Bursitis. Bursitis is characterized by inflammation of the subacromial, olecranon, trochanteric, prepatellar, suprapatellar, infrapatellar, pes anserine, or iliotibial bursa—synovial-lined cavities overlying bony prominences that minimize the friction of movement.31 Patellar and olecranon bursitis are most frequently associated with sports, particularly soccer and golf.
Clinically characterized by pain on flexion, bursitis can also present with localized tenderness, stiffness, and swelling of the affected joint. Bursitis generally responds to RICE (rest, ice, compression, elevation) therapy, but can potentially advance to a chronic disease state if the activity that caused the inflammation continues.31
Enthesitis. Characterized by inflammation of the bony insertions of a tendon or ligament, enthesitis is generally linked to an autoimmune disease such as ankylosing spondylitis or rheumatoid arthritis. But it can also be an acquired condition associated with repetitive motion. Sports-related activity is the most common cause of acquired enthesitis,32 with injury most likely to occur at the Achilles tendon, the insertion point of the tibial tuberosity, or the iliac crest.33 Like most RMIs, acquired enthesitis can usually be treated simply by stopping the offending activity. If not properly recognized or treated, however, permanent injury can occur. 34
Epicondylitis. This RMI results in pain or ipsilateral weakness of the upper extremity due to repetitive strain at the musculotendinous junction and its origin at the epicondyle. Neuropraxia is often associated with epicondylitis due to posterior interosseous nerve, median nerve, or ulnar nerve involvement at either the medial or lateral epicondyles.35
Commonly affecting computer users who perform repetitive motion via mouse manipulation, the term “mouse elbow” was first described in 1992.14 Golfer’s elbow (with involvement of the medial epicondyle), and tennis elbow (involving the lateral epicondyle) are also common, and individuals who frequently play simulated golf or tennis games are at risk.
FIGURE
Achilles tendon injury
An MRI reveals anterior bulging and thickening of the Achilles tendon (arrow)—the type of injury you might see in a patient using the Wii Fit exercise pad for running and stretching.
Tell patients how to prevent injury
Older patients and deconditioned “arm chair” athletes who are unaccustomed to prolonged physical activity face an increased risk for injuries related to video game sports. You can help by pointing out that because simulated activities require a fraction of the strength and endurance required to play the actual sport, people who might normally tire easily are apt to overdo it.
In fact, Nintendo has a dedicated safety page regarding the use of game consoles on its Web site (http://www.nintendo.com/consumer/wiisafety.jsp). The company advises Wii users to take a 10- to 15-minute break every hour, even if they don’t think they need it, to prevent repetitive motion and eyestrain injuries, and to stop playing for several hours if they experience tingling, numbness, burning, or stiffness. Some software titles, including Wii Fit, are programmed to remind users to take a break after they’ve been playing nonstop for 45 minutes to an hour. You can help by reminding patients of all ages that warm-up exercises, moderation, and hydration are crucial, whether the sports they’re engaging in are virtual or real.
Acknowledgement
The authors would like to thank Dan Dunlany for his invaluable research assistance.
CORRESPONDENCE
Lisa M. Coughlin, MD, Department of Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614; LcoughlinMD@gmail.com