Inner Elbow Pain From Repetitive Strain

Expert Opinion

• One of the most commonly injured areas in gaming and other repetitive gripping work 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, phone, pen or tool 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, grip a mouse, pen or phone, play an instrument, or use your wrist and fingers a lot in other ways, 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.

The name "Fighting Game Forearm" comes from gaming: it is common 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, and in anyone who grips a mouse, pen, phone or tool hard for long periods, 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

People with this condition are likely to begin experiencing pain and discomfort during the activity and a sore, achy, or stiff feeling after. Weakness is also likely to be present with gripping a controller, mouse, pen or phone, 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?

Repeated gripping under high stress, such as high APM gaming, long mouse sessions, drawing with a tight pen grip or holding a phone, raises the risk because of the repetitive strain in gripping the device. Each time we are hitting triggers, clicking a button or squeezing a pen or tool, 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: People with more stress may become more tense, gripping the mouse, controller, pen or tool 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 to 2 cm down from the medial epicondyle.
4. Massage in times of pain/discomfort.
5. Use 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 using 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, work or practice sessions).
3. Proper warm-up: Promotes blood flow and lubricates stiff joints.

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

When to see a doctor first

See a doctor before starting if you have any of these:

• Constant numbness that doesn't change with activity
• Worsening weakness
• Visible muscle wasting
• Major swelling or color change
• A recent injury or fall
• Fever
• Severe, unrelenting pain
• Symptoms that wake you every night

Seek urgent care for emergencies.

Frequently asked questions

Is inner elbow pain golfer's elbow or cubital tunnel?

Golfer's elbow is a tendon problem that causes aching pain at the bony bump on the inside of the elbow, worse with gripping. Cubital tunnel is a nerve problem that causes numbness or tingling in the ring and pinky fingers. You can have both, so tell your doctor or therapist about any tingling.

Read the cubital tunnel guide

Does an elbow strap help golfer's elbow?

A counterforce strap worn just below the inner elbow can ease pain for some people by changing how load reaches the tendon. It does not heal the tendon by itself. Use it for heavy tasks during a flare, and pair it with strengthening.

Can stress make inner elbow pain worse?

It can. Under stress, many people grip a mouse, controller, pen or phone harder without noticing, which adds strain to the forearm tendons. Poor sleep and anxiety can also make pain feel stronger. Checking your grip and taking calm breaks during tense matches or deadlines can help.

Should I stop lifting weights with golfer's elbow?

Usually not completely. Heavy gripping, curls and pull-ups may need to be eased or changed for a while. Lifting straps can reduce grip demand, and you can keep training your legs and core. A slow return to heavier grip work helps the tendon adapt.

Why does my inner elbow hurt when I hold my phone?

Holding a phone uses the wrist and finger flexor muscles that attach at the inner elbow. When those tendons are irritated, even a light grip held for a long time can make them ache. Switching hands, using a stand or resting the phone on a table can lighten the load.

See all questions

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.