With so many new communication devices on the market we are now able to conduct business not only from our offices and homes but in our cars, standing in line for a latte in airports and at the stadium watching a ballgame. 

Technology has provided us with hand-held devices such as BlackBerries and personal data assistant (PDA) Palm Pilot and other pocket PCs that provide storage and retrieval of information, cell phones with text messaging, and media players (IPOD’s).  These devices allow us to instantly communication with anyone anywhere and are used instead of laptops, computers, address books, or notepads. 

Just like other computer devices, PDAs can lead to pain, stiffness, and swelling near a joint in the hand or the wrist.  These portable communication tools require repetitive fingering motion; it's no wonder that people are being seen more frequently for tendon pain. 

Some of you may remember back when there were disorders of the thumb, called Gamer’s thumb or Nintendo thumb, caused from overuse of joy sticks back in the 1980’s. 

The American Society of Hand Therapists recently alerted consumers about a new OSH condition coined, “BlackBerry Thumb” and you guessed it right, it occurs from overuse of hand-held devices.  The complaint heard most often with this diagnosis is pain that increases with use of the thumb and continues even at rest.  Other disorders also being seen in addition to pain are carpal tunnel syndrome, triggering of the thumb and swelling of the thumb at the wrist known as DeQuervain’s Tenosynovitis.

You probably have heard of tendonitis such as tennis elbow, rotator cuff syndrome or trigger finger.  Tendon pain or tendinopathy is often diagnosed as tendonitis, inflammation of the tendon or tenosynovitis, inflammation of the synovial sheath surrounding the tendon.

"Itis" means inflammation so usually one would think that tendonitis is inflammation of the tendon.  Not necessarily so as noted by Barbara delateur, M.D., Professor of Physical Medicine and Rehabilitation of Johns Hopkins.  According to Dr. delateur the typically signs associated with inflammation are "redness, swelling and pain that results from broken blood vessels".  She further states that one could have tenosynovitis as the "tendons themselves don't contain many blood vessels, so it's hard for them to get inflamed."

What really is happening?  The cause is due to degeneration of the tendon from overuse.  Tendons are made up of collagen; overtime collagen breaks down, resulting in microscopic tears.  This is common in most of our daily activities.  In a normal healthy individual blood is carried into the area while we are resting and repairs those micro-tears, allowing us to perform our regular activities the next day without pain.  As we age, blood circulation decreases thereby limiting our ability to heal these tears, and there you have tendinosis.

It is the overuse of the same muscle fibers from repetitive motion injuries (RMIs), or repetitive strain injuries (RSIs), that will finally send you to the doctor with complaints of pain.  Trauma can also lead to tendon pain.  The doctor will perform an evaluation to determine the type of injury you have and order any necessary tests.  He or she will then refer you to a hand therapist to have you evaluated.  This will include an occupational profile to determine what factors and behaviors are leading to your symptoms.

What is important to know about these diagnoses is that each of them is treated differently.  You wouldn't treat tendinosis the same way you would treat tendonitis or tenosynovitis.  NSAID's (Nonsteriodal Anti-Inflammatory Drugs) and cortisone shots are used to target inflammation and will help reduce pain in the latter two.  What they won't do is repair the microscopic tears that cause the pain nor do they promote healing needed for tendinosis. 

It is important to know what you are being treated for and what your options are for treatment.  For all of the above rest is important.  You may or may not need bracing or splinting to rest the joint.  Splints can help reduce pain and prevent further injury by positioning the hand and thumb in proper alignment allowing you to hold the device in an optimal position.  Heat and ice are used in different stages in your rehabilitation to increase circulation of blood needed to heal tissue and to decrease pain.

Occupational therapists specializing in hand therapy can help with managing the active symptoms of RSI, prevent further injury and move you into a strengthening phase specialized for injured tendons and muscles.  Occupational hand therapists treat the physical complaints of pain and other symptoms as well as the impact the symptoms have on one’s ability to perform activities of daily living.

What can you do to avoid and improve symptoms of a repetitive stress injury when using a hand-held device?  Mostly limit how much time you use the device.  Use the following recommendations to help you change your habits.

• When using a BlackBerry device away from home place a pillow on your lap so your wrists are supported in an upright position.
  
• Support the device on a table or other surface to avoid sustained holding.
  
• Reduce the amount of repetitive movement by learning shortcuts on your PDAs.
  
• Copy and paste text instead of retyping all of the information.
  
• Use abbreviations when typing or emailing.
  
• Try using a stylus with a built-up grip to reduce pressure directly on the thumb or fingers.
  
• Limit your time on the device, no more than 10 minutes to avoid repetitive fingering motions and sustained holding.
  
• Use a headset with all calls.
  
• Maintain a healthy lifestyle with regular exercise.
  
• If you lift weights, make sure you alternate days performing upper body and lower body strengthening on opposite days. Or take a days rest in-between weight lifting sessions.
  
• Stretch after exercising to avoid tight muscles.  Stretching aids in getting blood to the tissue focus on your hands and forearms.
  
• Stop if you have pain during any activity that is usually a sign you are overusing you muscles and tendons.
  
• If you have pain wear splints to prevent repetitive motions of the thumb.
  
• Drink plenty of fluids to stay hydrated.

Lynda Williamson is a register and licensed occupational therapist (OTR/L) and certified hand therapist (CHT).  She is the owner of Strait Occupational & Hand Therapy in Port Angeles, WA a private, therapist-owned clinic that specializes in upper extremity rehabilitation for the shoulder, elbow, wrist and hand.  She can be contacted at 360-417-0703.