- Some Anatomy
- Some Symptoms and Syndromes
- Tennis Elbow Sundrome
- Golfer's Tunnel Sundrome
- Cubital Tunnel Sundrome
- Radial Tunnel Sundrome
- Shoulder "Winging"
- Possible Solutions
The two basic movements of the elbow are bending (flexion) and straigtening (extension). In addition to these movements the elbow plays a part in movements of the wrist and fingers.
The bending (flexion) and straightening (extension) of the fingers and the wrist is caused by muscles that attach to the bones near your elbow. The movements of turning the wrist palm up (supination) and palm down (pronation) occur in both the wrist and the elbow.
Irritation of the muscles that control these movements can cause elbow discomfort.
- The frequency of movement of the fingers (such as keyboarding or mouse clicking).
- The force you use to type. Those who have a habit of striking the keyboard hard will have a greater tendency towards elbow pain.
- The position of the arms, especially your elbows, while keyboarding.
One of the causes of elbow pain can be "vigorous" striking of the keyboard keys.
Some Symptoms and Syndromes
|Case Story 2|
|N was a receptionist in a busy reception area, with lots of phone calls and walk-in customers requiring attention. This position required a lot of simultaneous telephone and computer work (having to mouse to different fields and enter data in those fields). N was diagnosed with tennis elbow (lateral epiconylitis).
The telephone was placed on a mobile stand so that the phone could be brought closer into the workspace (and pushed out of the way when not in use). The standard mouse was replaced with a contoured mouse, and the keyboard replaced with a left-handed keyboard (numeric keypad on the left) so that the mouse could be brought closer to the keyboard, which reduced the amount of reaching.
The primary symptom in the elbow is usually pain, expecially when bending the wrist while the elbow is straight. Straightening (extending) the fingers can also cause elbow pain.
Elbow problems usually include:
- Pain and discomfort in the elbow, usually around the boney protruberances (called epicondyles).
- Limited range of motion (the elbow is limited in its movement, usually by pain).
- Pain radiating from the elbow down the arm and into the hand.
Tennis Elbow (Lateral Epicondylitis)
Pain in the outside bump or epicondyle of the elbow. This is sometimes called Tennis Elbow, not because only tennis players get the problem, but because the backhand swing in tennis is a common activity that can cause the problem.
The muscles of the forearm that bend the wrist back (extensors) begin at the lateral epicondyle and form a common tendon attachment. Bending the wrist back (extension), turning the hand palm side up, and lifting an object with the elbow straight are the more common activities that affect these tendons.
- Symptoms: Tenderness and pain at the lateral epicondyle, made worse by activities that require extending the wrist or holding an object in the hand with the wrist stiff. Pain may spread down the forearm with soreness felt in the forearm muscles. Activities like grasping can make matters worse: reaching into the refrigerator to get a litre of milk can be a painful process. Some people are unable to straighten their elbow.
- Cause: There are many activities, other than playing tennis, that can result in lateral epicondylitis - such as painting with a brush or roller, running a chain saw, and using many types of hand tools continuously. Repeated strains like hammering nails, picking up a heavy bucket, or pruning shrubs all contribute to this problem.
Golfer's Elbow (Medial Epicondylitis)
Pain in the inside bump or epicondyle of the elbow. This is sometimes called Golfer's Elbow, not because only golfers get the problem, but because the golf swing is a common activity that can cause the problem.
The muscles of the forearm that pull the wrist down are called wrist flexors. These muscles are located on the palm side of the forearm, and they begin at the medial epicondyle where they form a common tendon attachment. As the wrist is flexed or the hand used to grip, these muscles contract and pull against the tendons. For example, the force placed on the flexor muscles during a golf swing pulls on the tendons at the medial epicondyle.
- Symptoms: Tenderness and pain at the medial epicondyle, made worse by flexing (bending) the wrist. Pain may spread down the forearm.
- Cause: There are many activities, other than playing golf, that can result in medial epicondylitis - such as chopping wood with an axe, running a chain saw, and using many types of hand tools continuously. Repeated strains like hammering nails, picking up a heavy bucket, or pruning shrubs all contribute to this problem.
Cubital Tunnel Syndrome
Cubital Tunnel Syndrome affects the ulnar nerve where it crosses the elbow. The symptoms are very similar to the pain that comes from hitting your "funny bone." The funny bone is actually the ulnar nerve on the inside of the elbow that runs in a passage called the cubital tunnel. This area can become irritated from repeated injury or pressure, leading to a condition called cubital tunnel syndrome.
At the back of the elbow, the ulnar nerve passes through a tunnel of muscle, ligament and bone - which is named the cubital tunnel. From the elbow, the ulnar nerve continues on to the hand, supplying feeling to the fifth and half the ring finger.
The ulnar nerve actually stretches several millimeters when the elbow is bent. Sometimes the nerve will shift or actually snap over the bony medial epicondyle, causing irritation.
- Symptoms: Early signs of trouble include numbness on the inside of the hand and in the ring and little fingers. This can lead to pain and clumsiness in the hand and thumb as the muscles are affected and grow weaker. Symptoms may be similar to those in Medial Epicondylitis (Golfer’s Elbow) with pain occurring at the funny bone area of the elbow.
- Cause: Frequent bending of the elbow such as pulling levers, reaching, or lifting are common sources of problems. Leaning on the elbow, or constant direct pressure on the elbow may eventually cause cubital tunnel syndrome. For example, resting on the elbow while driving long distance or when running machinery with an elbow rest can cause prolonged pressure and irritation on the nerve. A direct blow or injury to this area may damage the ulnar nerve.
