Advertisement

Journal of Occupational Rehabilitation

, Volume 19, Issue 2, pp 175–184 | Cite as

Work-related Musculoskeletal Symptoms in Surgeons

  • Grace P. Y. Szeto
  • Pei Ho
  • Albert C. W. Ting
  • Jensen T. C. Poon
  • Stephen W. K. Cheng
  • Raymond C. C. Tsang
Article

Abstract

Introduction Surgeons are a unique group of healthcare professionals who are at risk for developing work-related musculoskeletal symptoms (WMS). The diversity of operating skills for laparoscopic and endovascular procedures impose different physical demands on surgeons, who also work under time pressure. The present study aims to examine the physical and psychosocial factors and their association with WMS among general surgeons in Hong Kong. Method A survey was conducted among surgeons working in the General Surgery departments in public hospitals of Hong Kong. Over 500 questionnaires were mailed and 135 surgeons completed the survey successfully (response rate 27%). Questions included demographics, workload, ergonomic and psychosocial factors. The relationship of these factors with WMS symptoms in the past 12 months was examined. Results Results indicated a high prevalence rate of WMS symptoms in surgeons, mainly in the neck (82.9%), low back (68.1%), shoulder (57.8%) and upper back (52.6%) regions. Sustained static and/or awkward posture was perceived as the factor most commonly associated with neck symptoms by 88.9% of respondents. Logistic regression showed the total score for physical ergonomic factors was the most significant predictor for all 4 body regions of musculoskeletal symptoms, with OR of 2.028 (95%CI 1.29–3.19) for the neck, 1.809 (1.34–2.43) for shoulder and 1.716 (1.24–2.37) for the lower back. Workstyle score was significantly associated with the symptom severity in the low back region (P = .003) but not with the other regions. Conclusion These results confirmed a strong association of physical and psychosocial factors with the musculoskeletal symptoms in surgeons. There is a potential for such musculoskeletal symptoms to escalate in the future, with rapid advances and increasing application of minimally invasive surgery.

Keywords

Work-related musculoskeletal symptoms Psychosocial Ergonomics Surgeons Laparoscopic and endovascular surgery 

Notes

Acknowledgments

The authors would like to express their sincere appreciation to the BUPA Foundation for funding this research project. We would like to thank the research assistants, Silvana Lau, YY Wong, Winnie Leung and Ted Wong. Without their help, this project would not be run so smoothly. We would also like to acknowledge Mr. Raymond Chung from the Hong Kong Polytechnic University, and Ms. TJ Yiao, from the Hong Kong University for providing expert advice on statistical analysis.

