Gastroenterologists face significant risk of musculoskeletal injury when using endoscopes if there’s overuse or improper use. An AGA Postgraduate Course breakout session on ergonomics Saturday afternoon included tips for optimal room design and strategies to minimize that risk during endoscopy. The session was led by Katherine S. Garman, MD, AGAF, of Duke University Medical Center, Durham, NC, and Amandeep K. Shergill, MD, of the University of California, San Francisco School of Medicine.
“We know from some of the data from the AGA survey on ergonomics that a lot of people really didn’t receive any education on this topic during fellowship,” Dr. Garman said. “Our goal is for a long and satisfying career spent serving our patients and preserving physician health and wellbeing at the same time. The challenge we face is that endoscopy subjects us to the potential for strain, overuse, related micro-trauma and injury, leaving us often feeling depleted at the end of the day.”
Indeed, Dr. Garman said, gastroenterologists report high rates of musculoskeletal injury related to endoscopy, with the highest rates of injury reported to the neck, left thumb and lower back.
Dr. Shergill reported the results of a biochemical analysis of colonoscopy that evaluated the forces exerted during the procedure. The analysis included 12 endoscopists (eight male, four female), who performed up to four colonoscopies each. A total of 41 colonoscopies were evaluated for bilateral thumb force, forearm muscle load and wrist posture.
“The analysis showed that left wrist extensor muscle loads exceeded established thresholds of risk during all phases of colonoscopy,” Dr. Shergill said. “Current colonoscope design requires non-neutral postures, and thumb forces required to manipulate the dials and insertion tube during colonoscopy resulted in high risk exertion throughout the exam.”
With regard to gender and musculoskeletal injury, Dr. Shergill said that women endoscopists are at a greater risk of right thumb, right wrist, right shoulder and upper back pain, noting that early physical therapy should be considered for women experiencing any of these symptoms.
“Additionally, more women performing endoscopy mandates a change in scope design,” she said. “Some endoscopes were designed for a 95th percentile male hand span for proper use. Ideally, a new standard scope head would accommodate a 5th percentile woman’s hand.”
When it comes to applying ergonomic principles to endoscopy, Dr. Garman said that, in addition to improved tool and endoscopy suite design, which are often beyond the control of the endoscopist, there are techniques and strategies endoscopists can employ to lower their risk of injury.
“For example, something as simple as a ‘microbreak’ — a quick one- to three-minute chance to relieve tension — should be done every 45 minutes or so,” Dr. Garman said. “You can think of microbreaks as periods of active movement sprinkled throughout the day. This emphasizes the concept of dynamic ergonomics and using movement to counter the static or tense positions one may assume during endoscopy.”