Wii shoulder, another variant of Wii-itis, is an acute inflammation of the upper extremity musculature after repetitive motion. This injury is most often associated with games that require swinging of the controller, such as Wii tennis or bowling. Upper extremity magnetic resonance imaging (MRI) of one Wii enthusiast revealed inflammatory swelling of the shoulder joint that extended to the suprascapular region, corresponding to a diagnosis of delayed–onset muscle soreness (DOMS).9
DOMS, which is often associated with acute injury patterns, is a well-accepted diagnosis among patients who play physically interactive sports and, by extension, video games.17 Usually lacking frank deformity on plain radiographs, DOMS is a disorder of the soft tissue that can best be visualized with MRI delineation of tissue planes and musculature compartments. Clinical signs and symptoms of DOMS can include edema of the affected extremity, rubor, and tenderness to palpation during active range of motion. Treatment for DOMS, like all RMIs, includes cessation of the offending activity.
Another recently reported variant of Wii-itis is the acute onset of carpal tunnel syndrome21 after playing Wii bowling for long periods of time. The case involved a 19-year-old woman who presented with swelling over the volar wrist and had positive Tinel and Phalen signs. She received conservative treatment with etodolac, a nightly volar splint, cold compresses, and rest.
Achilles Wii-itis refers to a partial or complete rupture of the Achilles tendon during simulated sports activity.22 This injury has been reported in people using the Wii Fit exercise pad for virtual running and stretching, and is diagnosed clinically with a positive Thompson sign (failure to plantar flex the foot while compressing the gastrocnemius). Complete Achilles rupture requires surgical repair, but less severe cases can be treated conservatively, with cold compresses, lifestyle modification, and nonsteroidal anti-inflammatory drugs (NSAIDs).
TABLE 2
Repetitive motion injuries (and possible causes)*30,36
| Type of injury | Games with potential for injury† | Possible injury sites | Common physical exam findings |
|---|---|---|---|
| Tendinopathy | Guitar Hero III: Legends of Rock The Legend of Zelda: Twilight Princess Wii Fit | Achilles tendon Patella Supraspinatous Forearm Extensors | Pain or stiffness in the local area of the tendon. Progression can lead to redness and swelling at the joint of the inflamed tendon |
| Bursitis | Kinect Sports: Soccer Dance Dance Revolution Star Wars: The Clone Wars Wii Fit | Subacromial bursa Trochanteric bursa Patellar bursa | Burning pain over the joint during and after activity, with delayed-onset joint stiffness due to local inflammation |
| Enthesitis | Wii Sports Sports Champions Kinect Sports | Achilles tendon Tuberosity of the tibia Iliac crest | Pain at joint on palpation or during range-of-motion exam. Calcification or fibrosis can be identified in chronic, nonacute presentations that are generally autoimmune mediated |
| Epicondylitis | Wii: Major League Baseball Grand Slam Tennis Tiger Woods PGA Tour | Olecranon process, lateral epicondyle (tennis elbow) | Point tenderness over the lateral epicondyle with acute pain on arm extension |
| Olecranon process, medial epicondyle (golf elbow) | Point tenderness over the medial epicondyle with acute pain on wrist flexion or resisted forearm pronation | ||
| *The authors have included games that, in their opinion, have the potential for injury based on the biomechanics involved (eg, running, jumping, waving, etc). † Many of these games are bundled and incorporate multiple activities (eg, baseball, bowling, boxing, soccer, track and field, tennis, volleyball). | |||
Categorizing Wii-type injuries
Game-related injuries typically fall into 4 broad categories: tendinopathy, bursitis, enthesitis, and epicondylitis. (See TABLE 2 for a list of games with the potential to cause particular types of injuries.)
Tendinopathy. Overuse tendon injuries, or tendinopathies, account for up to 50% of all sports-related injuries.23 By extrapolation, physically interactive game systems that simulate actual sports can be expected to increase tendon overuse injuries.
Most major tendons are vulnerable to overuse injury, including the Achilles (FIGURE), as noted earlier; and the patellar, rotator cuff, and forearm extensor tendons, among others. Repetitive motion, or strain, injuries to these tendons are often thought to be cumulative, with hypoperfusion, local inflammation, and neuropathy contributing to the degree of tendinopathy. Other risk factors for tendon injury include age and sex (men have a higher relative risk than women; older people, in their fourth and fifth decades of life, also face an increased risk), postmenopausal status, obesity, use of fluoroquinolone antibiotics or corticosteroids, and playing on nonpadded surfaces.24-29
Conservative therapy, with cessation of the offending activity and rest of the affected extremity, is the initial treatment of choice for tendinopathy. Severe cases of compound injuries or tendon reinjury can also be treated with splinting, taping, cryotherapy, electrotherapy, deep tissue tendon massage, pharmaceuticals (NSAIDs and corticosteroid injections), and early rehabilitation.15,30 Surgery may eventually be required to remove fibrotic tissue, modify the vascularity, or reconstruct the tendon.15