Applied Ergonomics 34 (2003) 107–113

Computer mouse use in two different hand positions:

exposure, comfort, exertion and productivity
Ewa Gustafsson*, Mats Hagberg
.
Department of Occupational Medicine, Sahlgrenska Academy at Goteborg .
University, St. Sigfridsgatan 85, Goteborg 412 66, Sweden
Received 30 August 2002; accepted 15 November 2002

Abstract

The aim of this study was to determine whether there are differences in exposure, comfort, exertion and productivity between a
neutral and a pronated hand position when using a computer mouse.
Nineteen experienced VDU workers performed a standardised text editing task with each mouse hand position. The wrist
positions and movements in the working arm were registered by an electrogoniometer and the muscle activity in the shoulder, two
extensors in the forearm and the first dorsal interossei (FDI) was registered by electromyography. The subjects rated perceived
exertion and comfort in work with each mouse hand position.
Work with the neutral hand position, compared to the pronated, gave a decreased muscle activity in the extensors of the forearm
and in the FDI and a trend indicating a decrease in the frequency of deviation movements in the wrist. At the same time, the subjects
showed a decreased productivity and they rated less comfort in work with the neutral hand position.
r 2003 Elsevier Science Ltd. All rights reserved.

Keywords: Input device; EMG; Wrist movements

1. Introduction pressure during work with different computer mice in

The most common nonkeyboard input device used
during computer work today is the computer mouse.
Musculoskeletal symptoms from the upper extremity are
common among computer mouse users according to
several studies. Sustained muscle loads in the forearm,
as well as nonneutral postures, are associated with
musculoskeletal disorders (Karlqvist et al., 1996; Jensen
et al., 1998; Cooper and Straker, 1998). Experimental
studies have shown differences in muscle activity and
wrist movements during computer mouse use with
different work techniques (Karlqvist et al., 1994;
Wahlstrom. et al., 2000). A study of 24 VDU-workers,
where half were computer mouse users and half
keyboards users only, showed that all of the computer
mouse users worked with more extreme ulnar deviation
of the wrist (Karlqvist et al., 1994). Keir et al. (1999)
recommended a reduction of wrist extension during
intensive mouse use after studying the carpal tunnel
*Corresponding author. Tel.: +46-31-3438-104; fax: +46-31-409-
728.
E-mail address: ewa.gustafsson@ymk.gu.se (E. Gustafsson).
different mouse tasks. Pronation of the forearm is
considered to be a potential risk factor for musculoske-
letal disorders in the elbow and the forearm (Zipp et al.,
1983).
Most of the computer mice used are traditionally
designed, i.e. they are held with a more or less pronated
forearm and are moved mainly with wrist movements.
In recent years computer mice, which are gripped with a
less pronated wrist, have been developed. Aara( s and Ro
(1997) have studied work with a vertical mouse (with the
appearance of a joystick on wheel) compared to a
traditional mouse. The vertical mouse, which was
moved mainly by whole arm movements, gave the
operator an almost neutral hand position and the thumb
was used as the main button controller. The study
showed that the muscle load on the forearm was
significantly less when working with the vertical mouse
compared to a traditional mouse.
The aim of this study was to determine whether there
are differences in exposure, comfort, exertion and
productivity between a neutral hand position (0

pronation/0
supination) and a pronated hand position
when using a computer mouse.

