title: Pinch force and forearm-muscle load during routine colonoscopy: a pilot study.
abstract: OBJECTIVE
  Overuse injuries of the hand, wrist, forearm, and shoulder are common among endoscopists and may be from repetitive pinching and gripping forces or awkward posturing. In this pilot study, we evaluated distal upper-extremity musculoskeletal load during colonoscopy (1) to confirm the feasibility of performing ergonomic measurements in endoscopists and (2) to identify tasks that may contribute to overuse injuries.
  
  
  METHODS
  Three experienced gastroenterologists were evaluated during 3 colonoscopies each.
  
  
  METHODS
  Veterans Affairs Medical Center, San Francisco, California.
  
  
  METHODS
  Right-thumb pinch force using a thumb-force sensor and bilateral forearm-muscle activity using electromyography.
  
  
  RESULTS
  The mean duration of the 9 colonoscopies was 19.5 minutes. The highest mean (SD) right-thumb peak pinch forces occurred during left (10.4 [4.1] N) and right (10.1 [4.5] N) colon insertion, which exceeded the injury threshold of 10 N. Mean peak forearm-muscle activity was also greatest during left and right colon insertion. Activity of the left abductor pollicis longus, left extensor carpi radialis, and right extensor carpi radialis exceeded the American Conference of Industrial Hygienists (ACGIH) hand activity level (HAL) action limit. The left extensor carpi radialis was at the ACGIH HAL threshold limit.
  
  
  CONCLUSIONS
  The small sample size, no force measurement for the left thumb, and all the gastroenterologists were men.
  
  
  CONCLUSIONS
  The pinch forces and forearm-muscle loads applied during routine colonoscopy may pose a risk for overuse injuries at the elbow and wrist.
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California 94121, USA. amandeep.shergill@ucsf.edu
authors.forename: Amandeep K
authors.initials: AK
authors.lastname: Shergill
authors.forename: Krishna R
authors.initials: KR
authors.lastname: Asundi
authors.forename: Alan
authors.initials: A
authors.lastname: Barr
authors.forename: Janak N
authors.initials: JN
authors.lastname: Shah
authors.forename: James C
authors.initials: JC
authors.lastname: Ryan
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: McQuaid
authors.forename: David
authors.initials: D
authors.lastname: Rempel
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D003113:Colonoscopy / Q000379:methods*; D004576:Electromyography; D005260:Female; D005542:Forearm / Q000502:physiology; D005762:Gastroenterology; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D009140:Musculoskeletal Diseases / Q000517:prevention & control; D009784:Occupational Diseases / Q000517:prevention & control; D016272:Occupational Health; D010865:Pilot Projects; D052581:Pinch Strength; D011336:Probability; D013314:Stress, Mechanical; D013933:Thumb / Q000502:physiology