Keyboard Wrist Pain

History:

The patient had been suffering for several years of hand, wrist and forearm pain on both sides and also some left sided shoulder pain. He is a 40-year-old professional console gamer and writer, both activities involve spending long hours either gaming or typing for various contracts. His pain had been so debilitating he had had to stop taking on new contracts for several months and decided to seek help after accepting a new contract due to be at least 5 months of very long hours.
His pain was worse after using any use of his hands for over 10 minutes such as writing, DIY, gaming, playing guitar or typing.

Examination:

The muscles in his forearms were wasted and his shoulders were protracted. There were no signs of bone abnormality, nerve or significant soft tissue injury. He had good movement, but his strength was reduced on both sides on grip and wrist strength in particular. His shoulders were also slightly weak in the rotator cuff. He had pain on palpation of his forearms generally, particularly pronator teres. He also had pain in his thenar (thumb) eminence. He also had a lot of tightness around his neck and shoulders.

Impression:

My working diagnosis was generalised tendinopathy (or RSI) of the forearm muscles, as well as the left shoulder. He was also showing signs of general weakness and muscle aches around the thumbs as his muscles were not strong enough for his day to day and work activity.

Treatment:

I discussed the presentation with the patient to ensure he had a good understanding of the problem and the likely outcome of treatment. I treated the weak and painful tendons with soft tissue mobilisation, massage, stretching, a graduated strengthening programme. His strengthening programme consisted of a series of weight and theraband work, as well as using a Powerball.
I also advised this patient to break from his work station regularly and take lots of short walks during the day as able.

Outcome:

He was seen 6 times over 3 months and I am pleased to say the patient’s pain has really settled and he has now completed his work contract with very little pain which is continuing to improve as he works on his strength.

Charlotte Saunders