‘High prevalence’ of extremity repetitive use injuries reported among endoscopists
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Key takeaways:
- Endoscopists who exhibited repetitive use injury symptoms performed fewer — and shorter — procedures.
- Pain was most often reported in endoscopists who performed at least 20 procedures weekly.
PHILADELPHIA — A “high prevalence” of extremity repetitive use injury symptoms were reported among endoscopists, which negatively affected performance, according to a presenter at the ACG Annual Scientific Meeting.
“A [2015] ASGE survey reported that 78% of endoscopists had an extremity repetitive use injury, or ERI,” Daryl Ramai, MD, MPH, MSc, an advanced endoscopy fellow at Brigham and Women’s Hospital, told attendees. “That same study showed that about 48% of GI fellows had ERI symptoms; in fact, 80% of those GI fellows stated that ERI symptoms began during their first year of GI fellowship.”
He added: “In the last decade, we have seen a lot of great studies on ERI, which have been valuable in highlighting this important issue, but I think it’s important to realize that most of these studies are qualitative in nature and derived from surveys and questionnaires. While they do have merit, there is a lack of objective data in the literature.”
To “fill this gap,” Ramai and colleagues enrolled endoscopists from the University of Utah (n = 35; mean age, 44.6 years; 25.7% women) to undergo a series of occupational therapy evaluations for repetitive use injuries. The endoscopists were also required to complete the validated QuickDASH questionnaire as well as an independent survey with 43 researcher-derived questions.
According to study results, 34.3% of the endoscopists reported current pain with 17.1% noting either numbness or “tingling” at night; current pain was most associated with endoscopists who performed at least 20 procedures weekly (P = .007).
Nearly half (48.5%) of the endoscopists reported having been bothered by pain within the past week, with 11.4% reporting tingling, 17.1% noting interrupted sleep and another 17.1% noting physical restrictions in their work duties.
Physical evaluations demonstrated that nearly half of endoscopists exhibited below-normal strength in their right grip (48.6%) and left grip (42.9%), with 88.6% demonstrating below-normal pinch strength for their age and gender.
“We found that any current pain was associated with more numbness or tingling at night, performing a lower number of procedures and higher average QuickDASH disability score,” Ramai told attendees. “Those who had decreased lateral pinch or two-point pinch score tend to perform less procedures and fewer hours performing endoscopy, [which] suggests that this was most likely having a direct effect on endoscopy.”
The researchers also observed that 71.4% of the endoscopists had at least one abnormal positive provocative test, with those who reported numbness at night (P = .015) or in current pain (P < .001) exhibiting higher DASH disability scores. Additionally, endoscopists whose weekly workload consisted of 20% to 60% endoscopic retrograde cholangiopancreatography procedures were more likely to exhibit reduced bilateral pinch strength.
“We have provided objective data to suggest that there is a high prevalence of ERI among our workforce,” Ramai said. “Early-onset ERI is an important component; in fact, about 40% of our endoscopists who had 0 to 5 years of training had ERI symptoms.”
He added: “ERI has a direct impact on the performance of endoscopists and the number of procedures that an endoscopist does. But we have seen that stretching exercises and strength-training exercises do seem to have a positive impact on ERI, and I encourage all of you to incorporate stretching exercises during your procedures.”
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Ramai D, et al. Positive provocative testing and symptom evaluation for objective detection of upper extremity repetitive use injuries among endoscopists. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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