Background:

Repetitive strain injuries, cumulative trauma disorders, occupational overuse syndrome, or work related upper limb disorders are terms used to describe a loose group of conditions resulting from overuse of a tool/instrument or activities that require repetitive movement.  The syndrome affects muscles, tendons, and nerves in the hands, arms, back and neck.  The medically accepted condition in which it occurs is when muscles in these areas are kept tense for long periods of time, due to poor posture and/or repetitive motions.

The syndrome is most commonly associated with assembly line and computer workers, but can and does occur in the medical profession.  Occupational hazards in our specialty of Plastic and Reconstructive Surgery have previously been overlooked as we treat these problems on a daily basis related to other professions.

 The objective of this study was to survey ASPS/PSEF board-certified plastic surgeons about their experiences related to repetitive strain and occupational injuries/hazards throughout their career.  The goal is to be proactive during residency and early on in ones practice to prevent/limit potential injuries.

 Methods:

5,437 members were surveyed by questionnaire via email about the presence of occupational injuries/hazards in their practice.  The results were anonymous.  Questions relating to focus of practice (hand, craniofacial, cosmetic, micro. etc), years in practice, diagnosis of medical/musculoskeletal conditions, preexisting or acquired conditions/injuries, operative techniques, use of headlights, loupes, etc, as well as an open answer comment section to extrapolate and strengthen the survey, allowing surgeons to share their experiences. 

 Results:

5,437 surgeons were sent the survey with 1,843 responding; a response rate of 34%.  A number of email addresses were incorrect on the roster and returned, so several surgeons never received the survey.  In regards to scope of practice, 68.9% of responders performed hand surgery, 93.4% aesthetic surgery, 52.8% craniofacial, 87.2% reconstructive, and 9.7% other.  94.2% were still practicing when the survey was distributed, with 34% in practice less than 10years, 33.5% for 10-20years, and 31.7% greater than 20 years.  6% were retired.  The most common symptomatic complaints were pain, decreased joint motion, swelling, numbness, and tingling.  The most common locations: index PIP and thumb MP joints of the dominant hand, non-dominant index DIP, wrist shoulder and elbow of the dominant hand, cervical and lumbar spine.  15.6% were diagnosed with an injury, and 30.7% of those with an injury, underwent surgery or a procedure to treat the injury, with 58.9% claiming the treatment helped/changed the way they practiced.  85.8% of responders were male, 14.4% female (2.4% became pregnant while in practice/residency; 12.7% claimed the pregnancy affected their symptoms).  95% have been stuck by a needle, with 17.2% using double gloves.  9.4% collect disability for injuries occurring while practicing.  4.2% sustained an injury (physical/emotional) caused by a patient. 

 Conclusion
The appearance of musculoskeletal symptoms among plastic surgeons, even after a short time in practice, suggests that ergonomics should be covered in the educational system to reduce risks to surgeons.  Some of the first warning signs noticed, were lower back and cervical spine pain/strains that persisted and didn’t respond to over the counter medications.

Good posture, ergonomics and limiting time in stressful working conditions can help prevent/slow the progress of these disorders.  Physical and occupational therapy, stretches, strengthening exercises, yoga and biofeedback training have shown to reduce neck/shoulder muscle tension and can help heal existing or even prevent some disorders.

There were some interesting correlations found, such as injuries related to liposuction.  A correlation was found between transferring patients and back problems, between blunt finger dissection and joint arthritis as well as non-dominant digit injuries and blotting while dissecting.  The use of headlights, microscopes, lead aprons during fluoroscopy, and loupes also correlated to certain injuries and more detailed associations/findings will be discussed.