The impact of cervical musculoskeletal disorders on UK consultant plastic surgeons: can we reduce morbidity with applied ergonomics?

Research output: Contribution to journalArticle


  • Yvette Godwin
  • Christopher MacDonald
  • Sarbjit Kaur
  • Li Zhelin
  • Chris Baber

Colleges, School and Institutes

External organisations

  • South China University of Technology
  • Department of Paediatric Plastic Surgery, Birmingham Children's Hospital


BACKGROUND: Based on anecdotal and observational evidence, we hypothesized that the prevalence of cervical musculoskeletal disorder (C-MSD) would be high among plastic surgeons. A questionnaire review was undertaken to test this hypothesis. Ergonomic assessment was undertaken to assess causal factors of C-MSD.

METHOD: An anonymous questionnaire recording demographics, physical symptoms and behavioral responses to C-MSD was distributed to UK Plastic Surgery consultants. The postural impact of wearing loupes was assessed using motion capture techniques and recording cervical muscular activity.

RESULTS: The questionnaire response rate was 81%. The prevalence of cervical spine morbidity was recorded as 32%. Employment implications included 28% of the cohort requiring sick leave. The professional impact was 7% permanently modifying their practice. There were 2 factors significant for C-MSD, the surgeons' age and the duration in hours of wearing loupes per week. Ergonomic assessment of surgeons operating in loupes demonstrated: 1. increased forward and lateral cervical flexion; 2. increased cervical muscular activity to maintain the protracted "head forward" posture; and 3. prolonged static posturing to maintain head position for visual focus. Table height adjustment and variation of loupe working distance can reduce neck flexion.

CONCLUSIONS: Cervical morbidity is a prevalent problem among plastic surgeons. Long procedures, static postures and neck flexion result in the "head forward" posture. This posture exaggerates when operating with loupe magnification. Early-middle-aged consultants are more prone to cervical morbidity hence afflicted when at the top of their game. The work force is diminished for a potentially avoidable morbidity. Rather than accept this morbidity, co-operation between plastic surgeons and ergonomist may help to reduce injury.


Original languageEnglish
Pages (from-to)602-610
JournalAnnals of Plastic Surgery
Issue number6
Publication statusPublished - 1 Jun 2017


  • cervical spine , musculoskeletal disorders , plastic surgeons , UK consultants