Mouse Elbow | Lateral Epicondylosis | Tennis Elbow
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.
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.
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.
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.
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.
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
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)
*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.
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.
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.
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Written By: Brett Becker, OTR/L, MS, ACE-CPT