ENTtoday

How Surgical Ergonomics Impact Surgeon Wellbeing, Outcomes, and Careers

by Julie L. Wei, MD, MMM •

  • Ensure that the neck and back are in alignment. Avoid overflexion of the neck and forward head posture, as both increase neck pain. Surgeons should maintain a neutral position as much as possible.
  • Align the neck, back, and hips while operating.
  • Ensure that the OR table height and monitor placement are at eye level and support a neutral craniovertebral position without strain.
  • Stabilize the arms to ensure good neck and back alignment when performing an airway endoscopy.
  • Adjust your seat, back rest, and arm rest, and use the arm stabilizer, as well as optimal patient positions, to support good ergonomics.
  • Do passive stretching in the OR before, after, and between cases.
  • Raise your arms and use I-beam clamps for straight arm lean and bent arm hang.
  • Ensure that you have good neck and back alignment when examining patients.
  • Never delay intervention once symptoms appear.

Donald Shrump, Jr., DC, MS

Dr. Shrump has worked with elite athletes around the world in countless professional sports organizations, including the NFL, NBA, NHL, MLB, MLS, NCAA, and organizations that work with elite junior athletes.

During his presentation, Dr. Shrump highlighted the fact that neck, back, and shoulder pain all require breathwork, stretches, intra-op optimizations, microbreaks, and awareness. Specifically, progressive training in deep cervical deep flexors, the core, and arms are needed for neck, back, and shoulder pain, respectively. Dovetailing with my recent ENTtoday article on wearable technology (see the May 2023 issue), Dr. Shrump also highlighted wearables surgeons can try to improve posture and ergonomics.

Dr. Shrump also mentioned data-based gender-specific differences in the risk of musculoskeletal (MSK) injury from professional athletic training that has changed the demand and training schedule for elite female athletes according to their menstrual cycles. Hormonal changes before, during, and right after their cycles increase the risk for women to suffer MSK injuries and impact their performance. It makes sense, and yet I wonder how many others in the audience felt a moment of discomfort. I did—after all, who would mention physician menstrual cycles at a national surgical scientific meeting? Although the culture of surgical training has traditionally been dominated by males, and being a female subjects trainees and surgeons to existing implicit and explicit biases regardless of our efforts, skills, and accomplishments, bodily functions like menstruation do have a scientific effect on our bodies.

Stephanie Pearson, MD

“Ergonomics is the No. 1 cause of all disability insurance claims, as work-related musculoskeletal disorders are highly prevalent,” Dr. Pearson told the audience. “The cost to the physician isn’t limited to their difficulty/inability to perform their job. There’s a physical, mental, and financial toll on the individual. There’s pain management, loss of identity, depression, and standard of living issues. Many physicians will continue to practice in pain instead of acknowledging that they aren’t OK—until it’s too late.”