The Elbow & Repetitive Strain Injuries

Unlike the shoulder, the elbow joint has a tremendous amount of bony stability. The lower end of the long bone of the upper arm (the humerus) meets the two long forearm bones (the radius and the ulna) at the elbow. The majority of the muscles that bend the wrist and the fingers attach to the inner portion of the elbow. The majority of the muscles that straighten the wrist and the fingers attach to the outer portion of the elbow.

The neutral position of the elbow, with the arm relaxed at the side of the body, is with the thumb facing forward and the palm facing toward the body. With the elbow bent, this neutral position is the “handshake” position.
Factors that Contribute to Elbow Pain

  • Repetitive wrist movement, especially with the forearm fully rotated palm-up or palm-down, repetitive rotation of the forearm, and repetitive elbow bending and straightening can all contribute to inflammation of the tendons as they insert into the elbow.
  • Bony and ligamentous grooves and tunnels near the elbow through which the three main nerves that provide power and sensation to the hand pass. The shearing motion or compression of the tendon and nerves as they pass through these tight areas can contribute to repetitive strain injuries.
  • The degree of the elbow carrying angle (the angle of deviation of the forearm bones in relationship to the upper arm bone when the arm is held at the side with the palm facing forward).
  • Maneuvering the arms around a larger upper body when placing the hands on the keyboard is also a factor.

Cubital Tunnel Syndrome

When you hit your “funny bone” you are actually hitting the ulnar nerve as it passes through a bony groove at the inside of the elbow. The nerve is particularly vulnerable as it passes through this superficial groove. Bending the elbow stretches the nerve through this groove tautly. Holding the elbow bent for prolonged periods, such as when holding a phone to the ear or sleeping with the elbows bent, can cause this nerve to become irritated. If you experience aching along the small finger (ulnar) aspect of the forearm and hand, or if you have tingling or numbness in the ring and small finger, it is especially important to avoid positioning the elbow in a bent position, either with activity or at night. Avoid repetitive elbow bending and straightening. Contact a medical professional for treatment.
Tennis Elbow (Lateral Epicondylitis)

Tennis elbow initially begins as an inflammation where the muscles attach to the outside edge of the elbow. Activities that contribute to this inflammation include repetitively pulling back (extending) the wrist and the fingers; repetitively rotating the forearm palm-up and palm-down, especially when holding an object in the hand; and lifting objects with the forearm rotated in the palm-down (pronated) position. Carrying a suitcase, briefcase or laptop backpack are activities that can cause tennis elbow.
Golfer’s Elbow (Medial Epicondylitis)

Golfer’s elbow is similar to tennis elbow, except that it begins as an inflammation where the muscles attach to the inside edge of the elbow. Activities that contribute to this inflammation include repetitively bending the wrist and closing the fingers; performing fine motor activities with the wrist bent, and repetitively rotating the forearm.

The farther away from the body that you perform activity, the more tension that is placed on the tendons where they insert into the elbow.

RSI and Prevention

Positioning

      • Avoid sleeping with the elbow bent more than 90 degrees to reduce the amount of stress on the nerve.
      • Don’t sleep with the hands placed behind the head.
      • Avoid sleeping on your stomach.
      • Use soft pillows under the arms.
      • Wear a sleeve with a pad that protects the elbow or wrap an ace bandage around a small, soft pad.

Computer Use

    • Position the keyboard so that the elbows are open more than 90 degrees.
    • Pad any sharply angled surfaces that the arms rest upon. Or place a folded towel under the arms as a cushion.
    • Don’t lean on the elbows.
    • Avoid repetitive elbow bending and straightening, excessive wrist movement or repetitive forearm rotation.
    • Use a split keyboard, especially if you find that you need to deviate the wrists out of the
      neutral position (middle finger in line with the forearm bones) when placing the fingers on the keyboard. This is particularly important if you have a large elbow carrying angle or a larger upper body.
    • Move the mouse from the shoulder, not the wrist.
    • Take frequent micro-breaks.
    • Stretch often.
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Trigger Finger – Repetitive Strain Finger Pain

Mouse and keyboard use can cause finger pain. One common cause of finger pain is called trigger finger. Trigger finger is a swelling of the tendon or tendon sheath in the palm of the hand of the tendons that bend the fingers. This swelling prevents the tendon from gliding smoothly through the sheath and the “pulley” (ligament) which holds the tendon to the bone. Trigger finger occurs most frequently in the middle finger and the ring finger, but it can occur in any finger or the thumb.SYMPTOMS

  • A locking, snapping, popping or catching sensation in the finger while making a fist.
  • This “triggering” of the finger can be quite painful at times.
  • The finger may “lock” into a bent position.
  • There will most likely be pain or tenderness in the palm of the hand over the site of the pulley which holds the tendon close to the bone.
  • There may be joint stiffness and pain in the affected finger.

