Department of Gastroenterology, San Francisco VA Health Care Center, San Francisco, California, USA; Department of Medicine, University of California, San Francisco, California, USA.
Department of Medicine, University of California, San Francisco, California, USA; Department of Bioengineering, University of California, Berkeley, California, USA.
Gastrointest Endosc. 2021 Mar;93(3):704-711.e3. doi: 10.1016/j.gie.2020.11.001. Epub 2020 Nov 5.
Endoscopists experience upper extremity musculoskeletal injuries. The primary aim of this study was to compare distal upper extremity biomechanical risk factors during colonoscopy with established risk thresholds. Secondary aims were to determine which subtasks during colonoscopy are associated with the greatest risk and to evaluate an intervention to reduce risks.
Twelve endoscopists performed 2 to 4 colonoscopies while thumb pinch force and forearm muscle loads of extensor carpi radialis (ECR) and flexor digitorum superficialis (FDS) muscles were collected. Peak exertion values were analyzed using amplitude probability distribution functions. An endoscope support device was evaluated during simulated colonoscopy (n = 8).
Mean endoscopist age was 42.3 years; 67% were men. Peak thumb pinch force exceeded risk thresholds for pinch force (10 N) and percent of time spent in forceful pinch for all colonoscopy subtasks. Peak ECR and FDS muscle activity exceeded the action limit (10% maximum voluntary contraction [MVC]) in both forearms. Peak left FDS, left ECR, and right ECR activity exceeded the threshold limit value (>30% MVC). Peak left FDS and ECR activity were significantly greater during insertion than during withdrawal (P < .05). Peak right FDS and ECR activity were significantly greater during right colon insertion compared with withdrawal (P < .05). The endoscope support device reduced left ECR muscle activity (P = .02).
Thumb pinch forces and time spent in forceful pinch indicate high-risk exposures during colonoscopy. Left wrist extensor muscle activity exceeded established thresholds with the greatest risk occurring during insertion. An endoscope support device reduced loads to the left wrist extensors.
内镜医师会经历上肢肌肉骨骼损伤。本研究的主要目的是比较结肠镜检查中远端上肢生物力学危险因素与既定风险阈值。次要目的是确定结肠镜检查中哪些子任务与最大风险相关，并评估一项降低风险的干预措施。
12 名内镜医师在进行 2 到 4 次结肠镜检查时，同时采集拇指捏力和伸腕肌（桡侧腕伸肌和指浅屈肌）的前臂肌肉负荷。使用幅度概率分布函数分析峰值用力值。在模拟结肠镜检查中评估了一种内镜支撑装置（n=8）。
平均内镜医师年龄为 42.3 岁；67%为男性。在所有结肠镜检查子任务中，拇指峰值捏力超过捏力（10 N）和用力捏力时间的风险阈值。双侧前臂的峰值桡侧腕伸肌和指浅屈肌活动均超过动作极限（10%最大自主收缩[MVC]）。左侧 FDS、左侧 ECR 和右侧 ECR 的峰值活动超过阈值极限值（>30% MVC）。与退出相比，插入时左侧 FDS 和 ECR 活动的峰值显著更高（P<.05）。与退出相比，在右半结肠插入时，右侧 FDS 和 ECR 活动的峰值显著更高（P<.05）。内镜支撑装置减少了左侧 ECR 肌肉活动（P=.02）。
拇指捏力和用力捏力时间表明结肠镜检查中存在高风险暴露。左侧腕伸肌活动超过既定阈值，插入时风险最大。内镜支撑装置可减少左侧腕伸肌的负荷。
