Institutions University of Utah, USA.

Disclosure compliance I understand.

Participant disclosure Elizabeth Cardell: NO financial relationship with a commercial interest; Jamie Latham: NO financial relationship with a commercial interest; Linda Amoafo: NO financial relationship with a commercial interest; Yue Zhang: NO financial relationship with a commercial interest; Brinnlie Harward: NO financial relationship with a commercial interest; Kathryn Byrne: NO financial relationship with a commercial interest; Natalie Mudrow: NO financial relationship with a commercial interest; John Fang: Consulting: Merit Medical.

Introduction.

Rates of musculoskeletal pain have been reported as 29%-89% of endoscopists in survey studies. No studies have queried an entire group of endoscopists for repetitive use symptoms. In addition, no study has tested or performed provocative testing on endoscopists for evidence of repetitive use injury.

Aim.

To query, examine and perform provocative testing of a complete cohort of endoscopists for evidence of upper extremity repetitive use injury.

Methods.

The study population consisted of faculty and fellows of an entire academic division of gastroenterology who perform endoscopy (n=35). The group completed 2 questionnaires: a self-report of symptoms related to performing endoscopy procedures (43 questions) and the QuickDASH (Disability of Arm, Shoulder, Hand) validated questionnaire evaluating the impact of symptoms on activities. The group then underwent evaluation by occupational therapists consisting of strength testing and a series of provocative tests to identify clinical evidence of injury. Demographic factors, reported symptoms and signs of injury were then analyzed for correlations.

Results.

Demographic and questionnaire responses are summarized in Table 1. Over one-third (34.3%) of the participants reported current pain and 17.1% reported numbness. In the week prior, 48.5% of the participants had been bothered by pain, 11.4% felt tingling, 17.1% had interrupted sleep and 17.1% limitations in work duties. Physical testing indicated many endoscopists had below normal strength in right grip (48.6%) and left grip (42.9%) and 88.6% had below normal pinch strengths for their age and gender. Finally, 71.4% of the group had at least one abnormal positive provocative test (Table 2).

Higher DASH disability scores were reported by participants reporting numbness at night (p=.015) and those who reported current pain (p <.001). Current pain was also associated with performing 20+ procedures per week (p=.007). Those with a positive provocative test of the neck or elbow were likely to have below normal pinch (p<.05) and grip strength (p<.05). When considering years and hours/week performing procedures, those performing less years and those with lower hours had lower DASH disability scores, while those performing more years and those with more hours had higher disability scores. Performing ERCP 20-60% of the week was also more likely to result in decreased bilateral pinch strength.

Conclusions.

Results from our self-report survey suggest that symptoms of repetitive use injury are high in our inclusive group of endoscopists and in the range reported previously. Physical exam and provocative testing confirmed a corresponding very high incidence of repetitive use injury. Reported symptoms and physical evidence of repetitive use injury is related to duration performing endoscopy and procedure type.