OCCUPATIONAL CAUSES

  • Repetitively gripping or bending and straightening the fingers (e.g. – mouse clicking)
  • Sustained gripping (e.g. – squeezing the mouse forcefully or holding a pen in a “death grip”)
  • Using tools that have handles with sharp or hard edges

ERGONOMICS

  • Avoid repetitive grasping and releasing of objects. Modify the activity if you are unable to avoid it. Look for ergonomic mice or larger barreled pens. Change your typing style so that your fingers are relaxed on the keyboard and mouse.
  • Avoid sustained grasp.
  • Keep the fingers relaxed over the keyboard. Do not plant your wrist down on the wrist rest while typing as this causes excessive and stressful finger movements to reach all the keys. Rather, the wrist should glide over the wrist rest, allowing the fingers to be positioned over the keys in a relaxed manner.
  • Purchase tools with padded, comfortable handles.
  • Handles should have some texture for easier holding. Slippery surfaces require more forceful grasping.
  • Minimize repetition. Periodically rest the hands during repetitive or stressful activity. Stretch frequently during repetitive activity.
  • Slow down!
  • Use the lightest grip possible (on tools, pens, the mouse, the steering wheel, etc.) that still allows you to maintain good control.
  • Use the least amount of force necessary during the activity.
  • Use the appropriate tool for the job.
  • Use ergonomically designed tools if available (modified or padded handles, larger grips with good traction, handles with modified designs).
  • Make sure that tools are in good condition and that cutting edges are sharp (reduces the force needed to use the tool).
  • Alternate work activities so the hands are not performing any one task repetitively for any length of time.

And It Hurts…Here…Because? Ergonomic Recommendations

The location of where you are experiencing pain while working at a desk or on a computer can often give clues as to what needs to be adjusted during an ergonomic intervention.  Here is a quick guide of worksite and work-method recommendations that may help when you are feeling pain in a specific area.

Finger Pain – May indicate arthritic joints, a trigger finger, or strain from overuse.  Avoid squeezing the mouse too hard or pounding the keyboard.  Keep a light touch when typing.  Hold your pen lightly when writing.

Thumb Pain– May indicate a trigger thumb or DeQuervain’s Tenosynovitis.  Often occurs from either squeezing the mouse too hard or from tensing the thumb (as if hitch-hiking) over the keyboard keys.  Keep the thumbs relaxed using only the minimal amount of force needed to control the mouse.  When typing, keep the thumbs relaxed and just hovering over the keyboard.  Don’t pound the space bar.  Also, when writing, use a larger-barreled pen and don’t squeeze the pen too tightly.  Keep the thumb tip relaxed and only slightly bent – it is common for people write with their thumb tips bent at an extreme angle.

Wrist Pain or Pain at the Base of the Hand/Thumb– May indicate a tendinitis where the wrist muscles attach (flexor or extensor tendinitis), DeQuervain’s Tenosynovitis, or Carpal Tunnel Syndrome.  These are often caused by swiveling the mouse in or by poor wrist positioning.  Keep the wrist neutral (flat – not bent forward or back or angled side-to-side; the middle finger should be in a parallel line with the forearm).  Initiate small movements to control the mouse from the elbow and shoulder.   Don’t squeeze the mouse too tightly – use only the minimal amount of force necessary to control it.  Check your keyboard size and fit.  Pain over the small finger side of the wrist is often caused by the outward angulation of the wrist required to rest your hand on the home keys.  Using an ergonomic split keyboard is a quick-and-easy way to provide neutral wrist positioning.

