Shouldering the load: musculoskeletal hazards in shoulder arthroplasty

Eric B. Wilkinson, Eric H. Gruenberger, Joseph W. Elphingstone, Marshall D. Williams, Sohrab K. Vatsia, Abdias Girardi, Michael L Knudsen, Eugene W. Brabston, Jonathan P. Braman, Brent A. Ponce

Research output: Contribution to journalArticlepeer-review


Hypothesis: Orthopedic reconstructive surgery can be physically demanding. The musculoskeletal related demands related to performing shoulder arthroplasty are unknown. This study investigates the prevalence of musculoskeletal injuries associated with performing shoulder arthroplasty. Methods: An anonymous online survey based on the validated Nordic Musculoskeletal Questionnaire (NMQ) was distributed to society members of the American Shoulder and Elbow Surgeons. The REDCap based branching chain logic survey consisted of four main sections including: 1) personal demographics, 2) practice demographics, 3) NMQ questionnaire, and 4) effects of injury. A novel addition to the nine-region NMQ survey evaluated these areas for bothersome subclinical symptoms with no formal treatment requirement. Results: Overall, 71% of 87 responding surgeons reported musculoskeletal symptoms related to performing shoulder arthroplasty. Within this group, 72% reported primary subclinical pain and 9% reported secondary exacerbation of a previous injury. Symptomatic regions and diagnoses were most often wrist/hand discomfort (20.7%) due to carpal tunnel syndrome and basilar thumb arthritis. Other associated symptoms included spine discomfort due to degenerative disc disease in the cervical (9.4%) or lumbar (18.4%) regions and elbow pain (6.7%) due to lateral epicondylitis or posterior interosseus nerve entrapment. The most common factors related to symptoms were case volume (24%), patient beach-chair operative positioning (17%), and table height (17%). Twenty-five surgeons required time off for work-related symptoms: 23 required <1 week and two required >1 week. Nine surgeons pursued nonoperative treatment and four surgeons underwent surgical intervention. Among all factors assessed, private practice surgeons reported symptoms significantly less frequently than those at tertiary referral (academic) centers. Discussion: A high percentage of orthopedic surgeon's experience musculoskeletal symptoms related to shoulder arthroplasty. The three most commons areas of work-related pain in shoulder arthroplasty are wrist/hand discomfort, degenerative changes in the cervical and lumbar areas, and elbow pain.

Original languageEnglish (US)
Pages (from-to)463-470
Number of pages8
JournalSeminars in Arthroplasty JSES
Issue number3
StatePublished - Sep 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors


  • Arthroplasty
  • Ergonomics
  • Expert Opinion Survey Study
  • Level V
  • Occupational hazard
  • Shoulder
  • Survey
  • Work injury


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