Outer Elbow Pain From Gaming

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Outer Elbow Pain From Gaming

Mouse Elbow | Lateral Epicondylosis | Tennis Elbow

Expert Opinion

One of the most commonly injured areas in gaming due to the stress and strain put on the wrist/finger extensors
Mouse Elbow is irritation of a common tendon origin that starts at the elbow and runs down through the wrist and fingers
These muscles/tendons are responsible for lifting up the finger and wrist each time a new button is pressed or action is completed which can be seen most often in PC gamers on their mouse side.

Mouse elbow is a condition that affects four extensor muscles/tendons in your forearm starting at your elbow. Tendons are like little ropes that connect your muscles to your bones, and they help you move specific joints. When you play video games or use your wrist and fingers a lot, these tendons can get irritated and swollen, causing pain. These tendons in particular are what allows each person to lift their fingers and wrist which is necessary to click/push buttons or move a mouse. Though these movements come from the wrist/fingers, pain is at the elbow due to the muscle/tendon attachments.

This diagnosis is termed “Mouse elbow” due to the frequent occurrence in PC gamers who play high actions per minute (APM) games/characters. In these games players are required to perform frequent actions for prolonged periods of time which can lead to overuse of the finger extensor muscles/tendons. Through improper positioning, poor conditioning, or inadequate rest these tendons will take the brunt of this and elicit pain. This name “Mouse elbow” is also interchangeable with Tennis elbow and lateral epicondylosis.

Common Things You Might Feel?

Gamers are likely to begin experiencing pain and discomfort while playing and a sore, achey, or stiff feeling after in the area indicated above. Weakness is also likely to be present with lifting and moving the mouse as well as lifting the finger up off the mouse. This is likely to decrease performance and alter the gameplay of the individual where movements may be slowed or less precise. Pain may be a sharp shooting pain if reaching across the desk to pick up a water bottle, while driving, or doing front shoulder raises in the gym.

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 use their wrists and fingers a lot! Gamers are at risk because of the long durations we play. Oftentimes this means we are taking less rest breaks when we are in the zone because we don’t always think to put our body first. Pain is something that can be reduced from distractions and gaming is a good distractor which makes it hard for gamers to know when to stop due to pain. Gamers are also at risk because of the specific motions required when playing. Gamers playing high APM games are at an increased risk because of the repetitive strain in lifting up (extending) the fingers and wrist, moving the mouse side to side (radial/ulnar deviation), and playing with a prolonged grasp all of which utilize these muscles.

For a short video explanation about how overuse injuries can develop in gamers and how to help them, check out the video linked here:

How to fix it / Recover / What can you do? Strategies to manage symptoms?

Returning from this injury takes a concerted effort, but can be done without much time away from the game. Below are a few steps that individuals need to understand and take when pain in this area occurs.

Identify the issue (One of the most important factors is early detection…do NOT push into or through pain)
Rest the wrist/fingers (Few days of reducing the workload, but be sure to continue moving the wrist, fingers, elbow)
- Splinting: This may be one way for individuals to rest the irritated tendon. It is important for a gamer to know that this should be used as minimally as possible, but may be necessary for very painful acute symptom management.
- A splint used for this diagnosis should be a standard wrist splint with the thumb free. This will restrict the irritated muscles/tendons from being used and allow the pain to subside while they heal.
- A counterforce strap can also be beneficial to compress the region of the irritated tendons, functionally creating a new muscle origin for the wrist extensors. This means that the tendons closer to the lateral epicondyle are now able to have some rest and relief even when the muscles are being used. The pad should be placed on the outer part of the elbow 1-2 cm down from the lateral epicondyle.
Massage in times of pain/discomfort
Utilize heat/ice (Hot/cold packs, warm water soak)
- Heat can be helpful before or during activity. Ice can be helpful following activity in the presence of pain. Be cautious using ice over specific nerves as this may lead to irritation.
Initiate isometric exercises **
- A good starting exercise to regain/maintain strength while limiting further pain or irritation
Stretching **
- Helpful in reducing pain throughout the entire range of motion
Isotonic strengthening **
- Necessary to improve strength and endurance to decrease pain while playing and prevent future injury from returning

Additional tip: Consider utilizing lifting hooks to help decrease the muscle recruitment necessary for pulling or certain gripping movements while lifting such as deadlifts, rows, bicep curls, lat pulldowns, etc. (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 Wrist Pain Link

Science Behind The Injury

The diagnosis was explained in short above, but for those wanting to know and learn more this is for you.

Specifically, this diagnosis is looking at five muscles/tendons (connect muscle to bone) which are responsible for lifting (extending) the fingers and wrist. These tendons will feel irritated near the elbow with gripping, lifting, or an overuse of activities such as typing or moving a mouse. When gripping there needs to be a balance between all of the forearm muscles so that the wrist stays in a neutral position. This required the help of the wrist/finger extensor muscles to counteract the wrist/finger flexors. Through repetitive use and inadequate amounts of rest the tendons may experience structural damage over time forming small microtears of the tendons. This overuse leads to a pain response to warn the body of damage so that individuals will stop the aggravating activity.

See for yourself!