Elbow Pain – May indicate an inflammation where the forearm muscles attach into the upper arm bone at the elbow – Medial or Lateral Epicondylitis.  Can also be caused by several nerve compression syndromes that occur near the elbow – Cubital Tunnel Syndrome, Radial Tunnel Syndrome.  Check out the positioning of the keyboard height and mouse location.  When working at a computer, your ear, shoulder and elbow should be stacked in a vertical alignment.  If your elbow is not relaxed at your side, you may need to change positioning by lowering the keyboard surface or getting in closer to your desk.  The elbow should not be bent at more than a 90 degree angle while using the computer.  A mouse that positions the arm in a more neutral “hand-shake” position may also be helpful.  Don’t swivel the mouse from the wrist.  Also, keep the hand relaxed on the mouse and use only the smallest amount of force necessary to activate the mouse click.  Don’t hold the index finger stiffly over the mouse (as if pointing) and don’t pound the mouse buttons, especially with a straight finger.  Rather, keep the index finger slightly bent and lightly touching the mouse.

Shoulder Pain – Often caused by reaching forward for long periods of time for the keyboard or mouse.  When working at a computer, your ear, shoulder and elbow should be stacked in a vertical alignment.  If your elbow is not relaxed at your side, you may be reaching forward causing strain on the arm muscles.  It takes work to hold the arm in this position for long periods of time even if the work itself is not too forceful.  To keep the upper arm muscles more relaxed, you may need to lower the keyboard surface or get in closer to your desk.  Check your chair.  Are you sitting back in the char?  Does it provide proper lumbar support and seat depth?  Look at the arm rest height.  You may need to lower the arm rests in order to keep the shoulders relaxed.

Neck Pain, Eye-Strain & Headaches – Often caused by poor positioning of the monitor.  Position the monitor directly in front of the keyboard so you are not twisting the body while using the computer.  Check out the height and distance of the monitor.  It may need to be adjusted so that you can clearly see the monitor print without tipping the head forward or back.  Avoid using bifocals while on the computer.  If you work extensively from copy, keep the copy in front of the monitor or directly to each side.  Use a tray that holds the copy close to monitor height to avoid repetitively looking up-and-down from the copy to the monitor.  Use a phone headset to avoid cradling the phone between the shoulder and the ear if you need to type and talk at the same time.

The Shoulder & Repetitive Strain Injuries

Anatomy

The shoulder is a unique joint in the body. It has a great deal of mobility in order to allow us to reach and perform activities away from our body. The cost of this mobility is a lack of stability. Most of the stabilizing forces at the shoulder are muscular and ligamentous rather than bony. These soft tissues that provide the shoulder motion and stability can be at risk for repetitive strain injuries.

The shoulder is composed of three bones: the clavicle (collar bone), the scapula (shoulder blade), and the humerus (long bone of the upper arm). The rotator cuff surrounds the shoulder and provides muscular stability for the humeral head. The shoulder blade controls shoulder motion. Nine of the fifteen muscles that attach to the scapula provide this motion.

RSI

With computer, desk, assembly or other types of hand intensive work, the neck and shoulders round forward and the upper arm tends to rotate inward. The chest muscles become tight. The muscles of the back weaken and stretch. The upper trapezius (the big, bulky muscles that make up the top of the shoulder) try to compensate by working harder than they should. Muscle knots and tension develop. The arms feel tired and weak. Eventually, this muscular imbalance can cause a tendonitis in the rotator cuff (supraspinatus) or in the biceps where it attaches to the humerus. Or the fluid cushion (bursa) between the rotator cuff and the shoulder bones can become inflamed (bursitis).

Poor posture can be the primary factor in developing shoulder pain. Other activities that tend to cause problems are prolonged or repetitive overhead reaching (such as when lifting binders or books down from shelves above the computer) or holding the arms elevated while typing, using the mouse, or performing other hand work. Tichauer (1978, The Biomechanical Basis of Ergonomics) discovered that a chair height that was 3 inches too low for a worker caused excessive shoulder movements and reduced productivity by as much as 50%.

