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Do you have Mouse
Elbow? Does your arm or elbow
hurt and you don’t know
why? You
may have a Repetitive Stress Injury (RSI) caused by using your
computer
mouse... or Mouse Elbow! To help you diagnose your
elbow and arm injuries you should first understand how your elbow works and some
of the most common injuries, so that you can compare and decide if you really do
have Mouse Elbow. One thing
you should keep in mind is that if your pain does persist or worsen you should
consult your doctor or a health care professional Elbow
injuries can be divided into three categories: single-event, often
collision related where direct trauma to your elbow has caused a fracture or
dislocation (acute injuries), single-event trauma this is seen in some
throwing injuries where a single event may have caused the injury but actually
it’s caused by a weakening of the ligaments do to overuse (acute on chronic),
and multiple-repetition overuse or repetitive stress Injuries (chronic)
such as tennis elbow and Mouse Elbow. Your elbow is the
joint where three long bones meet in the middle portion of your arm. The bone of
the upper arm (humerus) meets the inner bone of the forearm (ulna)
and the outer bone of your forearm (radius) to form a hinge joint. The
radius and ulna also meet in your elbow to allow for rotation of your forearm.
Your elbow functions to move your arm like a hinge (forward and backward) and in
rotation (twisting outward and inward). Your biceps muscle is the major muscle
that flexes the elbow hinge. Your triceps muscle is the major muscle that
extends the elbow hinge. The outer bone of
your elbow is referred to as the lateral epicondyle and is part of the humerus
bone. Tendons are attached to this area, which can be injured, causing
inflammation or tendonitis (lateral epicondylitis, or "tennis
elbow"). The inner portion of your elbow is a bony prominence called
the medial epicondyle. Additional tendons from the muscles attach here and can
be injured, causing medial epicondylitis or "golfer's elbow."
A fluid-filled sac
(bursa), which serves to reduce friction, overlies the tip of your elbow. Your
elbow can be affected by inflammation of the tendons or the bursae or conditions
that affect the bones and joints, such as fractures, arthritis or nerve
irritation.
Your body has a tremendous capacity to adapt to physical
stresses. In fact, many positive changes occur as a result of this. With
exercise and activity, bones, muscles, tendons, and ligaments get stronger and
function more efficiently. This happens because of an internal process called
remodelling. The remodelling process involves both the break down and build up
of tissue. There is a fine balance between the two and if break down occurs more
rapidly than build up, injury may occur. These Overuse injuries or Repetitive
stress Injuries (RSI) are the most common and the most difficult to treat.
You may have heard of Carpal Tunnel Syndrome, or even
know someone who has had it or is off on disability because of it, and don’t
understand what it is, or even think you may have it. (You probably have Mouse
Elbow!!) Well, at the base of
the palm of your hand is a tight canal or tunnel through which tendons and a
nerve going from your forearm to your hand have to pass, to get into your hand.
The nerve that
passes through this narrow tunnel to reach your hand is called the Median nerve.
This narrow passage between your forearm and hand is what is called the carpal
tunnel. The Median nerve is
the only nerve that passes through the carpal tunnel. This nerve provides the
sensation of feeling to your thumb, index and middle fingers and half of your
ring finger. It also controls the working of some of your thumb muscles that
permit you to pinch. When your median nerve is pinched it sort of "goes on
strike”, and you get tingling and numbness in the area until the pressure is
relieved There are other nerves that provide sensation to the rest of your hand
and control other hand muscles, but they do not pass through the carpal tunnel
and therefore are not involved in the carpal tunnel syndrome. It is important to
know that your carpal tunnel changes in size depending on the position of your
wrist. When your wrist and hand are
straight in line, the carpal tunnel is at its widest size. When your hand is
bent up or bent down at your wrist, the tunnel becomes slightly smaller.
Therefore if the tunnel is getting tight for whatever reason, there will be the
most room for the nerve when the wrist is kept straight. In this situation,
keeping the wrist bent up or down puts more pressure on the nerve and brings out
the numbness and tingling. Tennis elbow, which
is very similar to Mouse Elbow, is an overuse syndrome caused by
continued stress on the grasping muscles and supination muscles. The technical
name for tennis elbow is "lateral epicondylitis". This term indicates
an inflammation occurring near a small point of your upper arm bone (humerus)
just above your elbow joint on the outer side of your arm.