0003-6870/03/$ - see front matter r 2003 Elsevier Science Ltd. All rights reserved.
doi:10.1016/S0003-6870(03)00005-X
108 E. Gustafsson, M. Hagberg / Applied Ergonomics 34 (2003) 107–113
2. Subjects and methods
2.1. Experimental design
In a comparative, experimental study with repeated
measure, two different types of mice were used: a
traditionally designed mouse, Microsoft 2.1 A., which is
designed to be held with a pronated hand position, and a
newly designed prototype of a mouse, from now on
called the neutral mouse, which is held with a neutral
hand position and the ulnar side of the hand and wrist is
resting on the mouse. The main button of the neutral
mouse is placed under the pad of the index (or middle)
finger when gripping the mouse and you use the button
by pushing it horizontally towards the mouse (Fig. 1).
At their own VDU workstation, the subjects per-
formed a standardised text editing task for 15 min with
each hand position. The subjects were instructed to
select highlighted characters (random location) with the
mouse and then delete the characters by hitting the
delete key on the keyboard with the mouse-using hand.
They were instructed to work at the speed they normally
used. They were also informed that the number of pages
edited and the number of errors during this period were
registered.
Wrist positions and movements in the right wrist were
registered by an electrogoniometer and the muscular
load in four muscles in the right forearm, hand and
shoulder were registered by electromyography (EMG)
during each standardised task.
The perceived exertion was rated directly before and
after each standardised task and perceived comfort
during work was rated after work with each hand
position. When the standardised task was completed for
the two hand positions, the subjects also gave their
opinion of which mouse they preferred to use.
The order between the two mice was balanced with
respect to sex and time of day (morning and afternoon).
Fig. 1. The two hand positions. The pronated hand position to the left
with the traditional mouse and the neutral hand position to the right
with the neutral mouse.
2.2. Subjects
Nineteen employees, nine males and ten females,
participated voluntarily in the study. The subjects were
experienced VDU workers and used a computer mouse
as input device in their ordinary work. All the subjects
normally used their right hand to move the computer
mouse. Their age varied between 24 and 64 years (Md 47
years). The subjects trained with the neutral mouse for
half a working day before the study began. Before
the training they were informed that the neutral mouse
was designed to be moved with mainly whole arm
movements.
Those subjects who were not used to working with the
chosen model of traditional mouse were also allowed to
practice half a working day with this mouse. The
measurements then took place within a week from the
day of practice.
2.3. Measuring methods
2.3.1. Registration of wrist positions and movements
A biaxial electrogoniometer and a data logger (Model
X65 and DL1001, Biometrics; Gwent, UK) were used to
register flexion/extension and radial/ulnar deviation of
the right wrist. The goniometer was applied to the dorsal
side of the wrist on the right hand according to the
manual of the goniometer used.
The reference (zero) position of the wrist was
recorded when the forearm fully pronated was held in
a deviation and flexion/extension neutral position with
the palm down on the desk (Greene and Heckman,
1994). The sampling rate was 20 Hz and the measuring
data were transmitted after the measurement from the
data logger to a PC, where they were analysed using a
program written in Labview 4.0. The program calcu-
lated the 10th, 50th and 90th percentile of the wrist angle
distribution, the mean velocity and the mean power
frequency (MPF) for both flexion/ extension and radial/
ulnar deviation. A power spectrum was calculated using
the Auto Power Spectrum virtual instrument (VI) in
Labview. MPF was calculated on the portion of the
power spectrum between 0 and 5 Hz as recommended by
Hansson et al. (1996) with a low frequency cut-off of
0.033 Hz to eliminate the DC component of the
spectrum (MPF calculated between 0.033 and 5 Hz).
MPF is defined as the centre of gravity for the power
spectrum and has been used as a measure of repetitive-
ness (Hansson et al., 1996).
2.3.2. Registration of muscular load
The muscle activity was registered in four muscles: the
right extensor digitorum (ED), the right extensor carpi
ulnaris (ECU), the right first dorsal interossei (FDI) and
the pars descendent of the right trapezius muscle by
 E. Gustafsson, M. Hagberg / Applied Ergonomics 34 (2003) 107–113
EMG (Muscle Tester ME3000P, Mega Electronics Ltd,
Kuopio, Finland).
The electrodes for the ED, the ECU and the FDI were
placed as recommended by Perotto (1994) measured
from the lateral epicondyle, on 1/3 of the distance
between the epicondyle and the styloid process of radius
(ED) and styloid process of ulna (ECU), respectively.
For the FDI the electrodes were placed over the muscle
belly in the web between the thumb and the index finger.
The electrodes for the trapezius were placed as
recommended by Mathiassen et al. (1995) 20 mm lateral
to the midpoint of the line between the seventh cervical
vertebra and acromion.
Self-adhesive surface electrodes (M-00-N; Medicotest
AS, Copenhagen, Denmark) were used and were placed
in pairs with 20 mm centre distance on dry skin after the
area had been dry shaved, cleaned with alcohol, abraded
with sandpaper and cleaned with gauze saturated with
water.
The raw data were recorded on-line using a portable
PC and monitored in real time for quality control. The
sampling rate was 1000 Hz. Full wave rectifying and
filtering of the EMG signal derived the muscular activity,
using a time constant of 100 ms. Standardised reference
voluntary contractions (RVCs) were made by the
subjects to obtain reference voluntary electrical activity
(RVE) for the four muscles. For the ED, the ECU and
the FDI, maximal voluntary electrical activity (MVE)
was set with maximum static contraction against manual
resistance for 5 s with supported forearm and hand with
the palm against the desk. For the ED resistance were
given on the back of the hand and the proximal parts of
the fingers, for the ECU on the ulnar side of the hand
and fingers and for the FDI the thumb were pressed
against the lateral side of the proximal interphalangeal
joint of the index finger. For the trapezius, RVE was set
with both arms straight out with neutral shoulders in 90