RSI Prevention for Shoulder Pain

  • Neutral and Relaxed Shoulder Positioning
    • Postural awareness is of major importance in injury prevention.
    • The shoulders (upper trapezius muscle) should be relaxed while working.
    • Arms should be positioned at your side with the ears, shoulders and elbows in line.
    • Avoid rounding the shoulders or hunching forward
    • Maintain a neutral neck posture.
  • Ergonomics
    • Chair height should allow you to reach the work surface/keyboard/mouse with the elbows opened slightly greater than 90 degrees and the shoulders relaxed, not elevated.
    • Use of arm supports has been debated in the therapeutic community. The shoulders should be allowed to move freely to position the hands so that excessive movement is not required at the more vulnerable elbows, wrists and fingers. However, unsupported use of the arms is a contributing factor in shoulder pain.
    • If using arm rests, they should be positioned at a height that allows the shoulders to be relaxed. Do not plant the forearms down on the rests while typing. Allow the forearms to glide over the rests unless taking a break from hand activity.
    • Articulating Arm Rests are a good option for providing support with movement.
    • Position your activity and supplies so that repetitive or sustained lifting or reaching is avoided.
    • If you do need to reach frequently overhead, use a step-stool so that the object you are reaching for is closer to you with less shoulder stretch needed.
    • Keep the keyboard and mouse in close to the body
    • Place frequently needed items in a close work envelope between hip and shoulder height.
  • Tension and Stress
    Many people hold tension in their shoulders. When feeling stressed, try to break the cycle by practicing diaphragmatic breathing techniques or taking a quick break away from the demanding situation. Perform some shoulder rolls emphasizing the backwards and downwards movements.
  • Exercise
    • Stretch frequently throughout the day.
    • Take frequent micro-breaks.
    • Try these exercises to recreate muscular balance in the shoulder complex. Remember, these exercises should not cause pain. Start slowly using a light weight. Add additional weight and repetitions gradually.
      • Strengthen the Rotator Cuff with Side-Lying External Rotation
        • Hold a light weight in your right hand. Lying on your left side, hold your right elbow tucked in at your side. Not moving the elbow away from your side, lift your hand towards the ceiling, then smoothly and slowly move your hand towards your stomach. Repeat 8-12 times. Perform 1-2 sets. Repeat with the other arm.
      • Stretch the Pecs with the Doorway Stretch
        • Stand in a doorway facing the doorway jam. Bend your elbow placing one forearm along the doorway jam with the hand at about head height. Slowly rotate your body away from the doorway jam until you feel a nice stretch in your chest muscle close to your shoulder. Hold for 20-30 seconds. Repeat 2-3 times. Repeat with the other arm.
      • Towel Stretches for Internal and External Rotation
        • Drape a towel over your left shoulder holding to the upper end of the towel with your left hand. Place your right arm behind your back and grab on to the end of the towel. With your left hand, pull your right hand up along the spine as if you are trying to scratch an itch as high up your back as possible. Hold for 20 seconds. Repeat 2-3 times. Then with your right hand, pull the towel down, stretching the left hand along the spine as if you are trying to scratch an itch as low on the back as possible. Hold for 20 seconds. Repeat 2-3 times. Repeat with the other arm.
      • Shoulder Opener
        • Lie on a Foam Roller with the spine and heal supported and the arms relaxed at your sides. Support the arms with pillows if needed. Let the shoulders roll back around the foam roller. Stretch for a minimum of 3 minutes. Perform diaphragmatic breathing while stretching.

Pain-Free Mousing

When performing ergonomic assessments, the main factors that I have found that contribute to mousing pain include:

  • Mouse Positioning
  • Mouse Movement
  • Muscular Tension When Using the Mouse
  • Forearm Position

Here are some tips to help reduce your risk of developing a repetitive strain injury or tendinitis from mouse use.
MOUSE POSITIONING

Causes of Pain

  • Reaching forward for the mouse onto a desk that is higher than the keyboard.
  • Reaching for a mouse placed to the far side of the keyboard.

Tips for Preventing Pain

  • Position the mouse in a more comfortable and ergonomic location
    • Use an attachable mouse holder that adjusts to fit over numerical key pad (if you do not use the 10-key) or as closely to it as possible.
    • Or use a keyboard bridge over the numerical keys if you do not use the 10-key portion of the keyboard.
    • Or use a keyboard station such as the Contour Roller Pro which has a rollerbar mouse that is positioned immediately below the space bar of the keyboard.

MOUSE MOVEMENT

Causes of Pain

  • Excessive wrist or arm movement when activating the mouse.
  • Planting the wrist down and swiveling the mouse using wrist motion.
  • Planting the wrist down placing pressure against the carpal tunnel.
  • Bending the wrist backward (extended) when using the mouse.

Tips for Preventing Pain

  • The mouse should be at about the same level of the keyboard and positioned as closely to the keyboard as possible.
  • Avoid reaching forward, up, or out to the side when using the mouse. Position the mouse to avoid these movements (see mouse positioning tips).
  • Activate the mouse by using small movements from the shoulder and elbow muscles rather than the wrist muscles.

Ergonomics

  • Keep the shoulders relaxed.
  • The elbow should be held loosely at the side in a direct line under the shoulder.
  • The wrist should be held in a neutral position (not bent forward or back or angled to one side or the other).
  • Do not plant the wrist down on that desk or on a wrist rest. Glide the wrist over surfaces always maintaining the neutral position.

