Do you have Mouse Elbow?  Does your arm or elbow hurt and you donít 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 itís 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 donít 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 carpal tunnel is normally quite snug and there is just barely enough room in it for the tendons and one nerve to pass through it. If anything takes up extra room in the canal, things become too tight and the nerve in the canal becomes constricted or "pinched". This pinching of the Median nerve causes numbness and tingling in the area of the hand that the nerve goes to.

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 strikeĒ, 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.

Anything that takes up extra space in the carpal tunnel can make things too tight. This can include swelling in the tunnel, or a new structure taking up room in the tunnel, or change in the shape of the tunnel itself that can occur after a fracture.

The commonest cause of carpal tunnel is swelling in the tunnel itself and this can be caused by many different things. Inflammation of the tendons in the tunnel because of repetitive use of your hand and wrist causes the tendons to swell and can cause carpal tunnel. So can fluid retention, which occurs during pregnancy. (It is common to have carpal tunnel symptoms develop during pregnancy.)

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.

Symptoms can consist of pain, tingling or numbness in the thumb, index, middle and half the ring finger.. If symptoms persist long enough the thumb muscles that permit you to pinch deteriorate and the ability to pinch can be lost.

Tennis elbow is a misleading term because most people who have it did not get it from playing tennis. In fact, tennis elbow seldom has any connection with the game. The True Tennis Elbow is more properly described as tendonitis of the wrist extensor muscles. The primary cause of this condition is repetitive stress of your forearm, which leads to pain over the outer portion of your elbow, possible tendon tears, and reduced strength.

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 thatís 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 isnít 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 ĎGet fit Stay Fití 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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