) and fully recovered.
Staying alert to possible texting injury. Using mobile phones for texting has become widespread only relatively recently. Therefore, it may be an underrecognized cause of tendinopathy, especially among young people. By identifying the correct mechanism of overuse injury, you can recommend appropriate behavioral changes for achieving optimal results.
CORRESPONDENCE
Isaiah W. Williams, MS, PA-C, 790 Sunset Avenue #4, Suisun City, CA 94585; iwwilliams16@hotmail.com