Effects of combined wrist deviation and forearm rotation on discomfort score

The aim of the study was to examine the pattern of the change in discomfort for combined wrist deviation and forearm rotation as joint angles increased away from neutral in a repetitive task. There were five levels of wrist deviation (neutral, 35% and 55% of the range of motion (ROM) in radial and ulnar deviation) and five levels of forearm rotation (neutral, 30% and 60% of the ROM in pronation and supination). Twenty-five participants performed a repetitive flexion task with a force of 10 N +/- 1 N at a frequency of 15 exertions per min, with replication after 1 week for six of the participants. A visual analogue scale was used for recording the discomfort scores. Repeated measures analysis of covariance with the Greenhouse-Geisser correction, where necessary, was used on transformed values of the discomfort scores. Grip test endurance time at 50% of maximum voluntary contraction was included as a covariate. Wrist deviation (p = 0.007) and forearm rotation (p = 0.001) were found to have significant effects. Interactions of the main factors were not significant and nor was the covariate. Quadratic regression equations were derived and were used to generate iso-discomfort contours, which show a useful area of low discomfort around the central neutral zone of wrist postures, but with steep increases in discomfort at the extreme combinations of wrist ulnar/radial deviation with forearm pronation/supination. Discomfort equations and contours, showing wrist and forearm postures, which are either acceptable or potentially injurious, are useful for the design of industrial tools, machine controls and workspaces. Reference to these can help to reduce the risk of musculoskeletal injury associated with the tasks or tools by avoiding poor postures with unacceptable deviations from neutral posture.     

Wrist discomfort levels for combined movements at constant force and repetition rate

Sixteen male subjects each performed a repetitive, downwards, non-prehensile wrist exertion task with the arm pronated, at a rate of 15 times per minute and with a force of 10N +/- 1N in 49 combinations of flexion/extension and radial/ulnar deviation to 0%, 18%, 38% and 55% of the Range of Motion (ROM) for 5 min each. The dependent measure was discomfort measured on a 100 mm visual analogue scale and for most of the analyses these were standardized by using the min-max procedure of . These Standardised Discomfort Levels (SDLs) were fitted to mathematical equations from which iso-discomfort contours were derived relative to the percentages of flexion/extension and radial/ulnar-deviation ROM used. The lowest standardized discomfort was found for the neutral wrist posture, followed by 18% extension with neutral radial/ulmar deviation. The results reveal interesting features of the processes involved and provide useful avenues for further research.     

Wrist discomfort levels for combined movements at constant force and repetition rate

Sixteen male subjects each performed a repetitive, downwards, non-prehensile wrist exertion task with the arm pronated, at a rate of 15 times per minute and with a force of 10N?±?1N in 49 combinations of flexion/extension and radial/ulnar deviation to 0%, 18%, 38% and 55% of the Range of Motion (ROM) for 5 min each. The dependent measure was discomfort measured on a 100 mm visual analogue scale and for most of the analyses these were standardized by using the min?-?max procedure of <citeref rid="b20">Gescheider (1988)</citeref>. These Standardised Discomfort Levels (SDLs) were fitted to mathematical equations from which iso-discomfort contours were derived relative to the percentages of flexion/extension and radial/ulnar-deviation ROM used. The lowest standardized discomfort was found for the neutral wrist posture, followed by 18% extension with neutral radial/ulmar deviation. The results reveal interesting features of the processes involved and provide useful avenues for further research.     

The effects of complex wrist and forearm posture on wrist range of motion.

Previous research on wrist functionally has focused almost entirely on range of motion (ROM) in 2 or 3 isolated planes (flexion/extension, radial/ulnar deviation, and forearm pronation/supination), without investigating the potential effects of complex wrist/forearm posture on ROM. A quantitative analysis of these effects on wrist ROM was performed. ROM was measured in one plane using both a manual method and an electrogoniometer while the participant maintained a fixed, secondary wrist and forearm posture. The study revealed that combinations of wrist/forearm postures have significant effects on wrist ROM; the largest effects are those of wrist flexion/extension on radial deviation ROM. The study also found that, consistent with previous research, wrist deviation measurements obtained with an electrogoniometer were significantly different from those obtained manually. Biomechanical theories for the results obtained are discussed. This research could be used to enhance ergonomic evaluation techniques by providing a more accurate risk assessment of certain complex wrist postures, particularly those in which wrist flexion/extension is combined with radial deviation.     