Sit with your arm flat on the table and lift up your middle finger from the table. While doing this look at the outer part of the elbow where it hurts and you can see the muscles being used (contracting)

Tendons responsible:

Extensor Carpi Radialis Brevis (ECRB)
- The muscle is responsible for wrist extension (lifting) and radial deviation (bending towards your thumb) of your wrist.
  - Most commonly injured
Extensor Carpi Radialis Longus (ECRL)
- The muscle is responsible for wrist extension (lifting) and radial deviation (bending towards your thumb) of your wrist.
Extensor Digitorum Communis (EDC)
- The muscle is responsible for extending each joint of all the fingers aside from the thumb (digits 2-5). Also helps in extension (lifting) of your wrist
Extensor Digiti Minimi (EDM)
- This muscle is responsible for extension (lifting) of your wrist and pinky finger
Extensor Carpi Ulnaris (ECU)
- This muscle is responsible for wrist extension (lifting) and ulnar deviation (bending towards your pinky)

*Each muscle originates at the lateral epicondyle of the humerus and inserts at different points in the hand and fingers aside from ECRL which attaches just above this point on the humerus

**All muscles discussed also are active while gripping

It should also be known that gaming is not the only activity to bring on this condition and certainly other lifestyle factors play a role. School, work, and other hobbies can also further stress this tendon and can be important to thoroughly evaluate as well. Tennis/pickleball are common hobbies associated with this condition as well giving this the name “tennis elbow” as backhand hits put strain on these same muscles.

Differential Diagnosis:

Radial Tunnel Syndrome- Radial tunnel syndrome is irritation and compression of the radial nerve as it passes through the forearm. Through overuse and repetitive motions muscle of the forearm can become tight and put pressure on the nerve. This form of nerve irritation can present as a diffuse achy pain throughout the forearm and may mimic mouse elbow which can ultimately lead to a misdiagnosis. The radial tunnel is composed of several muscles which when overused and tight can put pressure on the radial nerve.

For the purposes of treatment, both radial tunnel syndrome and tennis elbow are treated in many of the same ways because they are caused by many of the same things. Oftentimes tennis elbow is treated by utilizing a wrist brace to rest the wrist extensors. One distinct difference in how both are treated is that a patient with tennis elbow may benefit from a counterforce (forearm) strap whereas an individual with radial tunnel syndrome should NOT use a tennis elbow strap.

Preventative Approach

There are several approaches to take in order to prevent this injury from occurring or coming back. There are 3 main factors to first focus on and address, but it is also important to keep in mind other secondary factors which can be helpful to address.

Strengthening exercises (Important for building up a foundational base to allow the tendon/muscle to keep up with the workload they are being asked of)
Intermittent stretching (During and after gaming sessions)
Proper warm-up (Promotes blood flow to the muscles/tendons and lubricates stiff joints)

Additional

Ergonomics/positioning
- (Poor positioning could put the muscles/tendons in a compromised position which forces it to work harder therefore making it more susceptible to injury)
Rest breaks
- (Pain levels can be reduced through distractions. Gaming is a big distractor, meaning that individuals should take breaks every 45-60 minutes to assess how you are feeling. Additionally, the break may not need to be the same for each person. If the injury severity is high then it may be better to take more frequent or longer breaks vs someone who has mild stiffness or discomfort where breaks can be more infrequent or shorter in duration)
- Creating a schedule that works for you and your game is also recommended. For example, consider taking a 10 minute break after 2 ranked games (~60 minutes) or a short 5 minute break to stretch following 1 ranked game (~30 min). Certain games will vary in duration, but planning ahead and forming a routine will be beneficial in the long run to avoid overuse. A general rule of thumb is, the longer you play, the longer the break should be to allow for some recovery. )
Massage
- (Helpful at times whenever pain or tenderness is present)
Ice
- (Following long bouts of gaming if painful)
Heat
- (Prior to gaming sessions or stretches)
Relative rest
- (If tenderness becomes apparent over the back side wrist area shown above then it is best to reduce the time playing or take some added time off)
Sleep/Nutrition/Mental health
- (These underlie all of what is experienced in a day and cannot be ignored in injury prevention)

References

Garg, R., Adamson, G. J., Dawson, P. A., Shankwiler, J. A., & Pink, M. M. (2010). A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. Journal of shoulder and elbow surgery, 19(4), 508–512. https://doi.org/10.1016/j.jse.2009.12.015

Keijsers, R., de Vos, R. J., Kuijer, P. P. F., van den Bekerom, M. P., van der Woude, H. J., & Eygendaal, D. (2019). Tennis elbow. Shoulder & elbow, 11(5), 384–392. https://doi.org/10.1177/1758573218797973

McGee C and Ho K (2021) Tendinopathies in Video Gaming and Esports. Front. Sports Act. Living 3:689371. doi: 10.3389/fspor.2021.689371

Ma, K. L., & Wang, H. Q. (2020). Management of Lateral Epicondylitis: A Narrative Literature Review. Pain research & management, 2020, 6965381. https://doi.org/10.1155/2020/6965381

Nourissat, G., Berenbaum, F., & Duprez, D. (2015). Tendon injury: from biology to tendon repair. Nature reviews. Rheumatology, 11(4), 223–233. https://doi.org/10.1038/nrrheum.2015.26

Pote, D. U., Solge, A., Karpe, V., Ghare, M. A., & Thatte, A. A. (2020). Comparative study of the effectiveness of the use of the universal tennis elbow splint compared to elbow brace in treatment of lateral epicondylitis. VIMS Health Science Journal, 7(4), 118–124. https://doi.org/10.46858/vimshsj.7405

Rineer, C. A., & Ruch, D. S. (2009). Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. The Journal of hand surgery, 34(3), 566–576. https://doi.org/10.1016/j.jhsa.2009.01.022