Letters

Hand-arm vibration syndrome may be associated with prolonged use of vibrating computer games

EDITORWe report the development of the hand-arm vibration syndrome in a 15 year old boy who presented with a two year history of painful hands. His hands became white and swollen when exposed to the cold and subsequently red and painful on warming. He had no clinical or laboratory features of an underlying connective tissue disorder.

The onset of his symptoms was preceded by the prolonged use of a widely available domestic computer game (Sony Playstation). He spent up to seven hours a day playing this game. He particularly enjoyed driving games using the vibration mode on the hand held control device ("rumble board"). He described the sensation of realism associated with the device vibrating when the on screen vehicle came "off road."

His presentation is typical of the hand-arm vibration syndromevibration white finger as it was previously knowndescribed in association with occupational exposure to vibration. This syndrome came into force as an industrial disease in April 1985.¹ As a result sufferers were able to claim compensation and disability benefit. The prolonged use of hand held vibratory tools such as gas powered chain saws and pneumatic tools has been implicated in the aetiology of this syndrome. The increasing recognition of the problem and the subsequent lawsuits that have arisen have led to the use of antivibratory tools and changes in working practice aimed at prevention.

To our knowledge, there are no published references on the hand-arm vibration syndrome in children. Injuries associated with the use of computers or their accessories, however, have been described, including joystick digit, mouse elbow, and a central palmar blister following rotation of the central console joystick of a Nintendo game in the palm of the hand.^2-4 No cases of the hand-arm vibration syndrome have previously been reported in association with prolonged use of vibrating hand held computer devices.

Children spend long periods playing domestic computer games. The seven hours a day that our patient reported is excessive and exceeds the manufacturer's recommendation, but we must assume that this is not an uncommon occurrence. We believe that, with increasing numbers of children playing these devices, there should be consideration for statutory health warnings to advise users and parents. The potential for developing the hand-arm vibration syndrome should be considered, although more evidence of its occurrence in this context is required. We encourage paediatricians encountering health related effects of using these devices to report their findings.

A G Cleary, specialist registrar. 
H McKendrick, general practitioner. 
J A Sills, consultant paediatric rheumatologist. 
Department of Paediatric Rheumatology, Royal Liverpool Children's Hospital, Liverpool, L12 2AP

1.	Social security (industrial injuries, prescribed diseases) amendment regulations 1985. London: HMSO, 1985. (SI No 1985/159.)
2.	Osterman AL, Weinberg P, Miller G. Joystick digit. JAMA 1987; 257: 782.
3.	Mirman MJ, Bonian VG. "Mouse elbow": a new repetitive stress injury. J Am Osteopath Assoc 1992; 92: 701[Medline].
4.	Wood J. The "how" signa central palmar blister induced by overplaying on a Nintendo console. Arch Dis Child 2001; 84: 288[Free Full Text].