The interacting effects of forearm rotation and exertion direction on male and female wrist strength

The accurate estimation of wrist strength is an important component of ergonomics task evaluation, as a vast majority of occupational tasks involve use of the hands to generate forces and moments. The purpose of this study was to examine the interacting effects of forearm rotation (pronation/supination) and wrist exertion direction on strength at the wrist joint in males and females. A total of 24 male and female participants performed maximum isometric wrist exertions while maintaining a non-deviated wrist posture (no flexion/extension or radial/ulnar deviation) and an open hand. Maximum wrist moments were obtained in combinations of three forearm rotations (90° pronation, neutral, 90° supination) and four exertion directions (flexion, extension, radial and ulnar deviation). A greater effect of forearm rotation was observed for males, as strength in the neutral forearm posture was significantly different than pronated and supinated postures in 5 of 8 comparisons. For females, both wrist flexion and extension strengths were higher in neutral, compared to supinated forearm postures. The findings of this study suggest that wrist strength does depend on forearm rotation, and this interaction between axes needs to be accounted for in future strength capability estimates.Relevance to industryThis study shows that wrist strength estimates, currently used by ergonomics software packages in industry, can be improved to more accurately reflect the actual wrist strength capabilities of workers during hand-intensive tasks.     

Flexion and extension forces generated by wrist-dedicated muscles over the range of motion

An experiment was performed to evaluate the relationships among active range of motion (ROM), gender, wrist position and direction of force exertion in their effects on the magnitude of static force exerted by the wrist-dedicated muscles in wrist flexion and extension. This study employed 60 right-hand-dominant subjects (30 male, 30 female) between 20 and 30 years of age, all reporting no prior wrist injury and good to excellent overall physical condition. The ROM of each subject was used to determine the number of wrist positions evaluated for static maximal voluntary forces generated in wrist flexion and extension while they were instructed to relax their fingers; thus only the six wrist-dedicated muscles were employed in the exertion. The ANOVA procedure showed gender, wrist position, direction of force exertion, and the wrist position interaction with direction to have significant effects upon maximal force exertion. Females averaged 76.3% of the mean male flexion force and 72.4% for extension. On average, extension forces were found to be 83.4% of those generated by flexing the wrist-dedicated muscles.     

Effect of a splint on measures of sustained grip exertion under different forearm and wrist postures

Despite the facts that gripping tasks have been found to be highly correlated with CTS and that splints are gaining popularity as personal protective equipment, the influence of splints on grip performance has not been determined adequately. The present study intends to investigate the influence of splints without the volar parts as well as of forearm and wrist postures on grip performances including maximal volitional contraction (MVC), maximum acceptable sustained time (MAST), cumulated exertion output (CEO), and normalized exertion level (NEL). Twenty college-student volunteers, 10 males and 10 females, were recruited. The factors of interest were gender, forearm position, wrist deviation, and splint (with and without). The forearm positions were set at 30 degrees internal shoulder rotation, 0 degrees internal shoulder rotation, and 30 degrees external shoulder rotation, the angles being measured between the sagittal plane and the long axis of dominant forearm. The wrist deviations were extension 30 degrees , neutral, and flexion 30 degrees , the angles being measured between the sagittal plane and the long axis of the grip gauge. The results indicate that the gender effect is the most dominantly significant on all evaluated response variables. Males have more MVC (220 vs. 337N), longer MAST (20.2 vs. 10.5s), and greater CEO (4306 vs. 1638Ns), but less NEL (66.6 vs. 73.9%MVC). The forearm posture is shown to be significant only on MVC. In addition, the effect of wrist posture cannot shift all responses, nor can the effect of splints. In general, a splint without volar part seems to be recommended while performing infrequent and forceful gripping tasks under the consideration of prevention, but there should be more information about the application of a splint without volar part while performing a repetitively gripping task.     

