Wrist and forearm postures and motions during typing

Awkward upper extremity postures and repetitive wrist motions have been identified by some studies as risk factors for upper extremity musculoskeletal disorders during keyboard work. However, accurate body postures and joint motions of typists typing on standardized workstations are not known. A laboratory study was conducted to continuously measure wrist and forearm postures and motions of 25 subjects while they typed for 10 – 15 min at a standard computer workstation adjusted to the subjects' anthropometry. Electrogoniometers continuously recorded wrist and forearm angles. Joint angular velocities and accelerations were calculated from the postural data. The results indicate that wrist and forearm postures during typing were sustained at non-neutral angles; mean wrist extension angle was 23.4 ± 10.9 degrees on the left and 19.9 ± 8.6 degrees on the right. Mean ulnar deviation was 14.7 ± 10.1 degrees on the left and 18.6 ± 5.8 degrees on the right. More than 73% of subjects typed with the left or right wrist in greater than 15 degrees extension and more than 20% typed with the left or right wrist in greater than 20 degrees ulnar deviation. Joint angles and motions while typing on an adjusted computer workstation were not predictable based on anthropometry or typing speed and varied widely between subjects. Wrist motions are rapid and are similar in magnitude to wrist motions of industrial workers performing jobs having a high risk for developing cumulative trauma disorders. The magnitude of the dynamic components suggests that wrist joint motions may need to be evaluated as a risk factor for musculoskeletal disorders during typing.     

Wrist and forearm postures of users of conventional computer keyboards

The aim of this study was to perform a comprehensive investigation to document wrist and forearm postures of users of conventional computer keyboards. We instrumented 90 healthy, experienced clerical workers with electromechanical goniometers to measure wrist and forearm position and range of motion for both upper extremities while typing. For an alphabetic typing task, the left wrist showed significantly greater (p < .01) mean ulnar deviation (15.0 degrees +/- 7.7 degrees) and extension (21.2 degrees +/- 8.8 degrees) than the right wrist (10.1 degrees +/- 7.2 degrees and 17.0 degrees +/- 7.4 degrees for ulnar deviation and extension, respectively). Conversely, the right forearm had greater mean pronation (65.6 degrees +/- 8.3 degrees) than the left forearm (62.2 degrees +/- 10.6 degrees). We noted minimal functional differences in the postures of the wrists and forearms between alphabetic and alphanumeric typing tasks. Ergonomists should consider the statistically significant and probable practical difference in wrist and forearm posture between the left and right hand in ergonomic interventions in the office and in the design of computer keyboards. Actual or potential applications of this research include guiding the design of new computer keyboards.     

Wrist and forearm posture from typing on split and vertically inclined computer keyboards

A study was conducted on 90 experienced office workers to determine how commercially available alternative computer keyboards affected wrist and forearm posture. The alternative keyboards tested had the QWERTY layout of keys and were of three designs: split fixed angle, split adjustable angle, and vertically inclined (tilted or tented). When set up correctly, commercially available split keyboards reduced mean ulnar deviation of the right and left wrists from 12 degrees to within 5 degrees of a neutral position compared with a conventional keyboard. The finding that split keyboards place the wrist closer to a neutral posture in the radial/ulnar plane substantially reduces one occupational risk factor of work-related musculoskeletal disorders (WMSDs): ulnar deviation of the wrist. Applications of this research include commercially available computer keyboard designs that typists can use and ergonomists can recommend to their clients in order to minimize wrist ulnar deviation from typing.     

Guidelines for wrist posture based on carpal tunnel pressure thresholds

OBJECTIVE: To develop work guidelines for wrist posture based on carpal tunnel pressure. Background: Wrist posture is considered a risk factor for distal upper extremity musculoskeletal disorders, and sustained wrist deviation from neutral at work may be associated with carpal tunnel syndrome. However, the physiologic basis for wrist posture guidelines at work is limited. METHODS: The relationship of wrist posture to carpal tunnel pressure was examined in 37 healthy participants. The participants slowly moved their wrists in extension-flexion and radioulnar deviation while wrist posture and carpal tunnel pressure were recorded. The wrist postures associated with pressures of 25 and 30 mmHg were identified for each motion and used to determine the 25th percentile wrist angles (the angles that protect 75% of the study population from reaching a pressure of 25 or 30 mmHg). RESULTS: Using 30 mmHg, the 25th percentile angles were 32.7 degrees (95% confidence interval [CI] = 27.2-38.1 degrees) for wrist extension, 48.6 degrees (37.7 -59.4 degrees) for flexion, 21.8 degrees (14.7-29.0 degrees) for radial deviation, and 14.5 degrees (9.6-19.4 degrees) for ulnar deviation. For 25 mmHg, the 25th percentile angles were 26.6 degrees and 37.7 degrees for extension and flexion, with radial and ulnar deviation being 17.8 degrees and 12.1 degrees, respectively. CONCLUSION: Further research can incorporate the independent contributions of pinch force and finger posture into this model. APPLICATION: The method presented can provide wrist posture guidelines for the design of tools and hand-intensive tasks.     

