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Fixing Hands, Breaking Backs: The Ergonomics and Physical Detriment of the Hand Surgeon
Sami P Tarabishy, MD1, Geoffrey Brown, MD1, Milton Armstrong, MD2 and Fernando Herrera, MD3, (1)Medical University of South Carolina, Charleston, SC, (2)Chief, Division of Plastic and Reconstructive Surgery, Medical University of South Carolina, Charleston, SC, (3)Division of Plastic Surgery, Medical University of South Carolina, Division of Plastic Surgery, Charleston, SC

Introduction:
Work-related musculoskeletal disorders (WMSDs) in surgeons have been well documented in the literature, with rates at high as 66%-94% for open surgery and 73%-100% for conventional laparoscopy. 78 to 81% percent of plastic surgeons have work related musculoskeletal symptoms, most commonly in the neck, shoulders, and lower back. Hand surgeons represent a unique surgical population due to frequent use of operative magnification and sitting stools. The purpose of this study is to examine the frequency and types of musculoskeletal work-related injuries experienced by hand surgeons and the factors that may contribute to those injuries.

Methods:
A pre-approved REDCap® survey was emailed to all active members of the American Association for Hand Surgery (AAHS). This survey included 12 demographic and 13 Nordic Musculoskeletal questions. Invitations were sent twice, and data collection remained open for 30 days.

Results:
1200 AAHS members were invited. 96(8%) responses were received with the majority being in the age range of 35-44 yrs. (34,35.4%), male (67,69.8%), attendings (88,91.7%), in academic practice (48,50%).

69(71.9%) respondents attribute discomfort to their profession, most commonly pain (56, 82.4%) and stiffness (46,67.6%), with pain in the last year reported most frequently in the neck (57, 59.4%) and wrist/hand (48, 50%) regions. 59(61.5%) of respondents had acute (<1 week) musculoskeletal discomfort, with the majority localized to the neck (27,28.1%), wrist/hand (25,26%), and lower back (18,18.8%). The onset of discomfort was most frequently reported after surgery (hours to days later) (45,48.9%).

Exercise was the most frequently reported therapy (37,40.2%) followed by modification of work environment (30,32.6%). For other medical therapies, most respondents reported use of over-the-counter medications (12,63.2%) and massage therapy (7,36.8%).

32(34.8%) of respondents state they worry these symptoms will interfere with ability to perform surgery in future. 16(16.7%) respondents have sustained a MSK injury directly related to work, and 7(43.8%) of those respondents had to decrease surgical workload while 10(62.5%) had to receive treatment for the injury.

Conclusion:
The ergonomics of hand surgery, including the use of loupes, microscopes, and sitting stools, appears to cause significant discomfort and detriment to the hand surgeon, especially in the neck and upper extremity. Our data indicate that hand surgeons have similar rates of musculoskeletal discomfort attributed to their profession as other previously studied "high risk" surgical subspecialties. Further research on injury patterns will allow the development of ergonomic preventative measures with the goal of facilitating longer and more productive careers for hand surgeons.


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