Complaints of pain after use of handcuffs should not be dismissed

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7175.55 (Published 02 January 1999) Cite this as: BMJ 1999;318:55
  1. F S Haddad, Senior registrar,
  2. N J Goddard, Consultant,
  3. R N Kanvinde, Consultant,
  4. F Burke, Professor
  1. Department of Orthopaedics, Royal Free Hospital, London NW3 2QG
  2. Grimsby District General Hospital, Grimsby, South Humberside DN33 2BA
  3. Pulvetaft Hand Unit, London Road, Derby DE1 2QYw

    EDITOR—Handcuffs are commonly used to restrain prisoners. It is not unusual for them to be applied in violent circumstances and for the prisoner to struggle. This can lead to overtightening of the handcuffs and considerable trauma to the structures around the wrist. We have recently seen fractures, lacerations, and injuries to the radial, ulnar, and median nerves (table). This is probably the tip of the iceberg, as many people with such injuries fail to attend for assessment, follow up, or investigation.

    Data on men arrested and handcuffed

    View this table:

    Superficial radial handcuff neuropathy is the most common injury,13 although injuries to the median, ulnar, and multiple nerves have all been described. 4 5 Nerve conduction studies both confirm the organic basis of the patient's complaint and help to define the prognosis. Fortunately most lesions are not degenerative.

    Kwik-cuffs, the most commonly used handcuffs in the United Kingdom, are applied by allowing the cuffs to spring shut on a ratchet. This can lead to direct trauma and allows overtightening to occur. We postulate that bony injuries are caused at the time the cuff is applied or by levering on the cuffs afterwards, which causes a considerable torque at the wrist joint. While a double locking mechanism exists to limit further tightening of the handcuff, this may be omitted when the prisoner is violent or aggressive, or time is lacking.

    Police officers are aware of the potential dangers. Kwik-cuffs are used only by those who have received the relevant training. Officers are nevertheless encouraged to use them to maintain control and for self protection. Moreover, they are instructed not to remove or adjust handcuffs until a safe controlled environment is reached. This may mean that detainees' complaints of overtight handcuffs are addressed only after a considerable time.

    It is probably inevitable that any restraint procedure offering reasonable safety for the police force entails a potential risk for those who lash out against the restraining structures applied to the wrist. It would be difficult to implement other ways of detaining them, although greater awareness of the possibility of handcuff related lesions may lead to an earlier reappraisal once events are proceeding in a controlled manner.

    Complaints of pain, sensory symptoms, or weakness after use of handcuffs should not be dismissed. While neuropraxia of the radial nerve may not lead to motor dysfunction, it can none the less be persistent and severe. Damage to the ulnar or median nerve and fractures can be extremely debilitating.


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