Outer Elbow Pain From Repetitive Strain

Expert Opinion

• One of the most commonly injured areas in gaming and mouse and keyboard work 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 or key is pressed or action is completed, seen most often on the mouse side, in PC gamers and in desk workers who use a mouse for long hours.

What Does This Diagnosis Mean

Mouse elbow is a condition that affects four extensor muscles/tendons in your forearm starting at your elbow. When you use a mouse, type, play video games, 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 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.

The name "Mouse elbow" comes from gaming: it is common in PC gamers who play high actions per minute (APM) games/characters. Long hours of mouse work at a desk load the same tendons. This name is also interchangeable with Tennis elbow and lateral epicondylosis.

Common Things You Might Feel

People with this condition are likely to begin experiencing pain and discomfort during mouse work, typing or gaming and a sore, achy, or stiff feeling after. Weakness is also likely to be present with lifting and moving the mouse as well as lifting the finger up off the mouse. 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?

High APM gaming and long hours of mouse and keyboard work raise the risk because of the repetitive strain in lifting up (extending) the fingers and wrist, moving the mouse side to side (radial/ulnar deviation), and holding a prolonged grasp on a mouse, controller, pen or tool: all of which use these muscles.

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

1. Identify the issue (early detection…do NOT push into or through pain).
2. 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: placed on the outer part of the elbow 1 to 2 cm down from the lateral epicondyle.
3. Massage in times of pain/discomfort.
4. Use heat/ice (hot/cold packs, warm water soak). Be cautious using ice over nerves.
5. Initiate isometric exercises: a good starting exercise to regain/maintain strength while limiting pain.
6. Stretching: helpful throughout the range of motion.
7. 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 Wrist Pain page.

Science Behind The Injury

Specifically, this diagnosis is looking at five muscles/tendons responsible for lifting (extending) the fingers and wrist. These tendons will feel irritated near the elbow with gripping, lifting, or 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.

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): Wrist extension and radial deviation (most commonly injured).
• Extensor Carpi Radialis Longus (ECRL): Wrist extension and radial deviation.
• Extensor Digitorum Communis (EDC): Extends each joint of all fingers aside from the thumb (digits 2 to 5); helps wrist extension.
• Extensor Digiti Minimi (EDM): Extension of your wrist and pinky finger.
• Extensor Carpi Ulnaris (ECU): Wrist extension and ulnar deviation.

Each muscle originates at the lateral epicondyle of the humerus (aside from ECRL which attaches just above this point) and inserts at different points in the hand and fingers. All are also active while gripping. Tennis/pickleball are common hobbies associated with this condition ("tennis elbow").

Differential Diagnosis

• Radial Tunnel Syndrome: Irritation and compression of the radial nerve as it passes through the forearm. Can present as a diffuse achy pain and may mimic mouse elbow, leading to misdiagnosis. Note: a person 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 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, typing or mouse 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

Can you get tennis elbow without playing tennis?

Yes. Most people with tennis elbow do not play tennis. It comes from repeated gripping and lifting of the wrist, such as mouse use, typing, manual work or lifting weights. In people who use a mouse a lot, for gaming or desk work, it often shows up on the mouse hand side.

Why does my outer elbow hurt when I pick up a cup?

Lifting a cup or bottle with your palm down makes the wrist extensor muscles work hard, and they attach at the outer elbow. When those tendons are irritated, that grip and lift can cause a sharp pain. Lifting with your palm up shifts the work to other muscles while you recover.

Do cortisone shots help tennis elbow?

Cortisone shots can ease tennis elbow pain in the short term. Research suggests results in the long run can be worse than with exercise-based care, and pain often returns. Talk with your doctor about the trade-offs, and pair any treatment with a plan to rebuild tendon strength.

What is radial tunnel syndrome?

Radial tunnel syndrome is irritation of the radial nerve in the upper forearm, just below the outer elbow. It causes a deep ache and is often mistaken for tennis elbow, though the sore spot is usually a little lower down the forearm. A tight elbow strap can make it worse.

Is a vertical mouse good for tennis elbow?

It may help. A vertical mouse holds your forearm in a more neutral, handshake-like position, which can ease the load on the outer elbow tendons for some people. Others find it awkward at first. Try it and see how your elbow responds over a few weeks.

See all questions

References

• Garg, R. et al. (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.
• Keijsers, R. et al. (2019). Tennis elbow. Shoulder & elbow, 11(5), 384-392.
• McGee C and Ho K (2021) Tendinopathies in Video Gaming and Esports. Front. Sports Act. Living 3:689371.
• Ma, K. L., & Wang, H. Q. (2020). Management of Lateral Epicondylitis: A Narrative Literature Review. Pain research & management, 2020, 6965381.
• Nourissat, G., Berenbaum, F., & Duprez, D. (2015). Tendon injury: from biology to tendon repair. Nature reviews. Rheumatology, 11(4), 223-233.
• 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.