References

  1. 1.
    Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiological evidence and the debate. J Electromyogr Kinesiol. 2004;14:13–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Buckle PW, Devereux JJ. The nature of work-related neck and upper limb musculoskeletal disorders. Appl Ergon. 2002;33:207–17.PubMedCrossRefGoogle Scholar
  3. 3.
    Gerr F, Marcus M, Ensor C, Kleinbaum D, Cohen S, Edwards A, et al. A prospective study of computer users: I. Study design and incidence of musculoskeletal symptoms and disorders. Am J Ind Med. 2002;41:221–35.PubMedCrossRefGoogle Scholar
  4. 4.
    Szeto GPY, Lam P. Work-related musculoskeletal disorders in urban bus drivers of Hong Kong. J Occup Rehabil. 2007;17:181–98.PubMedCrossRefGoogle Scholar
  5. 5.
    Westgaard RH, Vasseljen O, Holte KA. Trapezius muscle activity as a risk indicator for shoulder and neck pain in female service workers with low biomechanical exposure. Ergonomics. 2001;44(3):339–53.PubMedCrossRefGoogle Scholar
  6. 6.
    Engkvist IL, Kjellberg A, Wigaeus HE, Hagberg M, Menckel E, Ekenvall L. Back injuries among nursing personnel–identification of work conditions with cluster analysis. Saf Sci. 2001;37:1–18.CrossRefGoogle Scholar
  7. 7.
    Fujishiro K, Weaver JL, Heaney CA, Hamrick CA, Marras WS. The effect of ergonomic interventions in healthcare facilities on musculoskeletal disorders. Am J Ind Med. 2005;48:338–47.PubMedCrossRefGoogle Scholar
  8. 8.
    Shannon HS, Woodward CA, Cunningham CE, McIntosh J, Lendrum B, Brown J, et al. Changes in general health and musculoskeletal outcomes in the workforce of a hospital undergoing rapid change: a longitudinal study. J Occup Health Psychol. 2001;6(1):3–14.PubMedCrossRefGoogle Scholar
  9. 9.
    Liberman AS, Shrier I, Gordon PH. Injuries sustained by colorectal surgeons performing colonoscopy. Surg Endosc. 2005;19:1606–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Wauben LSGL, van Veelen MA, Gossot D, Goossens RHM. Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc. 2006;20:1268–74.PubMedCrossRefGoogle Scholar
  11. 11.
    Meijsen P, Knibbe HJJ. Work-related musculoskeletal disorders of perioperative personnel in the Netherlands. AORN. 2007;86(2):193–208.CrossRefGoogle Scholar
  12. 12.
    College of Surgeons of Hong Kong. http://www.cshk.org/new/index.htm.
  13. 13.
    Berguer R, Rab GT, Abu-Ghaida H, Alarcon A, Chung J. A comparison of surgeons’ posture during laparoscopic and open surgical procedures. Surg Endosc. 1997;11:139–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Bongers PM, Kremer AM, ter laak J. Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist? : a review of the epidemiological literature. Am J Ind Med. 2002;41(5):315–42.PubMedCrossRefGoogle Scholar
  15. 15.
    Feuerstein M, Shaw WS, Nicholas RA, Huang GD. From confounders to suspected risk factors: psychosocial factors and work-related upper extremity disorders. J Electromyogr Kinesiol. 2004;14:171–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Feuerstein M. Workstyle: definition, empirical support, and implications for prevention, evaluation and rehabilitation of occupational upper-extremity disorders. In: Moon SD, Sauter SL, editors. Beyond biomechanics: psychosocial aspects of musculoskeletal disorders in office worker. Bristol: Taylor & Francis; 1996. p. 177–206.Google Scholar
  17. 17.
    Feuerstein M, Nicholas RA. Development of a short form of the workstyle measure. Occup Med. 2006;56:94–9.CrossRefGoogle Scholar
  18. 18.
    Feuerstein M, Nicholas RA, Huang GD, Haufler AJ, Pransky G, Robertson M. Workstyle: development of a measure of response to work in those with upper extremity pain. J Occup Rehabil. 2005;15:87–104.PubMedCrossRefGoogle Scholar
  19. 19.
    Feuerstein M, Nicholas RA, Huang GD, Dimberg L, Ali D, Rogers H. Job stress management and ergonomic intervention for work-related upper extremity symptoms. Appl Ergon. 2004;35:565–74.PubMedCrossRefGoogle Scholar
  20. 20.
    Kuorinka I, Jonsson B, Kilbom Å, Vinterberg H, Biering-Sörenson F, Andersson A, et al. Standardised Nordic Questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233–7.PubMedCrossRefGoogle Scholar
  21. 21.
