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Research Christmas 2014: Going to extremes

Nintendo related injuries and other problems: review

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7267 (Published 16 December 2014) Cite this as: BMJ 2014;349:g7267

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In their intriguing paper, Jalink et al. warned of the risk of injuries and other medical problems caused by using a Nintendo video gaming system.1 Nintendinitis, Wiiitis, Wii knee and “Nintendo epilepsy” are some of the musculoskeletal and neurological disorders described in case reports and original papers identified by the authors through an accurate review of the international scientific literature. In recent years the competition between Nintendo, Microsoft and Sony for getting to a dominant position in the video game market and at the same time among their respective fans, who all claim to own the best gaming system, has reached unprecedented levels. The debate has continued for more than 20 years, and still goes on without ever reaching a definitive consensus. Even physicians and scientists seem to take part in this so-called “console war” – now fought through the eighth generation of video game devices (PS4, Xbox One and Wii U are some of the most widespread) – stating that physically-interactive video games (“exergames”, such as the Nintendo Wii) are more desirable than traditional sedentary video games in overweight children,2 3 or that PlayStation EyeToy elicits higher levels of movement in stroke rehabilitation,4 or that Xbox Kinect is the best console for exercise among women with fibromyalgia.5 and elicits greater energy expenditure.6

Just like Nintendo devices, the other above-mentioned consoles seem to share the risk of causing medical disorders in video game addicted people. In 2004 Vaidya described “Playstation thumb” as a repetitive strain injury resulting from continuous playing of Playstation games.7 Like Nintendinitis, it manifests itself as thumb pain and sometimes with blisters on the tips; moreover, it may occasionally be associated with pain, stiffness, swelling, numbness and tingling of the hands, wrists, elbows, shoulders, back or neck.8 Onycholysis and punctate hemorrhage on dermoscopy may also be found, therefore it should be considered in the differential diagnosis of fingertip lesions.9 10 “Playstation Lip”, first described in 2000, manifests with severe lower lip trauma, associated with jaw muscle fatigue and bleeding of the inside of the lower lip.11 The affected reported chewing and sucking intensely on their lower lips while concentrating on their Playstation games. Chronic contact hand eczema has been related to PlayStation controller use in two case reports and it is believed to be caused by benzoyl peroxide, an oxidant agent used in the plastics industry or other components of controller, i.e. cobalt and polyester resins.12 13 Similarly, the “silver” button on the Xbox controller was described as a potential nickel source, worsening atopic dermatitis in a 9-year-old boy.14 Another known dermatological lesion is “PlayStation Purpura”, described in a video game addicted 16-year-old boy as a number of asymptomatic pigmented macules on the volar aspect of his index fingers.15 Finally, a study conducted using an Xbox game system concluded that video game systems can induce motion sickness, if played for more than 50 minutes at a time.16 The aforementioned case reports suggest that medical disorders were caused by an inappropriate and exaggerated use of video game consoles, implying that video games in general are not harmful, but their prolonged or unsafe use can result in medical injuries. Overall, we agree that video games are a safe Christmas present, but recommend following the advice by Jalink et al. “those who receive such a gift should not swing the controller too hard, […] and they should take frequent breaks”.1

References

1. Jalink MB, Heineman E, Pierie JP, Ten Cate Hoedemaker Ho. Nintendo related injuries and other problems: review. BMJ 2014;349:g7267.
2. Siegmund LA, Naylor JB, Santo AS, Barkley JE. The effect of a peer on VO2 and game choice in 6-10 year old children. Front Physiol 2014;5:202.
3. Penko A, Barkley JE. Motivation and physiologic responses of playing a physically interactive video game relative to a sedentary alternative in children. Ann Behav Med 2010;39:162–169.
4. Neil A, Ens S, Pelletier R, Jarus T, Rand D. Sony PlayStation EyeToy elicits higher levels of movement than the Nintendo Wii: implications for stroke rehabilitation. Eur J Phys Rehabil Med 2013;49:13-21.
5. Mortensen J, Kristensen LQ, Brooks EP, Brooks AL. Women with fibromyalgia's experience with three motion-controlled video game consoles and indicators of symptom severity and performance of activities of daily living. Disabil Rehabil Assist Technol 2015;10:61-6.
6. O'Donovan C, Hirsch E, Holohan E, McBride I, McManus R, Hussey J. Energy expended playing Xbox Kinect™ and Wii™ games: a preliminary study comparing single and multiplayer modes. Physiotherapy 2012;98:224-9.
7. Vaidya HJ. Playstation thumb. Lancet 2004;363:1080.
8. Karim SA. Playstation thumb--a new epidemic in children. S Afr Med J 2005;95:412.
9. Bakos RM, Bakos L. Use of dermoscopy to visualize punctate hemorrhages and onycholysis in "playstation thumb". Arch Dermatol 2006;142:1664-5
10. Bernabeu-Wittel J, Domínguez-Cruz J, Zulueta T, Quintana J, Conejo-Mir J. Hemorrhagic parallel-ridge pattern on dermoscopy in "Playstation fingertip". J Am Acad Dermatol 2011;65:238-9.
11. Inglis RL, Welbury RR. PlayStation lip. Br Dent J 2000;188:585.
12. Kluger N, Pecquet C. Chronic contact eczema on the hand related to PlayStation(®) controller use. Int J Dermatol 2014;53:e196-7.
13. Giordano-Labadie F, Mariut I, Paul C. Addiction aux jeux vidéo et dermite des mains. Ann Dermatol Venereol 2011;138:127.
14. Jacob SE. Xbox--a source of nickel exposure in children. Pediatr Dermatol 2014;31:115-6.
15. Robertson SJ, Leonard J, Chamberlain AJ. PlayStation purpura. Australas J Dermatol 2010;51:220-2.
16. Merhi O, Faugloire E, Flanagan M, Stoffregen TA. Motion sickness, console video games, and head-mounted displays. Hum Factors 2007;49:920-34.

Competing interests: No competing interests

04 January 2015
Michele Augusto Riva
physician and medical historian
Luca Cambioli, doctor, University of Milano Bicocca and Francesco Castagna, doctor, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center,
University of Milano Bicocca
via Cadore 48, I-20900 Monza, Italy