MUSCULAR TENSION WHEN USING THE MOUSE

Causes of Pain

  • Forcefully squeezing the mouse between the thumb and small finger.
  • Forcefully activating the mouse buttons or switches.

Tips for Preventing Pain

  • Hold the mouse as lightly as you can while still maintaining control.
  • Keep the fingers held loosely against buttons and switches, not floating tensely in the air.
  • Do not pound mouse buttons or forcefully squeeze switches. Use only the lightest force necessary to activate controls.
  • Using a wireless mouse can eliminate the tension of pulling against the cord (even these small tensions add up by the end of the day).
  • Use a mouse and mouse pad that can be switched easily from the right to the left hand to share the work load between the two hands.
  • A keyboard station such as the Contour Roller Pro that incorporates a rollerbar mouse eliminates the need to hold the mouse.
  • Research mousing options such as the NoHands foot-activated mouse or a head-activated mouse placed in a baseball cap.
  • Perform forearm and wrist stretches throughout the day.
  • Gently stretch the thumb into the hitch-hiking position.

FOREARM POSITIONING

Causes of Pain

  • The forearm rotated into the palm-down position for long periods of time.

Tips for Preventing Pain

  • Vertical mice are good choices as the hand shake position with the forearm neutral rather than palm down can relieve forearm stress.
  • Stretch into the palm-up position throughout the day.

A Quick Comparison of Carpal, Cubital and Radial Tunnel Nerve Compressions

Three peripheral nerves provide power and sensation to the hand and arm.  The following is a quick comparison of the most common sources of pain caused by compression syndromes of these nerves.

nerve paths

Carpal Tunnel Syndrome

  • Nerve Affected:  Median
  • Location of Compression:   Wrist
  • Numbness and/or Tingling:  Usually in the Thumb, Index, Middle & Half of Ring Fingers
  • Pain:
    • Usually in the Thumb, Index & Middle Fingers
    • A band of pain around the wrist
    • Pain in the muscles at the base of the thumb
    • Pain radiates up the forearm
  • Likely Cause (activity related):
    • Frequent gripping/squeezing/holding of tools
    • Gripping or pinching tools or objects for a period of time
    • Finger movement with the wrist held at an awkward angle
  • Prevention:
    • Avoid sustained or repetitive grip and pinch
    • Maintain the wrist in a neutral (straight) position with activity
    • Avoid leaning on or putting pressure against the front of the wrist of the base of the hand
  • Splinting:   A wrist brace that  holds the wrist in the neutral (straight) position at night

Cubital Tunnel Syndrome

  • Nerve Affected:  Ulnar
  • Location of Compression:   Elbow
  • Numbness and/or Tingling:  Usually in the Ring & Small Fingers
  • Pain:
    • Usually in the Ring & Small Fingers
    • Pain in the hand muscles on the small finger side of the hand
    • Pain radiates up the forearm and into the elbow along the small finger side
  • Likely Cause:
    • Leaning on the elbow or pressure against the forearm along the small finger border
    • Frequently bending and straightening the elbow, such as when pulling a lever
    • Holding the elbow bent for long periods of time, such as when sleeping or holding a phone to the ear
    • Forceful elbow extension (straightening) activities, such as rowing, gym activity, push-ups
  • Prevention:
    • Avoid leaning on the elbow or putting pressure on the forearm muscles
    • Avoid holding the elbow bent more than 90 degrees for any length of time
    • Avoid repetitively bending and straightening the elbow
    • Avoid repetitive or forceful elbow extension activities
  • Splinting:   A soft pad or elbow support that holds the elbow in a mostly straight position at night

Radial Tunnel Syndrome

  • Nerve Affected:  Radial
  • Location of Compression:   Muscles on the back of the forearm near the elbow
  • Numbness and/or Tingling:  Uncommon
  • Pain:
    • Usually in the elbow and forearm muscles
    • Pain may radiate down the arm into the wrist and the back of the hand
    • Pain may radiate up the arm towards the shoulder
  • Likely Cause:
    • Computer mouse activity, swiveling the wrist and forceful mouse “clicking”
    • Holding the fingers tensely extended over the computer keyboard
    • Forcefully bending the wrist forward and back
    • Repetitive twisting movements, such as when using a screwdriver
    • Carrying or lifting heavy objects, particularly with the forearm pronated (palm rotated down)
  • Prevention:
    • Maintain the wrist in a neutral position while using the computer mouse
    • Don’t hit the keys or click the mouse forcefully and keep the fingers relaxed over the keys and mouse
    • Avoid repetitive and forceful wrist movements or twisting movements
    • Avoid heavy lifting, especially with the palm facing down, such as carrying a suitcase or heavy briefcase
  • Splinting:   A wrist splint that holds the wrist neutral may be helpful when performing stressful activities

