Surgeon Ergonomics During Arthroscopic Shoulder Surgery

Abstract

Background: Orthopaedic surgeons experience work-related musculoskeletal symptoms (WMS) due to working conditions. This study aimed to provide risk factors for WMS and preventative solutions during shoulder arthroscopy, as well as ergonomic differences between lateral decubitus and beach chair positioning. Methods: A pilot study of observational functional assessments through video analysis by an occupational therapist was performed. Two shoulder surgeons were recorded performing shoulder surgery in the lateral decubitus and beach-chair positions. Results: Surgeon A performed two procedures in the beach-chair position. Surgeon B performed a procedure in the lateral decubitus position. A risk factor for neck strain was monitor positioning. Shoulder strain was related to instrument length, patient height, and patient positioning in the lateral decubitus position, causing reaching and composite shoulder motions up to 90 degrees abduction with internal rotation and scapular elevation for periods of up to three-minutes. Repetitive end-range wrist motion was identified, as well as sustained static standing. Recommended solutions to preventing WMS were identified as monitor positioning perpendicular and at or slightly below surgeon eye level, minimizing back motion, employing proximal arm movements more often, and footwear or standing pads, or changing stance. Conclusion: Patient height, monitor position, length of arthroscopic equipment, working distance from the surgical field, and patient positioning in the lateral decubitus position were risk factors for WMS during arthroscopic shoulder surgery in this study. The lateral decubitus position resulted in increased, sustained periods of composite shoulder motions in positions at risk for WMS about the neck and shoulders.