Association for Academic Surgery (AAS)

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Learning From My (Ergonomic) Mistakes

I had not been an attending and operating for more than a few months before the insidious onset of pesky pains in the shoulder, elbow, and wrist of my dominant arm. Initially, I figured out “workarounds” to minimize or avoid painful movements and positions when possible, and pushed through the pain when unavoidable. I acquired quite a collection of menthol and camphor-containing products, ice packs, and NSAIDs in my office and at home. My injuries got to the point that it hurt to place or grab even light objects from the front passenger seat of the car, to push open doors, and then even to push elevator buttons. It wasn’t until I started experiencing the earliest twinges of discomfort in my non-dominant compensating arm that I sought advice from two of my colleagues and mentors. “You have to go see Dr. F” and “Dr. F is amazing!” they separately told me. Dr. F, as it turned out, was akin to the team physical therapist for our sarcoma surgery faculty. At one point that winter, 3 of us were his patients simultaneously. Under Dr. F’s care and guidance, my symptoms improved and eventually resolved.

Over the next few years, I was both relieved (that I wasn’t particularly ill-suited physically to be a surgeon) and distressed to learn how common musculoskeletal injuries are among surgeons. A nearby physical therapy center has treated more surgeons from my institution than I can count on my digits – and surely many more from the Texas Medical Center overall. Neck, back and shoulder pain was endemic. Although there are over 7300 Pubmed search results with the query “(surgery) AND (ergonomic)”, primarily published in the last 20 years, musculoskeletal symptoms are common among surgical trainees and surgeons in practice.1-2  Epstein et al conducted a recent systematic review and meta-analysis of 21 studies of physicians in procedural specialties.1 Among their findings, a significant proportion of physicians in procedural specialties suffered from work-related musculoskeletal disorders (MSDs) , including degenerative cervical (17%) and lumbar (9%) spine disease and rotator cuff pathology (18%).  12% required leave of absence, practice restriction or modification or early retirement. Despite this pervasive issue, the same group conducted a survey of 441 U.S. surgical residency programs (with 130 respondents) and found that surgical ergonomics education is rarely provided either formally (1.5%) or informally (25.4%).2

As I’ve become more attuned to my own ergonomic needs and shortcomings, and develop and recover from MSDs, I find that I have been paying greater attention to the ergonomics of our trainees. At 5’4” I’m often the shortest person at the OR table and nearly always on steps. I nag about table height, about forward head posture (aka “chicken neck”) when I see it, and about the position of their shoulders and elbows. I only wear loupes and headlight if absolutely necessary and I tell the fellows the same. I’m also thinking about the importance of ergonomics in the laboratory as I’m outfitting and establishing my laboratory. I recall my research fellowship years over a decade ago. There were hundreds of hours sitting awkwardly at the tissue culture hood, probably with chicken neck posture, and working at a bench top too high for me. There were so many repetitive motions in the lab, from snapping open and close thousands of Eppendorf tubes to innumerable reps of pipetting reagents and reaction mixtures up and down. Past personal experience (unfortunately) informs me now to invest in electronic pipetters and manual light touch pipette models, to configure the benchtops so things are within easy reach and with space underneath them (cutouts) to allow one to sit as close to the bench as possible. Unlike for surgical ergonomics, I found virtually nothing about laboratory ergonomics in the literature, save for an OSHA Fact Sheet and university EHS websites.5-8 Many of these recommendations are simple enough to implement and important to know and take to heart, so I share these with you.

I’m glad to see and appreciate the many efforts of surgical societies and surgical colleagues to bring ergonomics to the forefront in recent years.3-4 Institutions should also emphasize and prioritize the physical health and ergonomic well-being of their employees and invest in education, training, and material resources toward this end. The surgeons’ lounge at my hospital underwent a “refresh” this year. The update I most appreciate is the replacement of the static desks at each workstation with electric sit-stand workstations. #Game-changer.

  1. Epstein et al. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists A Systematic Review and Meta-analysis. JAMA Surg. 2018;153(2):e174947.
  2. Epstein et al. The Current State of Surgical Ergonomics Education in U.S. Surgical Training: A Survey Study. Ann Surg. 2019 Apr;269(4):778-784.
  3. https://www.societyofsurgicalergonomics.org/
  4. https://www.facs.org/for-medical-professionals/education/programs/surgical-ergonomics/
  5. https://www.osha.gov/sites/default/files/publications/OSHAfactsheet-laboratory-safety-ergonomics.pdf
  6. https://ehs.umass.edu/ergonomics-lab
  7. https://ehs.unc.edu/topics/ergonomics/laboratory-ergonomics/
  8. https://www.ehs.pitt.edu/workplace/ergonomics/lab
Emily Keung

Emily Keung

Dr. Keung is a surgeon-scientist who leads a translational research program studying the soft tissue sarcomas. She received her undergraduate degree from Harvard College and her medical degree from Harvard Medical School and completed general surgery residency and surgical critical care fellowship at Brigham and Women's Hospital and fellowship in Complex General Surgical Oncology at MD Anderson Cancer Center. She is a recipient of a Sarcoma Foundation of America Research Award, Society of Surgical Oncology Young Investigator Award, Society for Immunotherapy of Cancer Steven A. Rosenberg Scholar Award, and is a current participant of the MD Anderson Physician Scientist Program and the National Cancer Institute’s Early-Stage Surgeon Scientist Program.