The effect of six keyboard designs on wrist and forearm postures

There is increasing evidence that alternative geometry keyboards may prevent or reduce arm pain or disorders, and presumably the mechanism is by reducing awkward arm postures. However, the effect of alternative keyboards, especially the new designs, on wrist and arm postures are not well known. In this laboratory study, the wrist and forearm postures of 100 subjects were measured with a motion analysis system while they typed on 6 different keyboard configurations. There were significant differences in wrist extension, ulnar deviation, and forearm pronation between keyboards. When considering all 6 wrists and forearm postures together, the keyboard with an opening angle of 12 degrees , a gable angle of 14 degrees , and a slope of 0 degrees appears to provide the most neutral posture among the keyboards tested. Subjects most preferred this keyboard or a similar keyboard with a gable angle of 8 degrees and they least preferred the keyboard on a conventional laptop computer. These findings may assist in recommendations regarding the selection of keyboards for computer usage.     

Wrist posture affects hand and forearm muscle stress during tapping

Non-neutral wrist posture is a risk factor of the musculoskeletal disorders among computer users. This study aimed to assess internal loads on hand and forearm musculature while tapping in different wrist postures. Ten healthy subjects tapped on a key switch using their index finger in four wrist postures: straight, ulnar deviated, flexed and extended. Torque at the finger and wrist joints were calculated from measured joint postures and fingertip force. Muscle stresses of the six finger muscles and four wrist muscles that balanced the calculated joint torques were estimated using a musculoskeletal model and optimization algorithm minimizing the squared sum of muscle stress. Non-neutral wrist postures resulted in greater muscle stresses than the neutral (straight) wrist posture, and the stress in the extensor muscles were greater than the flexors in all conditions. Wrist extensors stress remained higher than 4.5 N/cm² and wrist flexor stress remained below 0.5 N/cm² during tapping. The sustained high motor unit recruitment of extensors suggests a greater risk than other muscles especially in flexed wrist posture. This study demonstrated from the perspective of internal tissue loading the importance of maintaining neutral wrist posture during keying activities.     

A laboratory study of the effects of wrist splint orthoses on forearm muscle activity and upper extremity posture

OBJECTIVE: To evaluate the effects of wrist splint orthoses (WSOs) on forearm muscle activity and upper extremity/torso postures. BACKGROUND: WSOs are ubiquitous in industry, but the literature as to their biomechanical effects is limited. METHOD: Study 1: Participants performed single-plane wrist exertions with or without a WSO while the electromyographic (EMG) activity of the flexor carpi radialis, flexor carpi ulnaris, and extensor carpi ulnaris was captured. Study 2: Participants performed simple computer jumper installation tasks with or without a WSO while upper extremity/torso postures were recorded. RESULTS: Study 1: A significant interaction between WSOs and wrist angle was observed in the response of forearm muscles (e.g., normalized EMG of the flexor carpi radialis increased from 4.2% to 15.9% as flexion increased from 0 degree to 36 degrees in the orthosis conditions, whereas in the no-orthosis condition it remained approximately 5% at all wrist flexion angles). Study 2: WSOs were found to effect wrist, torso, and shoulder postures, with the orthoses creating a 48% decrease (36 degrees vs. 18.6 degrees) in wrist flexion and 80% decrease (15 degrees vs. -3 degrees) in ulnar deviation but at a cost of increased shoulder abduction of 22% (36.5 degrees vs. 44.5 degrees) and increased lateral bend of torso of 30% (6 degrees vs. 7.8 degrees). CONCLUSIONS: WSOs increased forearm muscle activity at large wrist deviation angles and induced awkward shoulder postures in tasks requiring significant wrist deviation. APPLICATION: Use of WSOs in occupational settings should be carefully considered relative to task requirements, as orthoses may do more harm than good.     