The effects of posture on forearm muscle loading during gripping

The purpose of this study was to quantify the response of the forearm musculature to combinations of wrist and forearm posture and grip force. Ten healthy individuals performed five relative handgrip efforts (5%, 50%, 70% and 100% of maximum, and 50 N) for combinations of three wrist postures (flexed, neutral and extended) and three forearm postures (pronated, neutral and supinated). ‘Baseline’ extensor muscle activity (associated with holding the dynamometer without exerting grip force) was greatest with the forearm pronated and the wrist extended, while flexor activity was largest in supination when the wrist was flexed. Extensor activity was generally larger than that of flexors during low to mid-range target force levels, and was always greater when the forearm was pronated. Flexor activation only exceeded the extensor activation at the 70% and 100% target force levels in some postures. A flexed wrist reduced maximum grip force by 40-50%, but EMG amplitude remained elevated. Women produced 60-65% of the grip strength of men, and required 5-10% more of both relative force and extensor activation to produce a 50 N grip. However, this appeared to be due to strength rather than gender. Forearm rotation affected grip force generation only when the wrist was flexed, with force decreasing from supination to pronation (p<0.005). The levels of extensor activation observed, especially during baseline and low level grip exertions, suggest a possible contributing mechanism to the development of lateral forearm muscle pain in the workplace.     

The effects of posture on forearm muscle loading during gripping

The purpose of this study was to quantify the response of the forearm musculature to combinations of wrist and forearm posture and grip force. Ten healthy individuals performed five relative handgrip efforts (5%, 50%, 70% and 100% of maximum, and 50 N) for combinations of three wrist postures (flexed, neutral and extended) and three forearm postures (pronated, neutral and supinated). 'Baseline' extensor muscle activity (associated with holding the dynamometer without exerting grip force) was greatest with the forearm pronated and the wrist extended, while flexor activity was largest in supination when the wrist was flexed. Extensor activity was generally larger than that of flexors during low to mid-range target force levels, and was always greater when the forearm was pronated. Flexor activation only exceeded the extensor activation at the 70% and 100% target force levels in some postures. A flexed wrist reduced maximum grip force by 40-50%, but EMG amplitude remained elevated. Women produced 60-65% of the grip strength of men, and required 5-10% more of both relative force and extensor activation to produce a 50 N grip. However, this appeared to be due to strength rather than gender. Forearm rotation affected grip force generation only when the wrist was flexed, with force decreasing from supination to pronation (p < 0.005). The levels of extensor activation observed, especially during baseline and low level grip exertions, suggest a possible contributing mechanism to the development of lateral forearm muscle pain in the workplace.     

Accuracy and validity of observational estimates of wrist and forearm posture

Numerous observational methods for analysis of working posture of the wrist/forearm have been reported in the literature yet few of these methods have been validated for the accuracy of their posture classification. The present study evaluated the accuracy of estimates of working posture made by 28 experienced ergonomists using methods of scaling upper limb posture typical of those reported in the literature. Observational estimates of wrist/forearm posture of four jobs presented on video-recording were compared with posture levels measured directly with an electrogoniometer system. Ergonomists using a visual analogue scale tended to underestimate peak and average wrist extension with mean errors of -29.4% and -10.5% of the joint ROM, respectively (p<0.05). While estimates of wrist flexion, pronation and supination resulted in less bias, variability in observer error was large for all wrist postures. The probability of an analyst misclassifying the most frequently occurring posture using a three- and a six-category scale was 54 and 70%, respectively. The probability of misclassifying peak posture was 22 and 61% using a three- and a six-category scale respectively. This suggests a trade-off between the degree of precision afforded by the categorical scale and the likelihood of posture misclassification. Estimates of the temporal distribution of posture among the categories appeared to be biased towards more neutral postures than were measured for the jobs. This indicated the possibility of a trend towards underestimation of posture duration severity by the ergonomists.     

