Characterization of right wrist posture during simulated colonoscopy: an application of kinematic analysis to the study of endoscopic maneuvers.

Background: Endoscopic maneuvers are associated with a high incidence of musculoskeletal injuries.

Objective: To quantify wrist motion patterns during simulated endoscopic procedures to identify potential causes of endoscopy-related overuse injury.

Design: Twelve endoscopists with different levels of experience were tested on 2 simulated endoscopic procedures that differed in their level of difficulty.

Setting: Right wrist movement patterns were recorded during simulated colonoscopies by using a magnetic motion-tracking device. Analysis focused on 3 wrist degrees of freedom: abduction/adduction, flexion/extension, and pronation/supination.

Interventions: Subjects were tested on 2 GI lower endoscopies (colonoscopies) on a simulator.

Main Outcome Measurements: Time spent within ranges of the entire wrist range of motion for 3 wrist degrees of freedom.

Results: Endoscopists spent up to 30% of the duration of the procedures at the extremes of the wrist joint range of motion. Endoscopic experience did not affect the time spent at the extremes of the wrist joint of motion. The time spent within each range of motion differed depending on the wrist degrees of freedom and difficulty of procedure.

Limitations: This study examined only 1 upper limb joint in a limited number of subjects and did not measure interaction forces with endoscopic tools.

Conclusions: We identified wrist movement patterns that can potentially contribute to the occurrence of musculoskeletal injury in endoscopists. This study lays the foundation for future work on establishing links between upper limb movement patterns and the occurrence of overuse injury caused by repetitive performance of endoscopic procedures.