abduction and palms turned downwards with a 1 kg
dumbbell in each hand for 15 s.
The EMG-data were analysed in the ME3000P soft-
ware version 1.5 and the 10th (static level), 50th (median
level) and 90th (peak level) percentile of the muscle
activity were calculated for each subject. The analysing
program gave automatically the results in integers.
2.3.3. Perceived exertion and comfort
Immediately before and after work with both hand
positions, perceived exertion in the neck, shoulders,
arms, wrists and hands was rated using Borg’s CR-10
scale (Borg, 1990). The difference between the rated
perceived exertion before and after work with each hand
position was calculated for every rated body area. After
work with each mouse, the subjects also rated the
perceived whole body comfort using a bipolar scale,
ranging from 4, very poor comfort, to +4, excellent
comfort (Karlqvist et al., 1995).
109
2.3.4. Productivity
The number of pages edited within the specified time
and the number of errors were calculated for each hand
position.
2.4. Statistics
The results of the group are presented as medians for
each of the two hand positions as well as medians for the
differences of all the subjects with 95% confidence
intervals (CI) for median values (Altman, 1991).
As the data were not normally distributed, the
differences in the results between the use of the two
hand positions were compared by using the Wilcoxon
signed rank test for repeated measurement. The
differences between the sexes, order of the two hand
positions and time of day were compared with the
Wilcoxon rank sum test for group comparison. The tests
of significance were two-tailed with a significance level
of 0.05 (Altman, 1991).
The p-values were read from table B9 Wilcoxon one
sample (or matched pairs) test and table B10 The Mann-
Whitney test (Wilcoxon two sample test) in Altman (1991).
Median values and other data calculations were made
in the statistical program Jmp (version 3.2.6, SAS
Institute Inc., NC, USA).
3. Results
3.1. Wrist movements
The results are based on 15 subjects since five
measurements were excluded because of technical
problems.
A great variation in the registered wrist angles between
the subjects was found. The median value, however,
showed less ulnar deviation and also an effect indicating
a decrease in extension in work with the neutral mouse
hand position compared to the pronated hand position.
A trend indicating a decrease in the frequency of the
deviation movements was also found (Table 1).
3.2. Muscular activity
All subjects showed a decreased or unchanged
muscular activity in the forearm (EDC, ECU) during
work with the neutral hand position compared with the
pronated one.
The muscular activity in the FDI showed similar
results except for one subject, who showed increased
muscular activity.
The muscular activity in the right trapezius decreased
for some of the subjects and increased for others.
However, the median difference was 0% RVE in
the10th, 50th and 90th percentile (Table 2).
110 E. Gustafsson, M. Hagberg / Applied Ergonomics 34 (2003) 107–113

Table 1
Wrist positions and movements (MPF and mean velocity) in work with a pronated and a neutral hand position and the difference between the two
hand positions (n ¼ 15)

Wrist position and movement Pronated Neutral Difference (pronated–neutral)

Md 95% CI Md 95% CI Md 95% CI p-value

Flexion/extension
10th percentile (deg) 14 4; 22 11 7; 16 7 0; 16 o0.01
50th percentile (deg) 23 14; 32 18 2; 31 5 2; 16 o0.1
90th percentile (deg) 31 16; 36 23 14; 32 5 4; 13 >0.2
MPF (Hz) 0.60 0.50; 0.98 0.63 0.46; 0.92 0.09 0.19; 0.14 >0.2
Velocity (deg/s) 12.7 9.9; 15.8 14.8 11.6; 18.6 0.8 6.8; 1.6 >0.2

Deviation
10th percentile (deg) 2 7; 2 7 11; 4 5 0; 13 o0.05
50th percentile (deg) 5 2; 7 4 9; 0 7 2; 14 o0.01
90th percentile (deg) 11 4; 11 4 0; 9 5 0; 9 o0.02
MPF (Hz) 0.51 0.38; 0.55 0.44 0.37; 0.52 0.07 0.08; 0.17 >0.2
Velocity (deg/s) 8.7 7.1; 10.5 7.0 5.2; 8.9 1.5 0.1; 3.6 o0.05

Md=group median; 95% CI=95% confidence interval. A positive value in wrist angles stands for extension and ulnar deviation. A negative value
stands for flexion and radial deviation.

