In 1996, Dr. Ronald Ailsby, a Canadian orthopedic surgeon who had treated a number of bovine practitioners with shoulder and neck pain, hypothesized that performing reproductive examinations on large animals was associated with injury to the cervical plexus.1 Since then, several epidemiological studies of musculoskeletal injuries and discomfort (aches or pain in muscles, bones, or tissues) in veterinarians have been conducted in the United States,2–6 Australia,7 New Zealand,8,9 Europe,10–12 Turkey,13 and western Canada,14,15 with 3 of those studies2,7,14 focusing specifically on MSKD of veterinarians who work with cattle. Although the scope varied among those studies,1–15 the prevalence of MSKD among large animal veterinarians was consistently high, with the lifetime prevalence of MSKD ranging from 47% to 71% among large animal veterinarians in the United States.2,4,6 In a New Zealand study,8 the mean prevalence of any type of MSKD during the preceding 12 months was 100% (95% CI, 96% to 100%) among large animal veterinarians. In many studies, the region comprised of the neck and upper extremities (defined as neck, shoulders, upper back, arms, elbows, wrists, and hands) was the most common or second most common body region affected by MSKD in veterinarians.4,6,8,11
On average, each bovine practitioner in western Canada performs > 8,000 reproductive examinations/y, generally in the fall or early winter for beef cattle and year-round for dairy cattle.14 In cattle, reproductive examination is conducted primarily for determination of pregnancy status and is generally performed by manual insertion of the practitioner's arm into the rectum with or without an ultrasound probe, or insertion of an ultrasound probe into the rectum by use of an ultrasound handle extender, which eliminates the need for the practitioner to insert their arm into the rectum. Regardless of the method used for reproductive examination, bovine practitioners are exposed to repetitive and forceful nonneutral postures, or ergonomic hazards.15 Manual insertion of an arm into the rectum of a cow requires high force initially to pass through the anal sphincter and then nonneutral postures must be assumed to maintain body stability against the movements of the animal.15 There is evidence that awkward (nonneutral) postures, high forces, and repetitive movements can contribute to MSKD or injuries.16,17
Reproductive examination is consistently proposed as a major contributor to MSKD in large animal veterinarians on the basis of survey results.6,9,13 In a survey18 of Utah veterinarians, 40 of 43 (93%) respondents who frequently performed reproductive examinations on large animals (cattle and horses) reported MSKD that they attributed to that task. However, epidemiological studies have yielded equivocal results regarding the role of reproductive examination of large animals on the incidence of musculoskeletal injuries and MSKD in large animal practitioners. In a study8 of New Zealand veterinarians, the self-reported number of reproductive examinations performed each year was associated with the self-reported number of work-preventing musculoskeletal events, but a consistent dose-response relationship was not established. In a study7 of Australian bovine practitioners, obstetric procedures including reproductive examinations accounted for most serious injuries (ie, injuries that required hospitalization or prevented the practitioner from working), although only 17% of injuries associated with reproductive examination were attributed to overexertion or strain. Results of a study2 of members of the American Association of Bovine Practitioners indicated that although MSKD was most commonly reported for the arm and shoulder predominately used for reproductive examinations, the amount of exposure (ie, number of reproductive examinations performed) was not predictive of the likelihood of MSKD, and the severity of MSKD was not reported. In a study11 of German veterinarians, reproductive examination was associated with a small and nonsignificant increase in the odds of self-reported work-preventing injuries to the hand, wrist, and elbow. Only a study6 of California practitioners identified a significant, albeit small, dose-response relationship between the self-reported percentage of time spent performing reproductive examinations and the self-reported incidence of MSKD.
Our research team recently published a descriptive analysis14 of bovine veterinarians in western Canada. In that study,14 we quantified the prevalence of MSKD among survey respondents, described the effect of MSKD on veterinary work-related activities, and identified the most physically demanding tasks for further investigation. One hundred nineteen of 133 (89.5%) respondents indicated that they had experienced MSKD in the preceding 12 months, with the most commonly affected body regions being the shoulder (85/133 [63.9%]), lower back (75/133 [56.4%]), and neck (68/133 [51.1%]).14 Thirty-five of 133 (26.3%) respondents reported MSKD that interfered with regular work activities in the 12 months preceding the survey.14 One hundred two of 357 (28.6%) respondents indicated that reproductive examination was 1 of the top 3 most physically demanding tasks that they engaged in at work.14 A secondary analysis of those data revealed that practitioners who were female, less experienced, worked in larger practices, and engaged in primarily mixed-animal work were more likely to have MSKD of the shoulder.15
The purpose of the study reported here was to identify individual and work-related risk factors associated with work-preventing MSKD of the upper extremities of bovine practitioners working in western Canada. We hypothesized that the cumulative workload associated with reproductive examinations would be a significant predictor of MSKD in the upper extremities of survey respondents.
Supported by the Canada Research Chairs program (No. 228136) and the University of Saskatchewan Department of Medicine Grant program. Funding sources did not have any involvement in the study design, data analysis and interpretation, or writing and publication of the manuscript.
The authors declare that there were no conflicts of interest.
The authors thank Xiaoke Zeng for implementing the survey and conducting the descriptive analysis.
Standardized Nordic questionnaire
Western Canadian Association of Bovine Practitioners
SPSS for Windows, version 25.0, IBM Corp, Armonk, NY.
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