    National Institute for Occupational Safety and Health (NIOSH). Musculoskeletal disorders (MSDs) and workplace factors: a critical review of epidemiological evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. Second printing, US Department of Health and Human Services (DHHS), Center for Diseases Control and Prevention, NIOSH. Cincinnati: Publication no. 97–141, DHHS; 1997.Google Scholar
  22. 22.
    Hagberg MB, Silverstein R, Wells R, Smith MJ, Hendrick HW, Carayon P, et al., editors. Work related muscuoloskeletal disorders (WMSDs): a reference book for prevention. London: Taylor & Francis; 1995.Google Scholar
  23. 23.
    Frymoyer JW, Pope MH, Clements JH. Risk factors in LBP. An epidemiological survey. J Bone Joint Surg. 1983;65:213–8.PubMedGoogle Scholar
  24. 24.
    Anderson R. The back pain of bus drivers. Prevalence in an urban area of California. Spine. 1992;17(12):1481–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Arrighi HM, Herzt-Picciotto I. The evolving concept of the healthy worker survivor effect. Epidemiol. 1994;5:189–96.CrossRefGoogle Scholar
  26. 26.
    McMichael AJ. Standardised mortality ratios and the “healthy worker effect”: scratching beneath the surface. J Occup Med. 1976;17:126–7.Google Scholar
  27. 27.
    Hooftman WE, van der Beek AJ, Bongers PM, van Mechelen W. Gender differences in self-reported physical and psychosocial exposures in jobs with both female and male workers. JOEM. 2005;47(3):244–52.PubMedGoogle Scholar
  28. 28.
    Punnett L, Herbert R. Work-related musculoskeletal disorders: is there a gender differential, and if so, what does it mean? In: Goldman MB, Hatch MC, editors. Women and health. San Diego: Academic Press; 2000. p. 474–92.CrossRefGoogle Scholar
  29. 29.
    Bellman S, Forster N, Still L, Cooper CL. Gender differences in the use of social support as a moderator of occupational stress. Stress Health. 2003;19:45–58.CrossRefGoogle Scholar
  30. 30.
    Fillingim RB, Ness TJ. Sex-related hormonal influences on pain and analgesic responses. Neurosci Biobehav Rev. 2000;24:485–501.PubMedCrossRefGoogle Scholar
  31. 31.
    Berguer R, Smith WD, Chung YH. Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc. 2001;15:1204–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Luttmann A, von Hoemer U, Jager M, Sokeland. Posture analysis for surgeons during minimal invasive operations in urology. XVIIth Congress of the international society of electromyography and kinesiology 2008, Niagara Falls, Canada.Google Scholar
  33. 33.
    Berguer R, Smith WD, Davus S. An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg Endosc. 2002;16:416–21.CrossRefGoogle Scholar
  34. 34.
    van Veelen MA, Jakimnowics JJ, Kazemier G. Improved physical ergonomics of laparoscopic surgery. Minim Invasive Ther Allied Technol. 2004;13(3):161–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Reiner R, Reiter S, Rasmus M, Weitzel D, Feussner H. Acquisition of arm and instrument movements during laparoscopic interventions. Minim Invasive Ther Allied Technol. 2003;12(5):235–40.CrossRefGoogle Scholar
  36. 36.
    Berguer R, Forkey DL, Smoth WD. Ergonomic problems associated with laparoscopic surgery. Surg Endosc. 1999;5:466–8.CrossRefGoogle Scholar
  37. 37.
    Nguyen NT, Ho HS, Smith WD, Phillips C, Lewis C, De Vera RM, et al. An ergonomic evaluation of surgeons’ axial and upper extremity movements during laparoscopic and open surgery. Am J Surg. 2001;182:720–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Viikari-Juntura E, Rauas S, Martikjainen R, Kuosma E, Takala H, Takala E-P, et al. Validity of self-reported physical work load in epidemiologic studies on musculoskeletal disorders. Scand J Work Environ Health. 1996;22(4):251–9.PubMedGoogle Scholar
  39. 39.
    Westgaard RH. Work-related musculoskeletal complaints: some ergonomics challenges upon the start of a new century. Appl Ergon. 2000;31:569–80.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Grace P. Y. Szeto
    • 1
  • Pei Ho
    • 2
  • Albert C. W. Ting
    • 2
  • Jensen T. C. Poon
    • 2
  • Stephen W. K. Cheng
    • 2
  • Raymond C. C. Tsang
    • 3
  1. 1.Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong Kong SARChina
  2. 2.Department of SurgeryUniversity of Hong Kong Medical Centre, Queen Mary HospitalHong KongChina
  3. 3.Department of PhysiotherapyQueen Mary HospitalHong KongChina

Personalised recommendations