Treating, Not Ignoring, Our Own Aches and Pains

As hand and upper extremity surgeons, our goal is to make sure that every patient leaves with a well- formulated treatment plan to make their daily aches and pains go away. Between whipping in and out of examination rooms, we often overlook the simple suggestion that could help jump start rehabilitation for the car mechanic with a two- month history of lateral elbow pain or the secretary with new-onset carpal tunnel syndrome: ergonomic modifications in the workplace. Sometimes we are fortunate to have patients who have the insight and job environment to allow for such changes, but as we know, this isn’t always the case.

But what about physicians? Our job mandates a high level of critical thinking, preparation, and efficiency on a daily basis. It can be physically and mentally draining at times. As hand surgeons, we often brag to our surgical colleagues that we are lucky to have the luxury of sitting down during most surgeries. However, with our necks aching from wearing heavy loupes and our eyes tiring under the microscope, even as hand surgeons, we are clearly pushing the limits. At some point something’s got to give.

Unfortunately, we train and work in environments where we self- discourage any complaints of physical stress or fatigue [1]. Especially in production-based compensation systems, time off from work due to musculoskeletal disorders has obvious financial consequences. In fact, occupational injuries cost an astounding $190 billion annually in the United States due to lost productivity, and the health care industry ranks as the third most expensive of 313 national industries [2,3]. An estimated 83% of plastic surgeons and 44% of orthopaedic surgeons have had an occupational musculoskeletal injury at some point during their careers. Regrettably, the vast majority of these injuries go unreported and few surgeons have institutional resources available to help them recover [2,4].

There are no official guidelines specifically for preventing musculoskeletal injury in hand and upper extremity surgeons. Postural control is essential in the office and in the operating room. It has been well-recognized in industrial ergonomics that postural stress throughout the workday can lead to fatigue and disability [1].

Here are some ways you can improve your posture in the workplace:

1. Maintain an upright posture with a horizontal gaze.
2. Take brief breaks to re-evaluate one’s posture during lengthy surgeries.
3. Change the height of the table prior to the procedure to gain a comfortable resting posture especially when wearing magnifying loupes.
4. Use a computer stand or elevator in the office to help maintain a more horizontal gaze and neutral neck posture.
5. In cases involving arthroscopy, ensure that the monitors are in the appropriate position prior to the surgery.
6. Use an assistant to hold the camera while more fine instrumentation is being performed to avoid unnecessary struggling and stress on the shoulders.
7. For longer cases that involve standing, use a step stool for proper height, shift your body weight frequently, and stretch your legs during the operation to help reduce joint load.
8. Lastly, utilize your institution’s programs for physical wellness and stress management.

We are all fortunate to be in such a rewarding profession where we are able to take care of our patients so effectively, but we need to make sure in the process that we continue to take care ourselves.

References

1. Berguer R. Surgery and Ergonomics. Arch Surg. Vol 124. Sept 1999.
2. Davis WT, Sathiyakumar V, Jahangir AA, Obremskey WT, Sethi MK. Occupational injury among orthopaedic surgeons. J Bone Joint Surg Am. 2013 Aug 7;95(15):e107.
3. Leigh JP. Economic burden of occupational injury and illness in the United States. Milbank Q. 2011 Dec;89(4):728-72.
4. Capone AC, Parikh PM, Gatti ME, Davidson BJ, Davison SP. Occupational injury in plastic surgeons. Plast Reconstr Surg. 2010 May;125(5):1555-61
5. Shanafelt TD. Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. JAMA. 2009 Sep 23;302(12):1338-40