Award: Presidential Poster Award
Alexander Miller, MD, Michelle Herberts, MD, Stephanie Hansel, MD, MS, Joseph Murray, MD, John League, III, MMIS, Hinson Chadrick, RN, Carol Van Dyke, CCRP
Mayo Clinic, Rochester, MN
Introduction: Rates of musculoskeletal (MSK) injury among gastroenterologists are estimated to be as high as 75%, exceeding rates of 35% among non-proceduralists. Specific ergonomic/procedural factors influencing these injuries have yet to be defined. We sought to characterize potential risk factors for MSK injury by analyzing the physical traits and technical procedural data of a cohort of endoscopists.
Methods: The QuickDASH (Disabilities of Arm, Shoulder, and Hand) survey was sent to all gastroenterologists across a large tertiary care system. Added questions assessed injury characteristics, glove size, and other demographic data. Endpoints defining affected vs. unaffected groups include self-reported function-limiting upper extremity or back pain, injury necessitating limiting/stopping endoscopy, and trends toward higher QuickDash, Work Impairment, or Sport/Instrument Disability scores. A procedural database capturing all endoscopic activities of each respondent from 2011 to 2018 was queried to gather procedural types, volumes, durations, and insertion times; scope types; and polyp detection rates.
Results: 64 surveys were completed (28.1% female, mean age 44.4 ±10.8 yrs). The average time in practice was 18.9 (±10.8) years. 51% (n=33) of respondents reported significant activity-limiting pain, including hand/wrist (n=31), arm/elbow (n=12), shoulder (n=19), and back (n=24) pain. Characteristics between affected and non-affected groups are detailed in Table 1 with further exploratory analyses found in Table 2. Those needing to limit/stop endoscopy due to pain more frequently used pediatric scopes (31% vs. 19%, P=0.037), took longer to perform colonoscopy (25.3 vs. 22.1 minutes, P=0.035) and had lower yearly procedural volumes (532 vs. 807, P=0.009). Those with hand/wrist pain had longer colonoscopy insertion times (9.35 vs. 8.21 minutes, P=0.03) and less colonoscopy hands-on scope hours per year (81.2 vs. 111.7 hours, P=0.039). Females had more severe shoulder pain (P=0.04), but there were no other associations with sex or small glove size.
Discussion: Activity-limiting MSK injuries affect over 50% of endoscopists. MSK symptoms were associated with longer procedure times and higher EGD or push enteroscopy volumes. Symptomatic subjects were more likely to use pediatric colonoscopes. Hand/wrist pain is the most common and (presumably) the most limiting type of injury. Further prospective monitoring is warranted to better elucidate which variables are causative versus compensatory responses to injury.
Citation: Alexander Miller, MD, Michelle Herberts, MD, Stephanie Hansel, MD, MS, Joseph Murray, MD, John League, III, MMIS, Hinson Chadrick, RN, Carol Van Dyke, CCRP. P1267 - ERGONOMIC AND PROCEDURAL METRICS ASSOCIATED WITH MUSCULOSKELETAL PAIN AMONG ENDOSCOPISTS. Program No. P1267. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.