Table 2
Muscular activity in work with pronated and neutral hand position and difference in muscular activity in work with the two positions (n=19)

Muscle activity Pronated Neutral Difference (pronated–neutral)

Md 95%CI Md 95%CI Md 95%CI p-value

M extensor digitorum
10th percentile (% MVE) 5.0 3; 6 3.0 2; 4 2.0 1; 3 o0.001
50th percentile (% MVE) 8.0 6; 9 5.0 3; 7 3.0 2; 5 o0.001
90th percentile (% MVE) 13.0 8; 16 11.0 6; 12 3.0 2; 6 o0.001

M extensor carpi ulnaris

10th percentile (% MVE) 5.0 4; 8 3.0 2; 5 2.0 2; 4 o0.001
50th percentile (% MVE) 8.0 7; 12 6.0 4; 7 3.0 2; 5 o0.001
90th percentile (% MVE) 17.0 13; 18 12.0 9; 13 5.0 3; 6 o0.001

M interossei 1
10th percentile (% MVE) 2.0 1; 4 1.0 0; 2 1.0 0; 1 o0.05
50th percentile (% MVE) 6.5 5; 10 2.0 1; 4 5.0 3; 7 o0.001
90th percentile (% MVE) 11.5 8; 16 4.0 2; 7 7.5 4; 13 o0.001

M trapezius (pars descendent)

10th percentile (% RVE) 5.5 2; 8 5.0 3; 8 0 2; 1 >0.2
50th percentile (% RVE) 12.0 8; 16 11.0 7; 18 0 3; 4 >0.2
90th percentile (% RVE) 28.0 15; 38 25.0 16; 37 0 9; 4 >0.2

Md=group median; 95% CI=95% confidence interval. % MVE (maximal voluntary electrical activity) and % RVE (reference voluntary electrical
activity) are given.

3.3. Perceived exertion and comfort
The perceived exertion was rated higher in right
shoulder (CI 0.5; 2, po0:1) and wrist (CI 1; 2,
po0:05) in work with the pronated hand position
compared to the neutral. In the other rated body areas
no statistically significant differences in perceived
exertion between the two hand positions (p > 0:2) were
found. The median for the difference in rated perceived
exertion between the two hand positions were zero for
all de rated body areas.
The neutral hand position was considered to give
better whole body comfort than the pronated by three
subjects, while one subject rated the two as equal and 15
subjects rated work with the neutral hand position less
comfortable (Md 1 scale step, CI 2; 1, po0:05).
 E. Gustafsson, M. Hagberg / Applied Ergonomics 34 (2003) 107–113
3.4. Productivity
Twenty-four per cent decreased productivity were
shown in work with the neutral hand position. All
subjects edited fewer pages (Md 2.5 pages, CI 3.25;
1.5, po0:05) when working with the neutral hand
position compared with the pronated. Only minor
differences in number of errors between the two hand
positions were found, with a median of one more error
in work with the neutral hand position compared with
the pronated (CI 0; 1).
3.5. Preference
All subjects preferred to work with the traditional
mouse, which was held with the pronated hand position,
compared with the neutral mouse used in the study,
which was held with the neutral hand position. Half of
the subjects considered the neutral mouse to have less
precision and to be more difficult to move than the
traditional mouse used.
No statistically significant differences between males
and females, order of the two hand positions or time of
the day were found between the two hand positions in
any of the measurements.
4. Discussion
4.1. Wrist positions and movements
Forearm pronation/supination has been shown to
affect wrist goniometer measurement accuracy (Buch-
holtz and Wellman, 1997; Hansson et al., 1996; Johnson
et al., 2002). Jonsson and Johnson (2001) and Johnson
et al. (2002) have evaluated and compared the crosstalk
and off-set error when using two different electrogoni-
ometer system including the system used in the present
study. The goniometers were calibrated with the
subject’s wrist in 90
pronation as in the present study.
Their study showed that the measured values differ from
the true values. The true value can be calculated by
adding the error shown in their study to the measured
value. According to this, if we perform the calculation of
the effect for one typical subject, represented by the
group median values, for a representative wrist position
(the 50th percentile of flexion/extension and deviation)
the effect of the forearm supination/pronation in the
present study would be in pronated hand position (90

