A Wii problem
Authors: Thomas Fysh, JF Thompson
Journal: Journal of the Royal Society of Medicine (2009)

‘Gaming’ has been the subject of much controversy ever since the arrival of the Magnavox ‘Odyssey’ in 1972. The debate in the media and wider society tends to concentrate on the allegedly ruinous effects of gaming on vulnerable minds, with certain games often quoted as the inspiration behind antisocial behaviour, social alienation and worse. Through the 80s and 90s, computer and console games have become more advanced, and in November 2006, Nintendo released the ‘Wii’, a wireless computer console incorporating accelerometers in the hand control and infrared motion sensors in the console. The result is a more physically-oriented gaming experience and, arguably, a riposte to those who say that gaming encourages an unhealthy, sedentary lifestyle. Indeed, one cannot ignore the many studies showing the beneficial effects of gaming in several areas, for example after subacute stroke1 and in the rehabilitation of children with cerebral palsy.2 But a closer look at the literature reveals that gaming is certainly not without its dangers and as the technology has evolved, those dangers seem to become ever more tangible.

Inspired by the unusual presentation of a young woman to the vascular department recently, a PubMed search on computer game-related pathology and trauma was shown to provide an interesting and educational insight into this unusual medical realm. In the early days, medical reports highlighted concerns about the long hours people spent in front of screens and the possibility that this could cause deep vein thrombosis or ‘eThrombosis’.‘3 Others reported consequences of total gaming immersion including faecal incontinence,4 daytime enuresis5 and epilepsy.6 Video-game epilepsy, in fact, is well-documented and the subject of a recent trial which found that video games in particular were more likely to provoke seizures in subjects with photosensitive epilepsy than standard television programs, even if the same screen is used for both.7 Furthermore, the loss of sleep in adolescents who play games late into the night has been shown to result in poor memory function and learning.8 There has even been a report of acute psychosis induced by prolonged video-game use, unusually, perhaps, in an elderly gentleman.9

The unfortunate effects of gaming can, however, be more direct: in 1991, a type of pressure injury seen in adolescent gamers was described and christened ‘Nintendonitis’. After an enthusiastic and prolonged session with a new games console (in this case, a Nintendo 64), the patient developed a punched-out ulcer on her right palm.10 More than 13 years later, a very similar phenomenon was described in The Lancet, this time dubbed ‘Playstation 2 (PS2) Thumb’; a picture accompanies the article in which the nine-year-old author's thumb is seen to be blistered and flaking.11 PS2 thumb was later described in ‘epidemic’ proportions in The South African Medical Journal.12 Confusingly, the term ‘Nintendinitis’ (compared to ‘Nintendonitis’) was also coined in 1990 to describe a repetitive strain-type injury affecting the wrist and elbow.13 Upon the advent of the Wii, however, Playstation thumb and Nintendintis were eclipsed by altogether different problems.

The Wii revolution has seen gamers leave their armchairs and sofas to indulge in more physically demanding games such as ‘Wii Sports’. The result (apart from the destruction of several plasma televisions and at least one lawsuit against Nintendo) was a rise in traumatic Wii-related personal injury such as the ‘Wii-knee’ in which a 16-year-old boy avulsed several knee ligaments during a particularly energetic session with the console.14 Infraspinatus tendonitis was later described in the USA after following Wii tennis15 and this variant of ‘wiiitis’ was later imaged convincingly on MRI.16 Further accounts of Wii-related injuries followed, including one episode which saw an eight-year-old girl suffer deep scalp lacerations requiring sutures caused by a flying Wii remote control17 and, more recently, a case of Wii-induced traumatic haemothorax when an enthusiastic gamer lost her balance at the controls and fell awkwardly onto a piece of furniture.18 Adding our own experience of Wii-induced effort thrombosis (Paget Schrotter disease) to this catalogue of unfortunate events, one quickly appreciates the extreme physical strain some gamers put themselves through. Wii injury is so common, in fact that several websites and blogs have been set up in its honour. In one called www.wiiinjury.com , the latest report is of an inebriated man who accidentally punched his wife in the face as he attempted to battle a dungeon ‘boss’ in ‘Zelda: Twilight Princess’; the picture evidence is compelling. In another, www.wiihaveaproblem.com , I counted at least four fractured limbs, a dislocated patella and countless lacerations, almost invariably caused by breaking light fixtures while playing Wii tennis.

Stories such as these have led one US talk show host and fitness guru to sue Nintendo over the potential dangers of the Wii. Not only does Michael Torchia claim that Nintendo is concealing the dangers of its product but that the addictive nature of the games could even be contributing to the obesity epidemic by brainwashing people into thinking they are exercising when, by any reasonable definition of the word, they are not.19 But while one could sympathize with his view that the Wii could never replace traditional exercise, this extrapolation of his viewpoint seems a little far-fetched: Wii sports might have caused a few brow-raising and unusual injuries but is hardly reducing our nation's youth to helpless decrepitude. Even so, while the Wii revolution may fall short of actually reducing the nation's body mass index, one must concede that gaming is no longer confined to the realm of languid adolescence and that can't be a bad thing even if we haven't stumbled upon a new variant of sports medicine.