Pain can also occur in other areas of your forearm and elbow, and with
continued stress, the muscles and tendons may hurt even at rest.
The pain from tennis
elbow comes mainly from injured or damaged tendons near the elbow. Tendons are
strong bands of tissue that connect muscles to bones. When repeatedly stressed
or overused, tendons can become inflamed. This results in a painful condition
called tendonitis. (the medical term for inflammation of a tendon) Tennis elbow
is simply a specific type of tendonitis that occurs in a particular part of your
elbow The development of
tennis elbow can often be traced to the way of using the forearm muscles. The
"overload" of tendons is commonly seen in someone who plays more
tennis than usual, however a weekend of hedge clipping, excessive use of a
screwdriver, hammer, computer mouse, or performance of other activities
requiring constant squeezing or gripping can lead to this problem.
Your muscles control your hand and wrist movements and are
attached to tendons that connect to only two small points of bone just above
your elbow, one on the outer side, and the other on the inner side. The muscles
connected to the outer side of your elbow are responsible for, straightening
your fingers,
bending your wrist upwards, and rolling your forearm into a
palms-up position.
The muscles connected to the inner side of your elbow
are responsible for: bending your fingers,
bending the wrist downwards and
rolling your forearm into a palms-down position.
There are weak points
in the way tendons connect these muscles to your bone above your elbow. The
points where the tendons attach are sometimes too small to handle the strong
force of the powerful muscles. These tendons can get overloaded when your hand
and forearm are used in strong, jerky movements such as gripping, lifting, or
throwing. Tendons do not
stretch when pulled. They are rope-like structures made of strong, smooth, shiny
fibres. Strong forces or sudden impacts, however, can eventually tear these
fibres apart in much the same way a rope becomes frayed. This type of injury is
called a strain, and usually results in formation of scar tissue. Over time,
strained tendons become thickened, bumpy, and irregular. Without rest and time
for the tissue to heal, strained tendons can become permanently weakened. Damaged tendons can
occur on either side of your elbow. When it happens on the outside of the elbow,
which is most common, it is called tennis elbow or Mouse elbow. When it
happens on the inside, it is called "golfer's elbow." The development of Tennis/Mouse
elbow often relates to the way that you carry out activities such as
gripping, twisting, reaching, and moving. These activities can become hazardous
when you do them in fixed or awkward position,
with constant repetition, with excessive force,
and without allowing your body to recover from the wear and tear.
Tennis/Mouse elbow
is associated with jobs that require repeated or forceful movements of your
fingers, wrist, and forearm. It can develop because of too much force at once or
small amounts of force for too long a period, as in using your computer mouse. Specific movements
associated with the development of tennis/mouse elbow include,
simultaneous rotation of the forearm and bending of your wrist,
stressful
gripping of an object in combination with inward or outward movement of your
forearm, jerky throwing motions and movements to hit objects with your hand.
The movements of
rotating, bending, and gripping are particularly more hazardous when done while
your arms are extended forward and/or sideways away from your body. Tennis/Mouse
elbow can cause extreme tenderness on the outer side of your elbow. This
tenderness becomes painful when your wrist and elbow are moved in certain ways.
These include, bending your wrist while straightening your elbow.
trying to straighten your wrist against resistance
while straightening your elbow, trying to bend your hand back against resistance
while straightening your elbow, and trying to straighten your fingers against
resistance.
Tennis/mouse elbow
usually affects only one arm, and that’s the one that does most of the work.
Tennis/mouse elbow
can appear in many different ways. Some people get symptoms gradually after
doing the same type of work for several years. Others get it suddenly, soon
after they start doing a new type of work. Sometimes it can develop immediately
following a single violent muscle exertion or after your elbow becomes injured.
In some cases, tennis/mouse elbow occurs for no obvious reason. About one
percent of cases last more than one year. For these cases, surgery might be a
solution. However, surgery does not always improve the situation.
Finding out what
workplace activity is associated with tennis/mouse elbow is important.
