Positive Provocative Testing and Symptom Evaluation for Detecting Upper Extremity Repetitive Use Injuries Among Endoscopists

Background: Endoscopists have reported experiencing musculoskeletal pain, yet a comprehensive and objective investigation into repetitive use symptoms or injuries has not been conducted. We aim to evaluate a cohort of endoscopists for upper extremity repetitive use injury. Methods: We employed a 43 author-developed questionnaire as well as the validated QuickDASH (Disability of Arm, Shoulder, Hand) questionnaire. Subjects were evaluated by occupational therapists to identify clinical evidence of injury. Demographic factors, reported symptoms, and signs of injury were then analyzed. Results: Overall, 34.3% reported experiencing pain while 17.1% reported numbness. In the prior week, 48.5% of participants had been bothered by pain, 11.4% felt tingling, 17.1% experienced interrupted sleep, and 17.1% reported limitations in work duties. Physical testing revealed that many endoscopists had below-normal strength in their right grip (48.6%) and left grip (42.9%), and 88.6% had below-normal pinch strengths for their age and gender. Additionally, 71.4% of the group had at least one abnormal positive provocative test. Participants who reported numbness at night (p=0.015) and those who reported current pain (p<0.001) reported higher DASH disability scores. 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). Performing ERCP 20-60% of the week was more likely to result in decreased bilateral pinch strength. Conclusions: Our study found a high prevalence of repetitive use injury symptoms among endoscopists, corroborated by objective physical examination and testing.

Publication History

Received: 12 December 2024

Accepted after revision: 07 May 2025

Accepted Manuscript online:
12 May 2025