Radial Tunnel Syndrome

As a certified hand therapist, I often treat people suffering from the symptoms of carpal tunnel syndrome (CTS). A less commonly known injury, but one that we are seeing more frequently in the clinic, is Radial Tunnel Syndrome (RTS). If you are experiencing an aching or burning sensation in the back of the forearm or over the back of the wrist or hand, you may have symptoms of RTS rather than CTS.

Anatomy

The radial nerve is one of three main peripheral nerves that provide sensation and power to the arm and hand (the other two are the median nerve and the ulnar nerve). The radial nerve leaves the spinal cord at the neck and travels down the arm and into the back side of the forearm. In the forearm it passes through the supinator muscle, the muscle that turns the palm up (such as when using a screwdriver).

The radial nerve is responsible for providing sensation to the back side of the forearm and the back of the hand. It is also responsible for providing power to the muscles that pull the wrist back and straighten the fingers at the large knuckle joint.

Causes of Radial Tunnel Syndrome

As the nerve travels down the arm, repetitive or forceful movements can cause friction at several sites along the nerve pathway as it passes through muscles and ligament bridges. Repetitive or forceful movements can also cause swelling in the tissues that surround the nerve. This compresses the nerve, pinching it and causing sensations of aching, burning, numbness and tingling.

Symptoms of Radial Tunnel Syndrome

Symptoms of RTS include an aching or burning pain over the back side of the forearm and/or into the back of the wrist. There may be tenderness over the back of the elbow and forearm close to the elbow. Pain may become worse with activities that require a lot of wrist movement (such as manipulating the mouse), finger movement (such as clicking the mouse), and palm up movements (such as using a screwdriver). With pressure against the tender area close to the elbow, you may experience a tingling or radiating pain. The arm may feel tired and heavy.  An aching pain may radiate down the arm into the hand or up into the shoulder.  The back of the hand, the index finger knuckle, and the muscular space between the index finger and the thumb may feel swollen.

Things to Help Prevent and Control Pain from RTS

If you are experiencing symptoms of RTS, here are a few things you might try to help you reverse the symptoms.

  • Rest as best as you can from the activities that are causing the problem.
  • A vertical mouse that places the forearm in a neutral position (the “handshake” position) may be helpful.
  • Do not swivel the mouse with wrist movement.
    • Keep the wrist neutral (straight and level, not bent forward or back or angled to either side) when typing and using the mouse.
    • Control the mouse by using the larger shoulder and elbow muscles to move it.
  • Keep the fingers relaxed on the keyboard and mouse.
    • Don’t forcefully straighten or lift the fingers while typing or clicking.
    • Use the least amount of pressure necessary to activate the keyboard and control the mouse.
  • Use a wrist brace to limit wrist movement and to help keep the muscles of the forearm relaxed.
  • Take frequent micro-breaks.
  • Use cold packs and hot packs.
    • A cold pack placed over the forearm muscles several times a day can help control swelling from overuse.
    • Hot packs can help improve flexibility.
    • Both can temporarily relieve pain.
  • Gently stretch the forearm muscles.
  • Avoid the following:
    • Heavy lift, grip or activities that twist the forearm.
    • Using a screwdriver   (Use electric tools whenever possible.)
    • Picking up luggage.
    • Weight-lifting.
  • Be careful of using tennis elbow straps that can place additional pressure on the radial nerve.
  • Seek medical attention if symptoms do not rapidly improve.

RTS is often confused with tennis elbow. Tennis elbow is an inflammation of the tendons as they attach on to the lateral epicondyle (the bony bump on the outside edge of the elbow). The tenderness associated with RTS is often a few inches farther down the forearm, more on the muscle than on the bone. A tendinitis pain is often sharper with activity and, unless it is a severe case, lessens with rest. Nerve pain, such as with RTS, can be more of an aching, burning pain that may become more severe after activity or at night. When seeking medical attention, be specific with your description of symptoms so that you can help your doctor diagnose the problem accurately.