Effects of negatively sloped keyboard wedges on risk factors for upper extremity work-related musculoskeletal disorders and user performance

Several changes to computer peripherals have been developed to reduce exposure to identified risk factors for musculoskeletal injury, notably in keyboard designs. Negative keyboard angles and their resulting effects on objective physiological measures, subjective measures and performance have been studied, although few angles have been investigated despite the benefits associated with their use. The objective of this study was to quantify the effects of negative keyboard angles on forearm muscle activity, wrist posture, key strike force, perceived discomfort and performance and to identify a negative keyboard angle or range of keyboard angles that minimizes exposure to risk factors for hand/wrist injuries. Ten experienced typists (four males and six females) participated in a laboratory study to compare keyboard angles ranging from 0 degrees to -30 degrees , at 10 degrees increments, and a keyboard with a 7 degrees slope, using a wedge designed for use with standard QWERTY keyboards. Repeatability of exposures was examined by requiring participants to complete two test sessions 1 week apart. Dependent variable data were collected during 10 min basic data entry tasks. Wrist posture data favoured negative keyboard angles of 0 degrees (horizontal) or greater, compared to a positive keyboard angle of 7 degrees , especially for the flexion/extension direction. In general, the percentage of wrist movements within a neutral zone and the percentages of wrist movements within +/-5 degrees and +/-10 degrees increased as keyboard angle became more negative. Electromyography results were mixed, with some variables supporting negative keyboard angles whilst other results favoured the standard keyboard configuration. Net typing speed supported the -10 degrees keyboard angle, whilst other negative typing angles were comparable, if not better than, with the standard keyboard. Therefore, angles ranging from 0 degrees to -30 degrees in general provide significant reductions in exposure to deviated wrist postures and muscle activity and comparable performance.     

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.     

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.     

Assessment of physical demands and comparison of multiple exposure definitions in a repetitive sawmill job: board edger operator

The primary objectives of the study were to 1) describe the physical exposures in a sawmill job with a high incidence of upper extremity musculoskeletal injuries in terms of multiple measures of posture, exertion and frequency (with varying definitions) and 2) to examine the comparability of those definitions. Surface electromyography and electrogoniometry were used to quantify the muscle demands and joint motions. Fourteen board edger operators from two sawmill facilities participated. All exposure assessments, with the exception of surface EMG measurements, were performed on the production lines. EMG measurements were performed within the facility in a location removed from the production line. The measurements showed that, on average, ranges of motions of 59, 102 and 84 degrees respectively in the planes of wrist radial/ulnar deviation, flexion/extension and pronation/supination were required to perform the job. Significant differences (p < .001) were observed between ranges of motion defined by peak postures and those due to peak postures required to perform the primary task only. Performance of the primary task required an average of 32% of maximum voluntary contraction from the forearm muscles assessed. Repetitions per day ranged, on average, from 2,015 to 9,365. Incidence of reported upper extremity musculoskeletal injuries in the two facilities assessed was found to be higher with the greater total exposure. However, examination of the trend with a standardized measure of injury incidence was not possible.     

Observed finger behaviour during computer mouse use

Two-button computer mouse users may exhibit sustained, static finger lifting behaviours to prevent inadvertent activations by avoiding finger pressure on the buttons, which leads to prolonged, static finger extensor muscle loading. One hundred graduate students were observed during normal computer work in a university computer facility to qualify and quantify the prevalence of lifted finger behaviours and extended finger postures, as well as wrist/forearm and grip behaviour, during specific mouse activities. The highest prevalences observed were 48% of the students lifted their middle finger during mouse drag activities, and 23% extended their middle finger while moving the mouse. In addition, 98% of the students rested their wrist and forearm (77%) or wrist only (21%) on the workstation surface, and 97% had an extended wrist posture (15 degrees -30 degrees ) when using the mouse. Potential applications of these findings include future computer input device designs to reduce finger lifting behaviour and exposures to risk factors of hand/forearm musculoskeletal pain.     