pronation) +1
in flexion/extension and +4
in
deviation. (Hence, the true value for the 50th percentile
should be 24
extension and 9
deviation.) (see Table 1)
In neutral hand position (0
supination/0
pronation)
the effect would be 9
inflexion/extension and +5
in
deviation. (Hence, the true value for the 50th percentile
should be 9
extension and 1
deviation.) (see Table 1) If
111
we consider this effect of forearm supination/pronation
the difference in wrist extension will be larger and the
wrist position in the deviation plane will be more neutral
compared to the measured values presented in the
present study in work with the neutral hand position
compared to the pronated hand position.
The decrease in ulnar deviation in work with the
neutral mouse hand position observed in this study
could be expected since the ulnar side of the hand and
wrist are resting on the mouse during the mouse
operations.
The trend indicating a decrease in wrist extension
and frequency of deviation movements in work with
the neutral hand position can also be explained by the
design of the neutral mouse, which mostly made the
subjects use arm movements instead of wrist move-
ments.
4.2. Muscular activity
Since the used analysing program automatically gave
results only in integers there is an uncertainty in the size
of the calculated differences of 71% MVE/RVE. This
might effect the results, especially where the differences
are small, since only 19 subjects were studied.
The muscular activity in the extensor muscles of the
forearm decreased during work with the neutral hand
position, compared with the pronated one. This result is
in agreement with a study by Aara( s and Ro (1997) and
can probably be explained by the fact that the neutral
hand position is a more relaxing position for the muscles
with the wrist in a rest position similar to the position
when standing with the arm hanging relaxed beside the
body. In work with the neutral hand position the hand
and wrist was also resting on the neutral mouse.
Another explanation could be that the neutral mouse
like Aara( s’ vertical mouse was mainly moved by whole
arm movements. The decrease in the FDI during work
with the neutral hand position cannot entirely be
explained by the hand position but is probably also
due to the fact that less force was needed to click
the button of the neutral mouse compared to the
traditional.
4.3. Perceived exertion and comfort
There was a great variation in perceived exertion
among the subjects during work with the two hand
positions. This can probably be explained by differences
in work technique between the subjects and the fact that
some of them had difficulties moving the neutral mouse
smoothly on the desk surface.
The differences in perceived exertion between the two
hand positions for each subject were small, except for
the right shoulder and hand. This and the perceived
lower comfort can probably also be explained by the
112 E. Gustafsson, M. Hagberg / Applied Ergonomics 34 (2003) 107–113
fact that some of the subjects had difficulties moving the
neutral mouse smoothly. In work with the neutral hand
position, most of the subjects used a technique where
they moved the input device with arm movements, in
contrast to the pronated hand position, where they
moved the input device with hand or finger movements.
Arm movements involve larger muscles made for rough
motorial movements. Hand and finger movements
involve smaller muscles, which are made for fine
motorial movements.
4.4. Productivity and preference
The lower productivity expressed by the number of
pages edited during work with the neutral hand position
is supported by a recently presented study by Straker
et al. (2000). It showed a decrease of performance by
11% even after 2 weeks of practice with a mouse that
was held with a neutral hand position. In the present
study, almost all the subjects considered work with the
neutral hand position more restful and convenient for
the hand and the wrist but all the subjects still preferred
to work with the traditional mouse. This can probably
at least partly be explained by their familiarity with this
mouse design.
4.5. Possible effects on musculoskeletal disorders
High muscular load in the forearm muscles, like high
repetitiveness in wrist movements and extreme postures
in the wrist, is associated with musculoskeletal disorders
(Marras and Schoenmarklin, 1993; Ranney et al., 1995;
Bernard, 1997; Viikari-Juntura and Silverstein, 1999).
According to this it is likely that a neutral hand position
in work with a computer mouse can decrease the risk of
musculoskeletal disorders in intensive computer mouse
use. This is also in agreement with the study of Aara( s
et al. (1999), which showed that work with a vertical
mouse used with a neutral position of the forearm, wrist
and hand significantly reduced the pain in the neck,
shoulder, forearm and hand for VDU workers who
experienced pain in these areas.
4.6. Limitations of the study
Since the standardised task only consisted of text
editing, the results of this study can only be assumed to
be valid for this kind of computer work.
It is possible that the time of practice with the
prototype mouse was too short for some of the subjects.
A longer time of practice would perhaps have given
other results, above all regarding productivity, perceived
comfort and preference. The study by Straker et al.
(2000) referred to above showed, however, the same
results even after two weeks of practice.
It is possible that 15 min of work with each mouse was
too short. A longer time of measurement would perhaps
have given other results, especially regarding perceived
exertion.
5. Conclusions
This study shows that the hand position in work with
a computer mouse is of importance for the muscle
activity in the forearm and for the wrist positions and
movements. However, the study also shows that work
with the neutral mouse hand position in this experi-
mental setting resulted in lower productivity and less
perceived comfort.
According to the positive findings of Aara( s et al.
(1999, 2001) with reduced pain among VDU workers
when using a more neutral forearm and hand position in
work with the computer mouse it would be of interest to
study the health effect of using a neutral hand position
when working with the computer mouse in healthy
populations.
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