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Hand and Wrist Injuries Associated With Application of Physical Restraints: A Systematic Review.
Shawn Khan1, Adam Mosa1, Adam Clayton1
1University of Toronto, ON, Canada.
Hand (New York, N.Y.)
|July 2, 2022
Summary
Physical restraints like handcuffs and zip ties can cause nerve and bone injuries to the hand and wrist. These restraints are linked to entrapment neuropathies and fractures, impacting hand function.
Area of Science:
- Forensic Medicine
- Orthopedic Surgery
- Neurology
Background:
- Law enforcement commonly uses physical restraints such as handcuffs and zip ties.
- These restraints have been anecdotally linked to soft tissue and bony damage in the hand and wrist.
Purpose of the Study:
- To systematically review and characterize the safety of physical restraints.
- To summarize the effects of handcuffs and zip ties on hand and wrist function and disability.
Main Methods:
- A systematic literature search was conducted across EMBASE, MEDLINE, and CINAHL databases.
- Studies were selected and data extracted through an independent double-selection process.
- 16 studies involving 807 participants were included in the review.
Main Results:
- Superficial radial nerve lesions were the most frequent injury, affecting 82% of examined hands.
- Bony injuries occurred in 6% of hands, including radial styloid and scaphoid fractures.
- Zip tie studies reported handcuff neuropathy, with one case of severe ischemic monomelic neuropathy.
Conclusions:
- Physical restraints, including handcuffs and zip ties, are associated with entrapment neuropathies and bony injuries.
- These injuries can lead to significant hand and wrist dysfunction and disability.
- Higher quality evidence is needed to fully understand the long-term effects of physical restraints.
