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How Surgical Ergonomics Impact Surgeon Wellbeing, Outcomes, and Careers

by Julie L. Wei, MD, MMM •

I’m grateful to be resuming my clinical and surgical career this fall. I’ve endured three years of WMSD, from initial frozen shoulder (adhesive capsulitis) symptoms in 2019 that persisted despite injections, and then, after shoulder decompression surgery, a significant loss of range of motion from my right frozen shoulder and chronic shoulder pain from April 2021 to December 2022. That was followed by cervical radiculopathy from November 2021 to July 2022. A chance to now return to a career I love is a gift beyond description.

I now know the reasons for why I’ve experienced the unimaginable in terms of MSK. I’ve worked over 20 years with poor surgical ergonomics as a pediatric otolaryngologist with poor surgical ergonomics, and suffered excessive neck flexion for countless adenotonsillectomy cases, use of binocular microscopes and loupes for open cases and LTRs, chronic stress with tension carried in my neck and shoulders, poor compensatory and weak muscles, lack of core strength, reaching menopause at 40, holding asymmetric body positions, never stretching before, during, or after OR cases and clinic days, and there were some whiplash injuries from few car accidents in my early adulthood.

Tendy Chiang, MD

Dr. Chiang discussed a study he published in 2020 to demonstrate ergonomic risk in pediatric otolaryngology. His team used Rapid Upper Limb Assessment and calculated the risk of musculoskeletal loading within the upper limbs and neck, confirming that ergonomic risk is quantifiable and found in high-volume procedures such as adenotonsillectomy and tympanostomy. In fact, 100% of cases were performed with increased ergonomic risk. (Otolaryngol Head Neck Surg. 2020;163:1186–1193).

That study was followed up with a study published last year on using craniovertebral angle to quantify intraoperative ergonomic risk. (Otolaryngol Head Neck Surg. 2022;167(4):664–668). The authors reported the following:

  • The craniovertebral angle (CA) is defined as abnormal if it’s < 50°.
  • All surgeons had an abnormal CA while performing tonsillectomies, with an average CA of 24.9°.
  • There was a high interrater reliability.
  • The CA can be used to quantify the effects of ergonomic interventions such as vibrotactile biofeedback.

Dr. Chiang’s most recent study was on the association of vibrotactile biofeedback with reduced ergonomic risk during tonsillectomy (JAMA Otolaryngol Head Neck. 2023;149:397–403) Conclusion from this study included the following:

  • Common surgeries place us at substantial ergonomic risk for injury.
  • Vibrotactile biofeedback significantly reduces neck, back, and trunk ergonomic risk.
  • Ergonomic interventions and education have the potential to prevent WMSD and improve overall quality of life.

Daniel Wohl, MD

Next, Dr. Wohl shared the following ergonomic pearls regarding the OR and clinics with the audience: