A prospective study of handcuff neuropathies

Prior reports of handcuff-related neuropathies have been retrospective or small series of cases selected for their unusual electrophysiological or historical features. We conducted a prospective 27-month study at a large, urban, teaching hospital of all patients with a complaint of hand numbness, weakness, or paresthesias attributed to overtightened handcuffs. Forty-one patients were evaluated clinically, and electrodiagnostic testing was performed on 18. In the group with electrodiagnostic testing, neuropathies due to overtightened handcuffs were detected in 22 superficial radial, 12 median, and 9 ulnar nerves. The correlation between clinical and electrodiagnostic findings was best for superficial radial neuropathies, some of which were severe. Median and ulnar nerve injuries were generally mild. Similar clinical findings were obtained in the group without electrodiagnostic testing. Handcuff-related injury to the most commonly affected nerve, the superficial radial, can be severe and permanent.