Inner Elbow Pain From Gaming

Expert Opinion

• One of the most commonly injured areas in gaming due to the stress and strain put on the wrist/finger flexors.
• Fighting Game Forearm is irritation of one or multiple tendons that cross the wrist and lead to the hand and fingers.
• These muscles/tendons are responsible for gripping a mouse/controller when a button is pressed or action is completed.

What Does This Diagnosis Mean

Fighting Game Forearm is a condition that affects one or multiple tendons stemming from five muscles in your forearm, wrist, and fingers. When you play video games or use your wrist and fingers a lot, these tendons can get irritated and swollen, causing pain. These tendons allow each person to bend their wrist/fingers and rotate their forearm palm down.

This diagnosis is termed "Fighting Game Forearm" due to the frequent occurrence in gamers who play fighting-based games such as Mortal Kombat, Tekken, Street Fighter, etc. with a joystick. It can also be present in PC or console gamers as a lot of the irritation can come from strong or forceful gripping of the device. This name is also interchangeable with "Golfer's Elbow" or medial epicondylosis.

Common Things You Might Feel

Gamers are likely to begin experiencing pain and discomfort while playing and a sore, achy, or stiff feeling after. Weakness is also likely to be present with gripping a controller, mouse, or using a gaming joystick for games such as Street Fighter or Tekken. Pain may be present with activities such as bowling, golfing, rock climbing, or even just holding the phone to text.

Disclaimer: The following information is provided for general educational purposes only and should not be considered medical advice. It is not intended to replace consultation with a qualified healthcare professional. If you have specific concerns or questions about your health or medical condition, please seek the guidance of a licensed physician or another qualified medical practitioner. Any reliance you place on the information provided is solely at your own risk. In no event will the author or 1HP be liable for any loss or damage arising from using this information. Always consult with a healthcare professional before starting or changing any medical treatment or regimen.

How Does It Happen to Gamers?

Gamers playing high APM games under high stress are at an increased risk because of the repetitive strain in gripping the device. Each time we are hitting triggers or clicking a button, these muscles/tendons are being used. When proper care is not taken through adequate conditioning, rest, stretching, etc., then the muscles/tendons will fatigue and lead to structural damage in the form of small microtears near the inner elbow.

How to Fix It / Recover / What Can You Do?

1. Identify the issue (early detection…do NOT push into or through pain).
2. Stress Management — Individuals with more stress may become more tense, gripping the input device harder than needed and leading to added strain.
3. Rest the wrist/fingers (a few days reducing workload, but continue moving the wrist, fingers, elbow).
   • Splinting: A standard wrist splint with the thumb free. A counterforce strap can compress the region of the irritated tendons, functionally creating a new muscle origin — placed on the outer part of the elbow 1–2 cm down from the medial epicondyle.
4. Massage in times of pain/discomfort.
5. Utilize heat/ice (hot/cold packs, warm water soak). Be cautious using ice over nerves.
6. Initiate isometric exercises — a good starting exercise to regain/maintain strength while limiting pain.
7. Stretching — helpful throughout the range of motion.
8. Isotonic strengthening — improve strength and endurance to decrease pain and prevent recurrence.

Additional tip: Consider utilizing lifting hooks to decrease muscle recruitment for pulling/gripping movements while lifting (not an endorsement of IronBull Strength).

Surgery is very rarely required in order to effectively treat.

For a comprehensive guide on the exercises discussed, check out the videos on our Fix Elbow Pain page.

Science Behind The Injury

Specifically, this diagnosis is looking at five muscles and tendons responsible for bending (flexion) the fingers and wrist while also turning the palm down (pronation). These tendons — known as the flexor-pronator group — converge and attach at one common point: the medial epicondyle of the humerus.

Tendons responsible:

• Pronator teres — Turns the palm down (pronation), rotating the forearm.
• Flexor carpi radialis — Bends the wrist towards the palm (flexion) and towards the thumb (radial deviation).
• Flexor carpi ulnaris — Bends the wrist towards the palm (flexion) and towards the small finger (ulnar deviation).
• Palmaris longus — Not everyone has this muscle (~15% do not); if present, assists wrist flexion.
• Flexor digitorum superficialis — Bends the fingers (finger flexion), excluding the tips.

This injury can also be common in golfers (hence "golfer's elbow"), climbers, servers, and other professions/hobbies requiring forceful gripping and carrying heavy objects in a palm-up (supinated) position.

Differential Diagnosis

• Cubital Tunnel Syndrome — Compression or irritation of the ulnar nerve at the inside (medial) elbow ("cubital tunnel"). Numbness/tingling in the small finger and half of the ring finger closest to the small finger. Can be mistaken or confused with Fighting Game Forearm.

Preventative Approach

There are 3 main factors to first focus on, plus secondary factors.

1. Strengthening exercises — Build a foundational base for the tendon/muscle.
2. Intermittent stretching (during and after gaming sessions).
3. Proper warm-up — Promotes blood flow and lubricates stiff joints.

Additional: Ergonomics/positioning; rest breaks (every 45–60 minutes); massage; ice; heat; relative rest; Sleep/Nutrition/Mental health.

References

• DeLuca, M. K., Cage, E., Stokey, P. J., & Ebraheim, N. A. (2023). Medial epicondylitis: Current diagnosis and treatment options. Journal of Orthopaedic Reports, 2(3), 100172.
• Galloway MT, Lalley AL, Shearn JT. The role of mechanical loading in tendon development, maintenance, injury, and repair. J Bone Joint Surg Am. 2013;95:1620-8.
• McGee C and Ho K (2021) Tendinopathies in Video Gaming and Esports. Front. Sports Act. Living 3:689371.
• Reece CL, Susmarski AJ. Medial Epicondylitis. [Updated 2023 Apr 10]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
• Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. American Family Physician. 2005;72(5):811-818.