Upper limb discomfort profile due to intermittent isometric pronation torque at different postural combinations of the shoulder-arm system

Twenty-seven right-handed male university students participated in this study, which comprised a full factorial model consisting of three forearm rotation angles (60% prone and supine and neutral range of motion), three elbow angles (45°, 90° and 135°), three upper arm angles (45° flexion/extension and neutral), one exertion frequency (15 per min) and one level of pronation torque (20% maximum voluntary contraction (MVC) relative to MVC at each articulation). Discomfort rating after the end of each 5 min treatment was recorded on a visual analogue scale. Results of a repeated measures analysis of covariance on discomfort score, with torque endurance time as covariate, indicated that none of the factors was significant including torque endurance time (p = 0.153). An initial data collection phase preceded the main experiment in order to ensure that participants exerted exactly 20% MVC of the particular articulation. In this phase MVC pronation torque was measured at each articulation. The data revealed a significant forearm rotation angle effect (p = 0.001) and participant effect (p = 0.001). Of the two-way interactions, elbow?participant (p = 0.004), forearm?participant (p = 0.001) and upper arm?participant (p = 0.005) were the significant factors. Electromyographic activity of the pronator teres and biceps brachii muscles revealed no significant change in muscle activity in most of the articulations. Industrial jobs involving deviated upper arm postures are typical in industry but have a strong association with injury. Data from this study will enable better understanding of the effects of deviated upper arm postures on musculoskeletal disorders and can also be used to identify and control high-risk tasks in industry.     

Forearm torque strengths and discomfort profiles in pronation and supination

This experiment investigated maximum forearm pronation and supination torques and forearm discomfort, for intermittent torque exertions in supine and prone forearm angles for the right arm. Twenty-two subjects participated in the study that comprised two parts, the first of which involved measurement of maximum forearm torque in both twisting directions at five forearm angles including neutral. This was followed by endurance tests at 50% maximum voluntary contraction (MVC) in both directions. The second part of the study involved subjects performing 5-min duration of intermittent isometric torque exercises at 20% MVC in both directions at 11 forearm angles. Regression equations were developed that accurately predict torques as a function of forearm angle expressed as a percentage of maximum motion. Analysis of the discomfort data for the intermittent isometric torque exertions indicated that both forearm angle and twisting direction significantly affected forearm discomfort (p < 0.001). A significant two-way interaction (p < 0.01) was identified between forearm angle and direction for supine forearm angles only. The results provide important strength and discomfort models for the design of tasks involving static or repetitive forearm twisting. Such tasks have a strong association with forearm injuries including lateral and medial epicondylitis. These results provide needed data on the risk factors associated with these injuries so they can be prevented.     

Forearm torque strengths and discomfort profiles in pronation and supination

This experiment investigated maximum forearm pronation and supination torques and forearm discomfort, for intermittent torque exertions in supine and prone forearm angles for the right arm. Twenty-two subjects participated in the study that comprised two parts, the first of which involved measurement of maximum forearm torque in both twisting directions at five forearm angles including neutral. This was followed by endurance tests at 50% maximum voluntary contraction (MVC) in both directions. The second part of the study involved subjects performing 5-min duration of intermittent isometric torque exercises at 20% MVC in both directions at 11 forearm angles. Regression equations were developed that accurately predict torques as a function of forearm angle expressed as a percentage of maximum motion. Analysis of the discomfort data for the intermittent isometric torque exertions indicated that both forearm angle and twisting direction significantly affected forearm discomfort (p?<?0.001). A significant two-way interaction (p?<?0.01) was identified between forearm angle and direction for supine forearm angles only. The results provide important strength and discomfort models for the design of tasks involving static or repetitive forearm twisting. Such tasks have a strong association with forearm injuries including lateral and medial epicondylitis. These results provide needed data on the risk factors associated with these injuries so they can be prevented.     

Evaluation of handgrip force from EMG measurements

A series of experiments were performed in order to investigate whether estimates of handgrip force could be derived with fair accuracy from surface EMG levels recorded on the finger flexors of the forearm, taking into account the position of the wrist in the flexion-extension plane and in the ulnar-radial deviation plane. Handgrip forces (on a JAMAR dynamometer) and corresponding surface EMG levels (on the finger flexors of the forearm) were recorded for 20 subjects in 11 postures of the wrist and for 30% and 70% of the MVC in neutral posture. A mathematical empirical model was developed using multiple non-linear regression analysis. Although quite simple, it provides very reliable results, the correlation coefficient between predicted and observed forces being 0.895. Its use must, however, be restricted to work situations where: (a) the hand efforts are of the same type and involve the same muscles as those exerted on the dynamometer; (b) the hand is in neutral pro-supination; and (c) no voluntary effort is exerted by the wrist flexors except for maintaining the wrist posture.     

