Ergonomics and Musculoskeletal Health in Endoscopy

Endoscopy practitioners are subject to repetitive movements, sustained awkward postures and forceful manipulations when manoeuvring endoscopes and associated instruments. Such demands place significant strain on the neck, shoulders, back, hands and wrists, giving rise to musculoskeletal disorders (MSDs) that impair performance and reduce career longevity. Procedure duration, case volume and the complexity of therapeutic interventions exacerbate cumulative trauma, while suboptimal room layout, non-adjustable equipment and inadequate rest breaks deepen risk. Ergonomic principles address these challenges through workspace design, adjustable patient tables, optimised handgrip ergonomics and procedural workflow. Educational initiatives that integrate ergonomic training into endoscopy curricula promote awareness of neutral postures, microbreak strategies and the use of supportive aids. Emerging solutions include computer-vision posture analysis, bespoke support fixtures and instrument redesign to distribute forces more evenly. These developments not only enhance practitioner wellbeing but can improve procedural efficiency and patient safety. A concerted research effort now focuses on quantifying exposure, defining evidence-based preventive protocols and assessing novel interventions in a range of endoscopic subspecialties worldwide.

Research from Nature Portfolio

Recent studies have quantified the prevalence and impact of work-related MSDs among high-volume endoscopists, revealing that over 80 percent experience general musculoskeletal symptoms and nearly 77 percent attribute these to endoscopic activity. The neck, lower back, shoulder and thumb emerge as the most affected regions. Age, years of professional experience and weekly procedure count were identified as key risk factors. A notable proportion of practitioners reported temporary absence from work, analgesic use and physiotherapy, underscoring the need for targeted prevention. This work highlights the importance of standardised assessment tools and calls for interventional trials to refine workplace modifications and ergonomic guidelines.

Ergonomics and Musculoskeletal Health in Endoscopy publication trend

The graph below shows the total number of articles in ergonomics and musculoskeletal health in endoscopy across all publications each year (not limited to Nature Index journals).

Technical terms

Musculoskeletal disorders (MSDs): Injuries or pain affecting muscles, nerves, tendons, joints and spinal structures due to cumulative work-related stress.

Rapid Upper Limb Assessment (RULA): An observational ergonomic tool that rates postural risk factors for upper body to estimate potential for musculoskeletal injury.

Electromyography (EMG): A technique for recording electrical activity produced by skeletal muscles, used to assess loading and fatigue.

Decubitus position: The orientation of a patient lying on a surface (e.g., left or right lateral), which can influence the ergonomics of endoscopic procedures.

References

1. Review of Musculoskeletal Injuries and Prevention in the Endoscopy Practitioner. Journal of Clinical Gastroenterology (2014).
2. The impact of endoscopic activity on musculoskeletal disorders of high-volume endoscopists in Germany. Scientific Reports (2022).
3. Work-Related Musculoskeletal Injury Rates, Risk Factors, and Ergonomics in Different Endoscopic Specialties: A Review. Healthcare (2024).
4. An estimation of the endoscopist's musculoskeletal injury risk for right and left lateral decubitus positions during colonoscopy: a field-based ergonomic study. BMC Musculoskeletal Disorders (2023).
5. Pilot evaluation of a novel, automated ergonomics assessment tool. Endoscopy International Open (2025).