PRACTICE RECOMMENDATIONS
• Ask patients with repetitive motion injuries (RMIs) whether they use interactive game consoles and, if so, how much time they spend playing virtual sports each day. C
• Be aware that RMIs associated with video game use are similar to injuries associated with the sports they simulate. A
• Advise patients to take the same precautions with virtual sports as they would with any physical activities, including warm-up exercises and moderation. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
This article is an expansion of a poster session presented at the 12th annual Northeastern Ohio Universities College of Medicine Department of Surgery Resident Research Day in May 2009 and at the American College of Preventive Medicine Annual Meeting in February 2010.
The release of the Wii—Nintendo’s 4th generation gaming console—in 2006 revolutionized the video game industry. By March 31, 2010, more than 70 million units had been sold worldwide, earning Wii the title of “fastest-selling game console of all time.”1-3
Today, there are several game consoles that, like Wii, allow the user not only to push buttons or move levers, but to control the game using physical movements (TABLE 1). And the devices and the many sports they simulate—once popular primarily among adolescents—are in widespread use by people of all ages, including the young and fit, out-of-shape “arm chair” athletes, and elderly people in senior housing, rehabilitation centers, and long-term care facilities alike.4
Not surprisingly, simulated sports play has spawned an array of repetitive motion and overuse injuries. To identify and treat them, ask all patients who present with musculoskeletal injuries whether they engage in game console sports activities; if so, identify the type of game and how much time they spend playing it each day. Although injuries associated with specific video games are often given names like “Wii-itis,”5 “Nintendinitis,”6 and “Playstation thumb,”7 the types of injuries caused by playing simulated sports are generally the same as (or similar to) injuries sustained by those engaging in the sport itself.
TABLE 1
Popular motion-controlled games: A partial list
| Type of game console | |||
|---|---|---|---|
| Nintendo: Wii | Microsoft Xbox 360: Kinect | Sony Playstation 3: Move | |
| Motion-control mechanism | Handheld remote | Full body | Handheld remote |
| Games bundled with console | Wii Sports | Kinect Adventures | PS3 Sports Champions |
| Popular games | Wii Fit Wii Play Mario Kart Super Smash Bros Brawl Guitar Hero III: Legends of Rock | Kinect Sports Dance Central Your Shape: Fitness Evolved The Biggest Loser: Kinectimals | Sports Champions Time Crisis: Razing Storm Killzone 3 Little Big Planet 2 Sorcery |
| Manufacturer-recommended game space | ≤6 feet using wireless sensor | ≥6 feet from device | ≥6 feet from device |
| Sources: 1. Nintendo (http://www.nintendo.com/consumer/wiisafety.jsp). 2. Microsoft Xbox 360 (http:www.xbox.com/en-US/Kinect/PrivacyandOnlineSafety). 3. Sony Playstation (http://us.playstation.com/support/answer/index.htm). | |||
Video game pathology is well established
In 1987, Osterman et al published the first report of a musculoskeletal disorder associated with electronic games—a case of volar flexor tenosynovitis (“joystick digit”) trigger finger.8 Several years later, a physician coined the term “Nintendinitis” to describe video game-related overuse syndrome6—acute tendinopathy of the extensor pollicis longus tendon after prolonged play with early versions of the thumb-activated game controller.9,10 In 2002, a child using a vibrating Sony Playstation for up to 7 hours a day received a diagnosis of vibratory syndrome of the hand.11 A few years later, a report of “Playstation thumb,” an overuse syndrome associated with later generations of game consoles, followed.7
Several other reports of game-related injury patterns can be found in medical journals, including pressure ulcer formation (“ulcerative Nintendinitis”),12 the “How!” sign of central palmar blistering,13 “mouse elbow” secondary to epicondylitis,14 and other tendinopathies associated with various gaming consoles.10,15,16 All the reports clearly describe the relationship between video game use and the pathology, and clinical improvement after cessation of the activity.
Many manifestations of Wii-itis
An epidemiologic review of the National Electronic Injury Surveillance System (http://www.cpsc.gov/library/neiss.html) found that in the Wii’s first year, 67% of the musculoskeletal injuries reported (29% were defined as sprains and strains and 38% as overuse injuries) involved the use of the Wii to play simulated sports.17 Overuse syndrome associated with Wii was initially called “acute Wii-itis,”5 a description of acute tendinopathy of the infraspinatus.18 (Infraspinatus tendinopathy is most commonly associated with games involving intense arm activity, including Wii baseball, bowling, and boxing (TABLE 2).5 However, Wii-itis is now widely used to describe any acute inflammatory syndrome associated with use of this popular game console.
Wii knee, for example, refers to an acute patellar dislocation associated with simulated bowling.19 Multiple cases of patellar injury, including associated osteochondral fracture, have been reported in association with a variety of game titles, including Raymond Raving Rabbids and Brunswick Pro Bowling.19 In a review of self-reported Wii injuries, patellar dislocation was the fourth most common injury (hand lacerations were first, followed by periorbital hematoma [“black eye”], and forehead lacerations/ecchymoses).20