Prediction of forearm muscle activity during gripping

Occupational exposure is typically assessed by measuring forces and body postures to infer muscular loading. Better understanding of workplace muscle activity levels would aid in indicating which muscles may be at risk for overexertion and injury. However, electromyography collection in the workplace is often not practical. Therefore, a set of equations was developed and validated using data from two separate days to predict forearm muscle activity (involving six wrist and finger muscles) from grip force and posture of the wrist (flexed, neutral and extended) and forearm (pronated, neutral, supinated). The error in predicting activation levels of each forearm muscle across the range of grip forces, using the first day data (root mean square error; RMSEmodel), ranged from 8.9% maximal voluntary electrical activation (MVE) (flexor carpi radialis) to 11% MVE (extensor digitorum communis). Grip force was the main contributor to predicting muscle activity levels, explaining over 70% of the variance in flexor activation levels and up to 60% in extensor activation levels, respectively. Inclusion of gender as a variable in the model improved estimates of flexor but not extensor activity. While posture itself explained minimal variance in activation without grip force (< 10% MVE), wrist and forearm posture were required (with grip force) to explain over 70% of the variance of all six muscles. The validation process indicated good day-to-day reliability of each equation, with similar error for flexor muscle models but slightly higher error in the extensor models when predicting activity levels for the second day of data (RMSEvalid ranging from 8.9% to 12.7% MVE). Detailed error analysis during validation revealed that inclusion of posture in the model effectively decreased error at grip forces above 25% maximum, but was detrimental at very low grip forces. This study presents a potential new tool to estimate forearm muscle loading in the workplace using grip force and posture, as a surrogate to use of a complex biomechanical model.     

Effects of shoulder rotation combined with elbow flexion on discomfort and EMG activity of ECRB muscle

Work related MusculoSkeletal Disorders (WMSDs) are injuries or dysfunctions caused by occupational or non occupational tasks involving bad postures, high frequency of exertions or high force levels. In the present study, the effects of shoulder flexion/extension combined with elbow flexion angle on discomfort score were investigated for repetitive gripping task. A laboratory experimental simulation was conducted. Ten male participants volunteered in this study. Four levels of shoulder flexion/extension (−45° extension, 0° neutral, 45° & 90° flexion) with three levels of elbow flexion angle (45°, 90° & 135°) were taken as levels of independent variables. There were 12 combinations available for each participant and the experiment was conducted on the basis of random order of experimental combinations for each participant. Discomfort score on 100 mm visual analogue scale (VAS) and Electromyography (EMG) activity of Extensor Carpi Radialis Brevis (ECRB) muscle were dependent variables for the analyses. The task for the experiment was of 150N ± 5N grip force at a frequency of 15 exertions/minute for five minutes duration. After performing the MANOVA on the recorded data, the results showed that the shoulder flexion/extension and elbow flexion both were highly significant (p < 0.001). Also it was found that −45° shoulder extension combined with 45° elbow flexion angle was the most discomfort posture. The practical relevance of the study is that, in industrial tasks such posture should be avoided to minimize risk of WMSDs.Relevance to industryThe findings in terms of relationship between discomfort/EMG vs. shoulder rotation combined with elbowflexion are important to design Industrial tasks with the reduced risk of WMSDs. Such as, sheet metal cutting, fabrication of sheet metal work, die casting, and drilling operations may require the shoulder movements in extenion/flexion combined with elbowflexion.     

The effect of upper extremity support on upper extremity posture and muscle activity during keyboard use

Forearm support during keyboard use has been reported to reduce neck and shoulder muscle activity and discomfort. However, the effect of forearm support on wrist posture has not been examined. The aim of this study was to examine the effect of 3 different postures during keyboard use: forearm support, wrist support and "floating". The floating posture (no support) was used as the reference condition. A wrist rest was present in all test conditions. Thirteen participants completed 20 min wordprocessing tasks in each of the test conditions. Electromyography was used to monitor neck, shoulder and forearm muscle activity. Bilateral and overhead video cameras recorded left and right wrist extension, shoulder and elbow flexion and radial and ulnar deviation. The forearm support condition resulted in significantly less ulnar deviation (p < or = 0.007), less time spent in extreme ulnar deviation (p = 0.002) and less reports of discomfort than the "floating" condition (p = 0.002). The wrist support but not the forearm support condition resulted in less trapezius and anterior deltoid muscular activity (p < 0.007). These findings indicate that typing with upper extremity support in conjunction with a wrist rest may be preferable to the "floating" posture implicit in current guidelines.     