Radial Tunnel Syndrome
Radial Tunnel Syndrome is a condition that can cause aching in the forearm just below the elbow. Symptoms can be confused with lateral epicondylitis - or tennis elbow. Difficult to diagnose because the tests to look for the problem are not very accurate. Your doctor must rely mostly on the history that you give and the physical exam to make the diagnosis.
The radial nerve runs behind the arm crosses the elbow on the outside as it travels down the forearm into the hand. At the outside (lateral) portion of the elbow, the radial nerve travels in a tunnel that is formed by the surrounding muscles and bone. The nerve runs below the muscle (supinator) that allows you to twist the hand clockwise, like when you try to use a screwdriver to tighten a screw. Once the radial nerve goes under this muscle it branches out to attach to the muscles on the back of the forearm.
- Symptoms: Tenderness and pain at the lateral side of the elbow. The symptoms of radial tunnel syndrome are very similar to lateral epicondylitis, or tennis elbow. The symptoms get worse with using the arm - just like tennis elbow. The pain is on the outside of the elbow - just like tennis elbow. The one difference is that the place where the elbow is most tender is slightly different. In tennis elbow, the tenderness is mostly right where the tendon attaches to the lateral epicondyle of the elbow. In radial tunnel syndrome it is most tender about two inches further down the arm, right over where the radial nerve goes into the supinator muscle.
- Cause: Frequent repetitive use of tools, such as screwdrivers; wringing towels, etc.
The awkward positioning of the elbows while keyboarding is another common cause of elbow discomfort. Holding the elbows out from the body is a posture known as "winging". This posture is often assumed when the keyboard is too small for the operator.
Winging: holding the elbows away from the body while keyboarding.
Winging can also lead to:
- Shoulder discomfort, as the arms are held away from the body for prolonged periods of time.
- Neck discomfort, as the prolonged winging starts to place stress on the neck muscles.
- Wrist discomfort through increased ulnar deviation as the wrist has to bend more to the little finger side to reach the keys on the sides of the keyboard.
- Mouse and Mouse Examples
- Keyboard and Keyboard Examples
Before proceding to change your keyboard and mouse, consider your posture. Making improvements in posture can help you deal with problems in other areas, such as your elbow.
- Are you leaning on your worksurface (forearms or elbows resting on the worksurface while you type or operate the mouse)?
- Are you reaching for your mouse with a fully outstretched arm?
- Is the mouse at the same height as your keyboard, or are they placed on different surfaces?
- Does your chair have well-padded and adjustable armrests?
- How are you sitting; what is the height of your desk?
- Do you have to perch on the edge of your chair, or are you slouching?
- Are you twisting your neck to read a document?
- Are you twising your neck to hold the telephone while you type?
These and other issues should be considered when addressing elbow problems.
- Change the hand you are using to operate the mouse, or alternate between hands.
- Vertical mice are operated with your wrist in the "handshake" position, not in full pronation. This can reduce joint and muscle strain at the elbow. An example of a vertical mouse:
DXT Fingertip Mouse
DXT Fingertip Mouse (set to left-hand operation) + A4 Tech 'A' Style Slanted Keycap Keyboard
- Contoured mice can reduce elbow stress as they do not require you to hold your wrist in full pronation. They are operated the same as a standard mouse. An example of a contoured mouse:
Contour Design Contour Mouse
Contour Design Contour Mouse + Smartfish Technologies Compact Ergomotion Keyboard
- Trackballs are stationary mice that do not require a static grip (static grip means that the mouse must be pinched between thumb and fourth digit while it is being operated).
Clearly Superior Technologies LTrac Trackball
Clearly Superior Technologies LTrac Trackball + A4 Tech Left-Handed 'A' Style Slanted Keycap Keyboard
- Touchpads are another form of stationary mice.
Cirque Smart Cat Pro Touchpad
Cirque Smart Cat Pro Touchpad + SolidTek SK3001 Compact Keyboard
- Roller-style mice are also stationary mice.
Contour Design RollerMouse Pro2
Contour Design RollerMouse Pro2 + A4 Tech 'A' Style Slanted Keycap Keyboard
- Adjustable keyboards have vertical adjustment or "tenting." This helps to reduce wrist pronation and extension.
Kinesis Freestyle Keyboard with VIP Accessory
Kinesis Freestyle Keyboard + Kensington Orbit Trackball
- Fixed-split keyboards have built-in splay and angles, which help to reduce wrist pronation and extension.
Microsoft Comfort Curve 2000
- For right-handed mouse users a keyboard with the numeric keypad on the left reduces the amount of reaching for the mouse.
Evoluent Mouse Friendly Compact Keyboard
Evoluent Mouse Friendly Compact Keyboard + Evoluent VerticalMouse
- Contoured keyboards greatly reduce elbow and shoulder movement while typing.
Kinesis Advantage Contoured Keyboard
Kinesis Advantage Contoured Keyboard + Cirque Smart Cat Pro
- Combination keyboards incorporate both a keyboard and a mouse. Having the mouse close to the keyboard will reduce the amount of elbow movement needed to reach the mouse. These are also compact versions of these combination keyboards.
SolidTek Full Size Keyboard with Built-in Touchpad (SK7070)
SolidTek Compact_Touch (SK540)
- If you do a lot of number entry, a discrete numeric keypad might help. These keypads allow greater flexibility when positioning, allowing you to position the keypad in the most comfortable spot.
Kinesis Low Force Tactile Numeric Keypad
- For those who do not require a numeric keypad, another solution is to use a compact keyboard. Because these keyboards do not have a numeric keypad, the mouse can be positioned closer to the midline and reduce the amount of elbow movement needed to reach the mouse.
A4Tech X-slim Compact Keyboard
A4Tech X-slim Compact Keyboard + HumanScale SwitchMouse
- Adjustable keyboards have vertical adjustment or "tenting." This helps to reduce wrist pronation and extension.