Assessment of physical demands and comparison of multiple exposure definitions in a repetitive sawmill job: board edger operator

The primary objectives of the study were to 1) describe the physical exposures in a sawmill job with a high incidence of upper extremity musculoskeletal injuries in terms of multiple measures of posture, exertion and frequency (with varying definitions) and 2) to examine the comparability of those definitions. Surface electromyography and electrogoniometry were used to quantify the muscle demands and joint motions. Fourteen board edger operators from two sawmill facilities participated. All exposure assessments, with the exception of surface EMG measurements, were performed on the production lines. EMG measurements were performed within the facility in a location removed from the production line. The measurements showed that, on average, ranges of motions of 59, 102 and 84 degrees respectively in the planes of wrist radial/ulnar deviation, flexion/extension and pronation/supination were required to perform the job. Significant differences (p < .001) were observed between ranges of motion defined by peak postures and those due to peak postures required to perform the primary task only. Performance of the primary task required an average of 32% of maximum voluntary contraction from the forearm muscles assessed. Repetitions per day ranged, on average, from 2,015 to 9,365. Incidence of reported upper extremity musculoskeletal injuries in the two facilities assessed was found to be higher with the greater total exposure. However, examination of the trend with a standardized measure of injury incidence was not possible.     

Wrist postures in the general population of computer users during a computer task

Computer activities have commonly been linked to the development of musculoskeletal disorders (MSDs) in the upper limbs. However, to understand the effects computer use has on such disorders, it is necessary to identify and classify the movements involved in performing common computer tasks, one of these being typing. Motion analysis techniques were adopted to determine the movements involved during a typing task. This involved markers being placed on the knuckles, wrists and forearms of participants. This marker configuration allowed for the flexion, extension, radial deviation, ulnar deviation and a combination of these movements to be calculated. The results in one plane of motion show a mean extension|flexion and radial|ulnar deviation of 18.825°?±?10.013° and 5.228°?±?11.703° respectively. The most common position in two planes of motion was 20° extension with a simultaneous 20° ulnar deviation (10.72%). The results depict an alternative method of categorizing wrist positions in two planes during computer use. Coincident wrist postures should be addressed as opposed to motion in a single plane as these postures may result in different ergonomic risk factors developing.     

Wrist postures while keyboarding: effects of a negative slope keyboard system and full motion forearm supports

Abstract

Video-motion analysis was used to analyse hand/wrist posture for subjects typing at a 101-key QWERTY keyboard on a 68 cm high worksurface. Three conditions were tested: subjects typed at the keyboard without arm support, subjects typed with adjustable full motion forearm supports, and subjects typed with an adjustable negative slope keyboard support system. The average declination of the negative slope keyboard support chosen by subjects was 12° below horizontal, which flattened the angle of the key tops. Ulnar deviation was comparable in all conditions and averaged 13° for the right hand and 15° for the left hand. Full motion forearm supports did not significantly affect any postural measures. Dorsal wrist extension averaged 13° when typing with or without the full motion forearm supports, but this was reduced to an average — 1° with the use of the negative slope keyboard support system. Subjects chose to sit at a distance of 79 cm from the computer screen when using the negative slope keyboard system compared with 69 cm without this.     

An evaluation of the ergonomics of three computer keyboards

The influence of keyboard design on hand position, typing productivity and keyboard preference was evaluated by comparing two segmented alternative designs with the linear standard keyboard. The FIXED alternative keyboard featured a split angle of 12 degrees and a moderate lateral inclination angle of 10 degrees. The adjustable OPEN alternative keyboard was used with a 15 degrees split setting, which resulted in a marked 42 degrees of demiboard lateral inclination. Sixteen typists, who completed 10 h of training on both alternative keyboards, were videotaped while typing set texts on all three keyboards. Forearm and wrist angles based on three-dimensional video analyses were significantly different (p<0.05) among the three designs tested. Both alternative keyboards placed the forearm and wrist closer to neutral positions than did the standard keyboard. While the OPEN keyboard reduced pronation, it simultaneously increased radial deviation. The FIXED keyboard kept the forearm in moderate pronation and the wrist closer to neutral. More time was spent in neutral and moderate ranges of wrist motion when subjects typed on the FIXED compared with the other two designs. With respect to the standard keyboard, typing productivity was reduced by 10% on the FIXED and 20% on the OPEN designs. No significant difference in preference was found between the standard and FIXED keyboards, both of which were preferred over the OPEN. It was concluded that, of the three keyboards evaluated, the FIXED design incorporated moderate changes to the standard keyboard. These changes promoted a more natural hand position while typing thereby reducing the potential for cumulative trauma disorders of the wrist. In addition, the FIXED design preserved a reasonable level of productivity and was well accepted by users.     

