Clinical Considerations for Treating Gamers with Upper Extremity Injuries

Written by John Agonoy OTR/L

Virtual Hand Therapy Fellow '25/'26

A New Gaming World(s)

Video games have been a significant part of my life since the 1990s, beginning with systems such as the Game Boy Color with Pokémon and the Nintendo 64 with games including Super Smash Bros and Mario Kart. Since then, video games have made great strides in hardware and software, with gaming becoming a major global occupation encompassing recreation, lifestyle, communities, esports, and online careers. There are an estimated 3.6 billion players worldwide as of 2025 (Newzoo). Increasing accessibility of the internet, streaming platforms such as Twitch, content creation on YouTube, and the establishment of esports have expanded gaming beyond a hobby.

Gaming and gamers are very diverse. On the more intense end, competitive esports players may perform hundreds or thousands of rapid inputs during a single match, often measured as actions per minute (APM), while casual gamers may engage in lower-intensity but prolonged sessions. An esports player is a term for gamers with professional or semi-professional competition in mind. In a study published in the International Journal of Esports by Ekefjärd et al., professional gamers with more than a 35 hour/per week gaming regimen were positively associated with 8x higher odds of experiencing physical symptoms (2024). Conversely, another gamer playing a more relaxed game such as Star Dew Valley on a Steam Deck (handheld device) could have prolonged sessions lasting many hours with a lower APM.

Inputs and Outputs

When evaluating a patient who is an avid gamer, consider the platform they use, as different input devices place unique demands on the upper extremity.

●      Controllers: primarily used with consoles, rely heavily on repetitive thumb movements for buttons and joysticks, with the index fingers operating triggers and bumpers.

●      Mouse and keyboard: common in PC gaming, involve prolonged forearm pronation, repetitive finger inputs, and sustained wrist positioning.

●      Touchscreen devices require direct finger interaction through tapping, swiping, pinching, and scrolling, often with prolonged thumb use or sustained grip positions.

Identifying which upper extremity structures are stressed by a patient's preferred gaming platform can help guide evaluation and treatment. The repetitive and sustained demands placed on the upper extremity may contribute to overuse conditions including shoulder tendinopathies, lateral and medial epicondylitis, cubital tunnel syndrome, De Quervain's tenosynovitis, and carpal tunnel syndrome (Sant & Micallef Stafrace, 2021). In a sample of smartphone esports athletes, neck pain was the most commonly reported musculoskeletal complaint (41%), followed by shoulder (31%), wrist (18.6%), and elbow symptoms (12.4%) (Khan & Chaikumarn, 2024). These findings highlight the importance of assessing gaming-specific demands during evaluation.

The Hand Therapist's Perspective

Understanding a patient's gaming habits can provide valuable insight into upper extremity tissue loading, symptom provocation, and potential barriers to recovery. From a clinician's perspective, gaming presents several risk factors for repetitive strain injuries, including prolonged play duration, high actions per minute (APM), repetitive movements, sustained wrist positions, static posture, and inadequate recovery. Gamers share commonalities with musicians or athletes if they are in competitive esports, as participation may be tied to performance, identity, income, and quality of life. Severe symptoms could be career-ending and potentially significantly impactful to quality of life (Sant & Micallef Stafrace, 2021).

Key Evaluation Questions for Gamers

●      What platform do you use most often?

●      How many hours do you play per day or week?

●      Have your gaming hours recently increased or decreased because of symptoms?

●      Do symptoms worsen during specific games?

●      Are you a casual, enthusiast, or competitive player?

●      Is gaming primarily recreation, social participation, or a source of income?

Additional considerations include surgical precautions, ergonomic factors, tissues at risk, and the impact of orthoses on gaming performance. A photo of the patient's gaming setup can help identify modifiable factors such as posture, upper extremity positioning, and device-specific demands.

Similar to athletes returning to sport, gamers may benefit from graded return-to-play recommendations that progressively increase gaming duration and intensity while monitoring symptom response. Preemptive home exercises and stretches may be warranted, especially for gaming profiles with longer-hour sessions and intense gameplay. Patient education may focus on ergonomic modifications, scheduled stretch breaks, tendon gliding exercises, grip or controller adaptations, and edema and pain management strategies.

As gaming continues to grow, hand therapists will likely encounter gaming-related upper extremity injuries with increasing frequency. Gaming hardware continues to evolve, with virtual and augmented reality expanding opportunities for both gaming and rehabilitation. Recognizing gaming as a meaningful occupation can help clinicians develop collaborative interventions that support both recovery and long-term participation. As hand therapists, we routinely modify meaningful activities rather than simply eliminating them. Gaming should be approached similarly. Whether a patient is a casual gamer, esports competitor, content creator, or someone who connects with friends online, understanding the occupational value of gaming can lead to more collaborative, patient-centered, and sustainable treatment recommendations.

References

●      Ekefjärd, S., Piussi, R., & Hamrin Senorski, E. (2024). Physical symptoms among professional gamers within eSports, a survey study. BMC Sports Science, Medicine and Rehabilitation, 16(1), 18.https://doi.org/10.1186/s13102-024-00810-y

●      Khan M, Chaikumarn M. (2024). Musculoskeletal disorders, perceived stress, and ergonomic risk factors among smartphone eSports athletes: A cross-sectional study. J Musculoskelet Surg Res. 2024;8:247-55. doi: 10.25259/JMSR_113_2024

●      Newzoo. (2025). Global Games Market Report 2025. newzoo.com

●      Sant, K., & Micallef Stafrace, K. (2021). Upper Limb Injuries secondary to Overuse in the Esports community. Is this a rising epidemic?. International Journal of Esports, 1(1). Retrieved from https://www.ijesports.org/article/39/html