OUR LUCAYA, BAHAMAS Performing Mohs surgery or other close, long-duration procedures may cause repetitive strain injuries, Dr. Henry W. Randle said at the annual meeting of the American Society for Mohs Surgery.
Mohs surgeons are at particular risk for injuries resulting from prolonged work that involves repetitive movements and awkward body positions. "Even young surgeons are at risk. Early intervention is important," said Dr. Randle of the Mayo Clinic, Jacksonville, Fla., whose interest in the topic stemmed from his own experience with neck pain after years of performing Mohs surgery.
A survey of 17 Mohs surgeons from three Mayo Clinic sites (Florida, Minnesota, and Arizona) revealed surprising results: 16 reported symptoms of repetitive strain injuries. Of those, 12 said the symptoms started while they were performing Mohs surgery, while 4 reported preexisting conditions that worsened during the procedure. "This was really quite striking. I thought we'd find three or four," he said.
The group comprised 12 men and 5 women, with a mean age of 39.5 years. They had an average of 7 years' experience with Mohs surgery, spending approximately 24 hours per week performing the procedure. The majority (14) operated primarily while standing.
Among the 12 who reported symptoms that began while practicing Mohs, the average age of onset was 35.4 years after a mean of just 2.5 years in practice. "This was much earlier than I thought … It happens very early in your career," he said.
Neck pain was the most common complaint, affecting 10 of the 17 respondents. Shoulder pain was reported by 9, low back pain by 7, eye fatigue/burning by 5, headaches, by 4, and leg edema by 3. Low back pain was more common among the surgeons who typically worked while standing, while neck pain was more common among those who were usually seated while doing Mohs.
But on the bright side, there are ways of minimizing these problems. After analyzing videotapes of six study participants, an expert in occupational medicine and ergonomics made the following recommendations to alleviate the various symptoms:
▸ Neck pain. Often a result of too much distance between the surgeon and the patient, neck pain can be exacerbated by bulky operating tables that require the surgeon to bend over too far. Less bulky operating tables, such as dental chairs, can allow for closer access to the patient. Odd angles of the neck can also lead to pain. Repositioning yourself in front of the patient and taking frequent breaks to stretch can provide relief.
▸ Shoulder pain. Reaching over the patient is a common cause. Sometimes with older patients who can't move themselves very easily, surgeons will tend to adjust themselves around the patient. But it's better to move the patient (or have the nurse do it) than to strain. A chair that provides sternal support allows the surgeon to rest his or her elbows while leaning forward over the patient, thereby easing tension in the neck, Dr. Randle explained.
▸ Low back pain. Surgeons with low back pain who stand for Mohs surgery might try sitting. Chairs with sternal support can also help alleviate low back pain. For those who still want to stand, "sit stands" allow the surgeon to take short breaks and lean back during the procedure.
▸ Eye fatigue and headaches. Bright lights and glare contribute to both problems. Lowering the lighting in the room and using black instruments may help.
▸ Leg edema. Inactive posture is the culprit here, but the problem can be alleviated by moving around and taking frequent breaks. Sitting, foot rests/rails, and compression stockings may also help. Floor mats with surface variations have been installed in the operating rooms at Mayo to help alleviate foot pressure. Gel-containing shoe inserts available over the counter at drugstores can accomplish the same thing.
During the question and answer period, audience member and fellow conference speaker Dr. Daniel Buchen, who is in private practice in New Jersey and Staten Island, N.Y., told the audience that he is a loyal follower ofbut has no financial ties toa program called PowerPosture (www.powerposture.com