Some 50–76% of otolaryngologists report musculoskeletal pain — most often, neck pain — over the course of an average year, says Johns Hopkins neurotologist and lateral skull base surgeon Deepa Galaiya, wellness director for the Division of Otolaryngology–Head and Neck Surgery. Galaiya investigates how improving ergonomics in the operating room can keep surgeons at the top of their game.

In one recent study, published in Otolaryngology–Head and Neck Surgery,
Galaiya examined how seated posture could contribute to muscle fatigue during surgical drilling. In a simulation for ear surgery, 13 head and neck surgeons and surgical trainees from Johns Hopkins wore sensors measuring muscle activity while they used a surgical drill to remove the top of a raw eggshell without cracking it. They performed the task three times in randomly assigned positions: neutral, where the knees and elbows were at 90-degree angles; slouched, where the operating table and seat were lowered and a microscope was slightly below the surgeon’s eyeline; and craned, where the operating table and seat were raised and the microscope was slightly above the surgeon’s eyeline.

The wrist muscle and upper trapezius — a triangular muscle in the back connecting the neck and shoulders — were the ones that experienced the most fatigue regardless of surgical position, Galaiya says. However, there was significantly more fatigue in the trapezius when surgeons slouched. Additionally, female surgeons experienced more fatigue than males, possibly due to the weight of the drill, she says. 

To best reduce fatigue, Galaiya advises, surgeons should ensure that all limbs are in 90-degree angles and the body, particularly the neck, is in a neutral position. “The neck being craned or the back being slouched are both really bad positions long term for degenerative disc disease.”

Surgeons can also benefit from using a support under the arm to keep hands steady and reduce upper arm exertion when moving instruments, she says.