Postures,typing strategies,and gender differences in mobile device usage: An observational study

Mobile device text messaging and other typing is rapidly increasing worldwide. A checklist was utilized to characterize joint postures and typing styles in individuals appearing to be of college age (n = 859) while typing on their mobile devices in public. Gender differences were also ascertained. Almost universally, observed subjects had a flexed neck (91.0%, n = 782), and a non-neutral typing-side wrist (90.3%, n = 776). A greater proportion of males had protracted shoulders (p < 0.01, χ² test), while a greater proportion of females had a typing-side inner elbow angle of <90°, particularly while standing (p = 0.03, χ² test). 46.1% of subjects typed with both thumbs (two hands holding the mobile device). Just over one-third typed with their right thumb (right hand holding the mobile device). No difference in typing styles between genders was found. Future research should determine whether the non-neutral postures identified may be associated with musculoskeletal disorders.     

Effect of horizontal position of the computer keyboard on upper extremity posture and muscular load during computer work

The distance of the keyboard from the edge of a work surface has been associated with hand and arm pain; however, the variation in postural and muscular effects with the horizontal position have not been explicitly explored in previous studies. It was hypothesized that the wrist approaches more of a neutral posture as the keyboard distance from the edge of table increases. In a laboratory setting, 20 adults completed computer tasks using four workstation configurations: with the keyboard at the edge of the work surface (NEAR), 8 cm from the edge and 15 cm from the edge, the latter condition also with a pad that raised the work surface proximal to the keyboard (FWP). Electrogoniometers and an electromagnetic motion analysis system measured wrist and upper arm postures and surface electromyography measured muscle activity of two forearm and two shoulder muscles. Wrist ulnar deviation decreased by 50% (4 degrees ) as the keyboard position moved away from the user. Without a pad, wrist extension increased by 20% (4 degrees ) as the keyboard moved away but when the pad was added, wrist extension did not differ from that in the NEAR configuration. Median values of wrist extensor muscle activity decreased by 4% maximum voluntary contraction for the farthest position with a pad (FWP). The upper arm followed suit: flexion increased while abduction and internal rotation decreased as the keyboard was positioned further away from the edge of the table. In order to achieve neutral postures of the upper extremity, the keyboard position in the horizontal plane has an important role and needs to be considered within the context of workstation designs and interventions.     

Variance in direct exposure measures of typing force and wrist kinematics across hours and days among office computer workers

To determine the number of direct measurements needed to obtain a representative estimate of typing force and wrist kinematics, continuous measures of keyboard reaction force and wrist joint angle were collected at the workstation of 22 office workers while they completed their own work over three days, six hours per day. Typing force and wrist kinematics during keyboard, mouse and idle activities were calculated for each hour of measurement along with variance in measurements between subjects and between day and hour within subjects. Variance in measurements between subjects was significantly greater than variance in measurements between days and hours within subjects. Therefore, we concluded a single, one-hour period of continuous measures is sufficient to identify differences in typing force and wrist kinematics between subjects. Within subjects, day and hour of measurement had a significant effect on some measures and thus should be accounted for when comparing measures within a subject. PRACTITIONER SUMMARY: The dose response relationship between exposure to computer related biomechanical risk factors and musculoskeletal disorders is poorly understood due to the difficulty and cost of direct measures. This study demonstrates a single hour of direct continuous measures is sufficient to identify differences in wrist kinematics and typing force between individuals.     

Effect of computer keyboard slope and height on wrist extension angle

The goal of this study was to determine the systematic effect that varying the slope angle of a computer keyboard along with varying keyboard height (relative to elbow height) have on wrist extension angle while typing. Thirty participants typed on a keyboard whose slope was adjusted to +15 degrees, +7.5 degrees, 0 degrees, -7.5 degrees, and -15 degrees. The height of the keyboard was set up such that participants' wrists were at the same height as their elbows, above their elbows, and four cm below their elbows. Results showed that as keyboard slope angle moved downward from +15 degrees to -15 degrees, mean wrist extension decreased approximately 13 degrees (22 degrees at +15 degrees slope to 9 degrees at -15 degrees slope). Keyboard height had a similar effect with mean wrist extension decreasing from 21.8 degrees when the keyboard was lower than elbow height, to 7.3 degrees when the keyboard was higher than elbow height. Potential application of this research includes the downward sloping of computer keyboards, which could possibly be beneficial in the prevention of musculoskeletal disorders affecting the wrist.