Pinch force and forearm-muscle load during routine colonoscopy: a pilot study

San Francisco Veterans Affairs Medical Center, San Francisco, California 94121, USA.
Gastrointestinal endoscopy (Impact Factor: 5.37). 02/2009; 69(1):142-6. DOI: 10.1016/j.gie.2008.09.030
Source: PubMed


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.
Three experienced gastroenterologists were evaluated during 3 colonoscopies each.
Veterans Affairs Medical Center, San Francisco, California.
Right-thumb pinch force using a thumb-force sensor and bilateral forearm-muscle activity using electromyography.
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.
The small sample size, no force measurement for the left thumb, and all the gastroenterologists were men.
The pinch forces and forearm-muscle loads applied during routine colonoscopy may pose a risk for overuse injuries at the elbow and wrist.

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    • "Reduced sensation in gripping may cause individuals to exert a higher/lower grip force due to a diminished sense of touch or a skinobject micro-slippage sensation Moberg (1962, 1964, 1975), Nowak et al. (2003), Johansson (1996), Johansson and Westling (1984b, 1987, 1991), Westling and Johansson (1984a, b), Lowe and Freivalds (1999), Thonnard et al. (1997, 1999), Hermsdorfer et al. (2004), Nowak and Hermsdorfer (2003) and Nowak et al. (2001) Increased sensation Increased sensation in gripping may cause individuals to exert a higher grip force based on the sensation of a more secure grip Seo et al. (2009), Adams et al. (2007), Asserin et al. (2000), Bobjer et al. (1993), Buchholz et al. (1988), Koudine et al. (2000), Savescu et al. (2008), Sivamani et al. (2003), Enders and Seo (2011) and O'Meara and Smith (2001) Pinch force Controlled pinch force Pinch forces are controlled, maintained and regulated in order to elaborately manipulate objects Freund et al. (2002), Iyengar et al. (2009), Rost et al. (2005), Seo and Armstrong (2008), Smaby et al. (2004) and Towles et al. (2002) High/low pinch force High/low pinch forces may affect the development of hand-related musculoskeletal disorders or injuries Eksioglu et al. (1996), Ellis et al. (2004), Shergill et al. (2009), Sokas et al. (1989) and Keir et al. (1998) Adjusted pinch force Pinch forces may vary when different pinch techniques are applied while conducting pinch-related tasks Smaby et al. (2004), Choi et al. (2010), Ellis et al. (2004) and Lau and Ip (2006) P.K. Ng et al. 198 can also be created. As such, the framework of this study can be proposed as shown in Figure 1. "
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    ABSTRACT: Although studies show that torque and sensation are important factors to consider in grip force, there appears to be few frameworks that focus on their roles in pinch force. This study proposes a framework that potentially explains the roles of torque and sensation in pinch force. A review was done on these factors followed by a literature synthesis which categorised them into sub-factors. The sub-factors were combined to output a framework that explains the mechanisms of their interactions. This framework enriches the knowledge on pinch force levels for reduced injury risks by identifying preliminary factors that may influence pinch force. It can potentially be used to improve the effectiveness of manufacturing tasks. Although further research on it is required, it still provides researchers with more factors to consider for studies on occupational risks and injuries. With this framework, researchers can potentially improve predictions on functional outcomes in precision manufacturing tasks.
    Full-text · Article · Apr 2014 · Theoretical Issues in Ergonomics Science
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    Full-text · Article · Aug 2009 · Gastrointestinal endoscopy
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    ABSTRACT: Background The endoscopy unit before remediation may be a high-risk area for slip and fall injuries due to a large number of exposed above-the-floor wires in the endoscopy rooms, dimmed lighting during endoscopic procedures, and staff inattention to obstacles due to preoccupation with the endoscopic patient. Aim To describe a novel, previously unappreciated workplace hazard to endoscopic personnel: Exposed wires in the endoscopy unit. Methods This study is a retrospective review of 110,000 endoscopic procedures performed during the last 5 years at an academic, teaching hospital with a high-volume endoscopy unit. All significant orthopedic injuries to endoscopic personnel from slips, twists, and falls from tripping over exposed cords in the endoscopy unit were reviewed. The severity of injury was documented based on roentgenographic findings, number of days of missed work, number of days with a modified work schedule, and requirement for orthopedic surgery. The number of potentially exposed cords per endoscopy room was determined. Results During the 5-year study period, three endoscopic personnel suffered significant orthopedic injuries from slips, twists, and falls from tripping over cords, wires, or tubing lying exposed over the floor in the endoscopy suite: The resulting injuries consisted of fourth and fifth metacarpal hand fractures due to a fall after tripping on oxygen tubing; a rib fracture due to tripping on electrical wires trailing from an endoscopy cart; and a grade II ankle sprain due to the foot becoming entangled in oxygen tubing. All injuries resulted in lost days of work [mean 9.3 ± 11.0 (SD) days] and in additional days of restricted work (mean 41.7 ± 31.8 days). One injury required orthopedic surgery. Hospital review revealed a mean of 35.3 ± 7.5 cords, wires, or tubing per endoscopy procedure room, the majority of which were exposed above the floor before remediation (n = 10 rooms). Remediation of exposed wires included: bundling related wires together in a cable to reduce the number of independent wires, covering exposed wires on the floor with a nonslip heavy mat, and running wires from ceiling outlets to equipment high above ground (e.g. mounted endoscopy video monitors). Conclusions Tripping, slipping, and falling over exposed wires can cause significant injury to endoscopic personnel. This previously undescribed hazard should be preventable by simple remediation, and all endoscopic personnel, hospital architects, hospital administrators, and governmental regulators should be alerted to this potential hazard
    No preview · Article · Oct 2009 · Digestive Diseases and Sciences
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