Damage to the arms and elbows can become chronic if the activity causing the
condition is not changed or discontinued. To help prevent tennis/mouse
elbow, you should arrange your workstation properly so that you do not have
to continually reach long distances. The choice of tools and placement of
equipment can also help keep reaching distances to a minimum and limit the
weight held or handled while reaching. Proper work
practices include, working without bending your wrist, using smooth movements
rather than jerky ones, and using work/rest schedules that allow time for you to
change your position, rest your working body parts, and relax your mind. Most golfers are
aware of a condition called golfers elbow, which affects both amateurs
and professionals. Golfers elbow, also known as medial epicondylitis involves
inflammation of the muscles and tendons that bend your wrist and fingers
forward. The injury usually occurs in the right elbow of the right-handed
player. The pain is felt on the inner part of
your elbow and may initially only be present when playing golf, however
daily activities may become painful as the inflammation becomes worse. Golfers elbow is
usually an overuse condition associated with excessive driving or it develops as
a result of mis-hitting the ball and striking the ground. Weak, inflexible
muscles, improper equipment or technique may lead you to developing golfers
elbow. Golfers may also
develop tennis elbow, which affects the muscles, and tendons that bend the wrist
backwards. It can develop in either elbow of the golfer. A right arm injury in
the right-handed player is associated with a poor grip or over-straightened
elbows. A left arm injury in the right-handed player develops when a shot is
blocked by a big divot or by hitting rough ground. Widespread use of the
computer mouse is taking its toll. In 1988 not a single workers' compensation
claim form in the United States reflected computer-related trauma disorders
associated with mouse use. By 1993, the number has soared to 325,000. Repetitive
strain is rapidly becoming one of the major occupational hazards causing
thousands of work related injuries annually, and that number is expected to grow
as workplaces continue to automate. But your computer mouse isn’t to blame,
you are using the mouse without proper support for your arm. While most commonly
associated today with computer use, RSI (repetitive stress injuries) affects
workers in a wide range of fields from assembly-line production to professional
athletes. While the symptoms
of these injuries may vary, they are all caused by performing repetitive
movements in a fixed position all or most of the time with only a limited range
of movement. We are simply
forcing our small muscle groups to perform the kind of prolonged activities,
which are the job of big muscle groups.
There are ways to help prevent and reduce computer- related RSI
including changing work habits and improving posture. For example, you can click
in comfort by supporting your arm on a large surface or armrest.
Proper technique is critical in avoiding overuse injuries.
The treatment for most overuse injuries usually consist of
some or all of the following Modification
of Activity: Adopt a hard/easy workout schedule and cross train with other
activities that allow you to maintain your overall fitness levels while your
injury recovers. Activities that
make the pain worse should be avoided or at least cut back. While continued
activity in the presence of mild discomfort is not harmful, severe pain will
only prolong the necessary recovery time and should be avoided. Ice: Cold therapy is very helpful for these types of injuries (RSI) to limit pain and to decrease inflammation. The area should be iced 2 to 3 times a day and be applied for 20 to 30 minutes each time. Medication:
Aspirin-like medicines, which include ibuprofen, Motrin, and Advil, are very
helpful in controlling the pain and inflammation of tennis/mouse elbow. The medicine should be taken daily for at least four to six
weeks when treating severe cases. For less severe cases these medicines may be
taken only when needed. All of these medications can have side effects and
should be used under the direction of a physician. A physician may also
prescribe ultrasound or electrical stimulation to increase circulation to the
area. Stretching
and Strengthening Exercises:
Stretching and strengthening of the involved muscles and tendons are a primary
treatment for Repetitive Stress Injuries. In
my book ‘Get fit Stay Fit’ I outline some of the better exercises to
perform. In more severe cases, a
referral to a physical therapist may be necessary. Straps and braces: Elbow straps are very helpful to help ease the pain and discomfort and they are designed to be worn 2-3 centimetres from your elbow. This is intended to take the stress off the tendon where it attaches to the bone. The strap is to be worn during sports and during work. These straps should not be used as a sole means of treatment, but should supplement muscular stretching and strengthening exercises. The majority of cases of elbow injuries get better without surgery. If treated early you can usually return to normal function. If left untreated, the symptoms may became more severe and become more chronic. This is why prevention and early intervention are so important. |
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