Thumbs Up: Endoscopistʼs Thumb as an Occupational Hazard Related to High Volume Endoscopy

Abstract

Endoscopists performing high volume endoscopies are at risk of developing occupational injury related to mechanical stress on the tendons at the base of the thumb. de Quervains's syndrome, or stenosing tenosynovitis of the thumb tendon, has been reported as an occupational hazard of endoscopy [1]. It occurs as a result of repetitive overuse of the left thumb while grasping and turning the wheels of the endoscope while moving the wrist in radial and ulnar directions. This leads to thickening, inflammation and eventually stenosis of the fibrous tendon sheath as it passes over the distal radius. The friction-induced tenosynovitis can lead to fibrosis and eventually stenosing tenosynovitis. We describe a case of de Quervains's syndrome of the left thumb occurring in a high volume endoscopist that responded to conservative therapy. A 50-yr-old right-handed clinical gastroenterologist who had performed more than 25,000 endoscopies over the prior twenty years, with an increase in procedural volume in the last six years, complained of severe pain at the base of his left thumb. Pain would occur with exaggerated thumb movements during endoscopy. This interferred with performance of endoscopy. The pain would also awaken the physician in the middle of the night and interrupt sleep. Examination revealed moderate swelling and point tenderness over the left thumb tendons at the distal portion of the radial styloid. A positive Finkelstein's test was demonstrated, consistent with de Quervains's syndrome. He was treated with aspirin, thumb rest for one week, and a thumb splint at night. This treatment regimen resulted in clinical improvement such as to be able to continue his regular endoscopy schedule. de Quervains's tenosynovitis affecting the tendons of the thumb can occur as an occupational hazard of high volume endoscopy (1). It is caused by repetitive overuse of the left thumb during grasping and turning of the wheels of the endoscope while moving the wrist in radial and ulnar directions. The syndrome can respond to conservative therapy, as in our case. Other therapies include steroid injection with a reported 90% response rate, and surgical incision of the tendon. Rarely, when this syndrome is advanced, it may terminate an endoscopic career. (1) Cappell MS. Colonoscopist's thumb: DeQuervain's syndrome (tenosynovitis of the left thumb) associated with overuse during endoscopy. Gastrointestinal Endoscopy 2006, 64:841–843.