Generic filters

Colonoscopy Performance Produces Force Levels and Durations of Force Elevation That Are Associated With Upper Extremity Injury

Douglas K. Rex, MD, MASGE, reviewing Shergill AK, et al. Gastrointest Endosc 2020 Nov 5.

Musculoskeletal injuries are common in endoscopists.

This study used surface electromyography of wrist flexors and extensors as well as pressure transducers on the thumbs to measure force. Measurements were made for 12 endoscopists performing 2 to 4 colonoscopies each. Four of the endoscopists were female, and the mean age of all participating endoscopists was 42 years.

Peak thumb forces for both the right and left thumbs exceeded the threshold force levels and durations of time in forceful pinch that have been associated with injury. Peak forearm muscle activity was also increased to levels and durations above recommended safe levels, particularly during insertion as well as for the right forearm during insertion through the proximal colon. 

Compared to men, women tended to generate higher forces at potentially injurious levels for longer periods.

Douglas K. Rex, MD, FASGE


This study puts important quantitative measures around thumb and forearm stress during colonoscopy and suggests that colonoscopy inherently creates stresses that would be expected to produce injury. Mitigating techniques, exercises, ancillary devices, and alternative platforms are needed to reduce injury risks for endoscopists.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Shergill AK, Rempel D, Barr A, et al. Biomechanical risk factors associated with distal upper extremity musculoskeletal disorders in endoscopists performing colonoscopy. Gastrointest Endosc 2020 Nov 5. (Epub ahead of print) (

Scroll to Top