Wrist strength is dependent on simultaneous power grip intensity

The effect of grip activities on wrist flexion/extension strength was examined. Twelve healthy subjects performed maximum wrist flexion/extension exertions with one of five levels of simultaneous grip effort: minimum effort; preferred effort; 30%, 60% and 100% maximum voluntary contraction. As grip force increased from the minimum to the maximum effort, average wrist flexion strength increased 34% and average wrist extension strength decreased 10%. It appears that the finger flexor tendons on the volar aspect of the wrist act agonistically in wrist flexion and act antagonistically to wrist extension. When an object gripped by the hand is fragile or uncomfortable, the reduced finger flexor activity will limit wrist flexion strength. Gripping a slippery object that requires high grip effort will result in reduced wrist extension strength. Grip force should be controlled during measurement of wrist flexion or extension strength. When analysing a task that involves both grip and wrist exertions, use of grip/wrist strength values that were measured during grip exertions only, or wrist exertions only, may incorrectly estimate the true grip/wrist strength, as grip and wrist activities significantly interact with each other as demonstrated in this paper.     

Wrist strength is dependent on simultaneous power grip intensity

The effect of grip activities on wrist flexion/extension strength was examined. Twelve healthy subjects performed maximum wrist flexion/extension exertions with one of five levels of simultaneous grip effort: minimum effort; preferred effort; 30%, 60% and 100% maximum voluntary contraction. As grip force increased from the minimum to the maximum effort, average wrist flexion strength increased 34% and average wrist extension strength decreased 10%. It appears that the finger flexor tendons on the volar aspect of the wrist act agonistically in wrist flexion and act antagonistically to wrist extension. When an object gripped by the hand is fragile or uncomfortable, the reduced finger flexor activity will limit wrist flexion strength. Gripping a slippery object that requires high grip effort will result in reduced wrist extension strength. Grip force should be controlled during measurement of wrist flexion or extension strength. When analysing a task that involves both grip and wrist exertions, use of grip/wrist strength values that were measured during grip exertions only, or wrist exertions only, may incorrectly estimate the true grip/wrist strength, as grip and wrist activities significantly interact with each other as demonstrated in this paper.     

Prediction of forearm muscle activity during gripping

Occupational exposure is typically assessed by measuring forces and body postures to infer muscular loading. Better understanding of workplace muscle activity levels would aid in indicating which muscles may be at risk for overexertion and injury. However, electromyography collection in the workplace is often not practical. Therefore, a set of equations was developed and validated using data from two separate days to predict forearm muscle activity (involving six wrist and finger muscles) from grip force and posture of the wrist (flexed, neutral and extended) and forearm (pronated, neutral, supinated). The error in predicting activation levels of each forearm muscle across the range of grip forces, using the first day data (root mean square error; RMSE_model), ranged from 8.9% maximal voluntary electrical activation (MVE) (flexor carpi radialis) to 11% MVE (extensor digitorum communis). Grip force was the main contributor to predicting muscle activity levels, explaining over 70% of the variance in flexor activation levels and up to 60% in extensor activation levels, respectively. Inclusion of gender as a variable in the model improved estimates of flexor but not extensor activity. While posture itself explained minimal variance in activation without grip force (<10% MVE), wrist and forearm posture were required (with grip force) to explain over 70% of the variance of all six muscles. The validation process indicated good day-to-day reliability of each equation, with similar error for flexor muscle models but slightly higher error in the extensor models when predicting activity levels for the second day of data (RMSE_valid ranging from 8.9% to 12.7% MVE). Detailed error analysis during validation revealed that inclusion of posture in the model effectively decreased error at grip forces above 25% maximum, but was detrimental at very low grip forces. This study presents a potential new tool to estimate forearm muscle loading in the workplace using grip force and posture, as a surrogate to use of a complex biomechanical model.