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Reducing Pain in Mohs Practitioners

At the annual meeting of the Pacific Dermatologic Association, Dr. Mariusz Sapijaszko of the Western Canada Dermatology Institute in Edmonton, Alberta, addressed the pain and headaches that afflict almost 90% of Mohs practitioners. Drawing from several studies, Sapijaszko shared ergonomics tips to implement in order to reduce risks for a wide range of musculoskeletal problems and headaches. 

In 2007, a study from the Mayo Clinic used Mohs surgeons from as a model to investigate the role of ergonomics in work-related muscular skeletal pain and disorders since the frequency of office-base surgeries are increasing. Of the 17 participants, the researchers found that 59% experienced chronic neck pain, 53% experienced shoulder pain, 41% experienced lower back pain, about a third experience eye fatigue, and one fourth experienced headaches. The study authors writes, “Videotapes of 6 surgeons revealed problems with operating room set up, awkward posture, forceful exertion, poor positioning, lighting, and duration of procedure.” 

Since the 2007 study, researchers have regularly surveyed Mohs surgery members from the American College and found that 90% of them reported some type of musculoskeletal symptoms or injuries, noting, “The nature of the occupation leaves the surgeon vulnerable to injury. Ergonomic modifications in behavior and in workplace are recommended to reduce pain and injury in surgeons.”  

With these findings in mind, Dr. Sapijaszko compiled ergonomic tips using his own clinical practice, recommendations offered by researchers from the 2007 Mayo Clinic study, and experts who focus on optimizing the operating theater environment. Sapijaszko suggests the following modifications:  

To reduce neck-related symptoms:  
• Keep your gaze angle between 15 and 30 degrees below horizontal.  
• Position the patient close to you.  
• Take short surgery breaks to stretch and adjust your posture.  
• Use a stool with sternal support or a sit/stand stool.  

To avoid lower back pain:  
• Change positions frequently.  
• Use a footrest or foot rail.  
• Use a stool with sternal support.  

To prevent eye fatigue:  
• Decrease the intensity of surgical lighting with a dimmer switch.  
• Use goggles or glasses that contain antiglare film.  
• Use brushed steel instead of polished steel instruments.  

To minimize peripheral edema:  
• Wear compression stockings.  
• Use a footrest or foot rail.  
• Use gel insoles, or anti-fatigue floor mats.  

To reduce headaches:  
• Keep ambient noise below 56 dB.  
• Select music based on the preference of the surgeon, patient, and other OR staff.  

To optimize your comfort, optimize patient comfort:
• Select a procedure table that has adjustable positions for knee, hip, and neck angles as well as good lower back and lumbar support and a comfortable pillow type and position. Dr. Sapijaszko, sharing that he favors fully adjustable tables and recommends a 12-degree tilt for the patient’s head, notes, “You need to lie down on your own table and find out how good or bad it feels.”  

Sources: 1, 2, 3, 4

Image: Aldo Cavini Benedetti

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