Correction to This Article
In a photo caption with an April 23 article on BlackBerry e-mail devices, the identifications of two White House staff members were transposed. The photo appears at right with a correct caption. Also, the caption incorrectly said that the photo was taken last week; it was taken last October.
For Some, Thumb Pain Is BlackBerry's Stain

By Amy Joyce
Washington Post Staff Writer
Saturday, April 23, 2005 12:00 AM

Sandy Boyd's BlackBerry had become her passion. Now it has also become a source of pain.

About three months ago, the National Association of Manufacturers vice president noticed that, as she started to type, the area between her thumb and wrist would begin to throb.

Orthopedists say they are seeing an increasing number of patients with similar symptoms, a condition known as "overuse syndrome" or "BlackBerry thumb." In some patients, the disability has become severe.

Bette R. Keltner, dean of the Georgetown University School of Nursing & Health Studies has been forced to put her BlackBerry down. After two years of constant use, her hands were in so much pain, she had to stop typing. She remembers the trigger point: It was a 10-hour conference one Saturday where she answered about 150 e-mails. "Days later, I was in excruciating pain," she said.

The American Society of Hand Therapists issued a consumer alert in January saying that handheld electronics are causing an increasing amount of carpal tunnel syndrome and tendinitis. With that warning, the society included directions on how to properly hold the devices, urging users to take breaks and, if possible, place pillows in their laps so their wrists are in a more upright position.

But at airports and hearing rooms and other places where handheld users while away pauses by thumbing their keyboards, there are no pillows in evidence and very few breaks from the tap-tap-click of e-mailing.

"You become so accustomed to the convenience. This is a kind of tool where you can get five things done while waiting for another meeting to happen," said Keltner.

Keltner now has tendinitis and has spent months in various therapies, including acupuncture, acupressure and a magnetic bracelet. After she realized the BlackBerry had caused her tendinitis, she still tried to use it -- but less often. Shorter notes, more breaks between e-mails. But that brought no relief. She recovered after 12 weeks of therapy. But three months later, even though she has quit messaging, she said her tendinitis is back.

BlackBerry subscribers now total 2.51 million, more than double the 1.07 million subscribers a year ago. Research in Motion Ltd., the maker of the BlackBerry, declined through a spokeswoman to comment on the disability issue. Some other handheld devices, such as PalmOne Inc.'s Treo and T-Mobile Inc.'s Sidekick phones, use similar thumb-operated keyboards. The small keyboards are tough on hands and wrists, according to Paige Kurtz of the American Society of Hand Therapists.

The pains associated with BlackBerrys and other handhelds used to be common among video game players, but Stuart Hirsch, clinical assistant professor of orthopedics at St. Joseph's Hospital and Medical Center in Paterson, N.J., believes teens who are frequent gamers are a little more immune. Also, though many handheld game devices also use thumb-operated controls, they typically don't require as much range of motion as keyboards spanning the entire alphabet as well as punctuation marks.

"Tendinitis won't affect your teenage son the way it will a parent," Hirsch said. "Children are more tolerant of overuse than adults because they are younger."

XBox includes a "Healthy Gaming Guide" message on its Web site, encouraging users to be aware of pain when they overuse the video game device: "When playing video games, as with many activities, you may experience occasional discomfort in your hands, arms, shoulders, neck or other parts of your body. However, if you experience symptoms such as persistent or recurring discomfort, pain, throbbing, aching, tingling, numbness, burning sensation, or stiffness, DO NOT IGNORE THESE WARNING SIGNS. PROMPTLY SEE A QUALIFIED HEALTH PROFESSIONAL."

However, a British researcher of cyber culture, Sadie Plant, found that teenagers and young adults throughout the world are becoming so adept at using their thumbs for messaging, they have started to use them for ringing doorbells and pointing. Japanese teenagers are sometimes called "the thumb generation" because of their heavy-duty messaging. Plant has said that teens use their thumbs more than index fingers, making them faster and more muscled.

Hirsch, who said he has seen at least a couple of patients with injuries related to their PDA or thumb keyboard, said he tells patients to send short answers on the devices. "Many people who are traveling use their BlackBerry to save them time," he said. "Thumbs were not designed for individuals to do this without certain limits. I'm not sure why some people have trouble with it and some don't. Some people are going to be more sensitive to this product."

Workplace injuries in white-collar jobs have grown with the widespread use of mobile communications technology. It used to be that worker's compensation was reserved mostly for blue-collar workers who smashed fingers in heavy machinery or fell off ladders. Factory workers complained for years of what were then mysterious ailments -- carpal tunnel, tendinitis and "trigger finger." Today, those injuries have spread across cubicle-land.

According to the Bureau of Labor Statistics, ergonomic disorders are the fastest-growing category of work-related illnesses for which it receives reports. In 1981, only 18 percent of all reported illnesses were repetitive strain injuries, known as RSI. By 1992, that figure had grown to 52 percent.

That number has leveled off, said Emil Pascarelli, author of "Dr. Pascarelli's Complete Guide to Repetitive Strain Injury: What You Need to Know About RSI and Carpal Tunnel Syndrome" and professor emeritus of clinical medicine at Columbia University.

He attributes the change to companies and employees becoming more knowledgeable about setting up a work station to prevent injuries. However, with the onslaught of tiny handheld devices, Pascarelli said there is a "potential for an epidemic" for new repetitive strain injuries. "These new devices are really introducing a new potential injury issue. I think it has the potential for being an explosive issue in the next few years," he said.

Boyd is trying to wean herself from her BlackBerry by writing fewer and shorter messages. "I was writing treatises on my BlackBerry," she said. "I have to not bring it with me. Because if it's near me, I'm not always so good about not using it."

Keltner, who found similar strategies didn't work, has gone cold turkey. No more BlackBerry. I'm breaking the addiction," she said. "But I'm frustrated. I'm making more phone calls. . . . I hate not being efficient."

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