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BACKGROUND: Surgeons are in high demand due to the ageing population's increased need for surgery. However, the high prevalence of musculoskeletal pain (MSP) threatens their career longevity. While improving intraoperative ergonomics is crucial, physical exercise training is also widely used in managing MSP. The objective is to investigate the added effectiveness of intelligent physical exercise training (IPET) when combined with intraoperative ergonomic recommendations (ERGO), compared to ERGO alone, in reducing MSP among abdominal and pelvic surgeons. METHODS: This pragmatic, multicenter, 20-week, superiority, open-label randomized controlled trial (RCT) is conducted in two phases. Phase 1 is a 3-month ergonomic educational period (ERGO) delivered to all participants. Phase 2 is the RCT, where participants are randomized 1:1 to ERGO (control) or ERGO + IPET (intervention). ERGO provides recommendations for operating room (OR) ergonomics, including posture and microbreaks, displayed in and around ORs. IPET prescribes 50 min of individualized weekly exercise, tailored to MSP, job profile (sedentary, walking/standing, or heavy work), physical capacity, and health risk indicators, and is delivered via a mobile application. Eligible surgeons specialize in gynecology, urology, and colorectal surgery and perform ≥ 4 h/week of abdominal or pelvic surgery (robot-assisted, laparoscopic, or open, excluding vaginal surgery), and complete the Phase 1 questionnaire. Surgeons advised against exercise by their GP are excluded. Participants are recruited from regional and academic hospitals in Denmark and North America. Enrollment begins with completion of the ERGO survey and consent in the baseline questionnaire. Recruitment started 13 December 2023, with a target sample size of 83. The primary effect of interest is the between-group difference in MSP intensity (0-10 numeric rating scale) at 20 weeks in the body part reported as most painful at baseline, analyzed using a linear mixed model with baseline MSP as covariate. Harms include increases in MSP or injury, though these will not be systematically collected. Participants and research staff are not blinded. Outcome interpretation will be blinded to group allocation. DISCUSSION: This trial addresses a gap in strategies to mitigate MSP among surgeons by combining ergonomics recommendations with app-delivered IPET. Findings may inform strategies to improve surgeon well-being and reduce future workforce shortages. TRIAL REGISTRATION: Clinicaltrials.gov, NCT06112106. Registered on October 4, 2023.

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This review provides an evidence-based overview of ergonomics in otolaryngology-head and neck surgery, with guidance for optimizing positioning during in-office and operative procedures. Herein, we summarize recent findings highlighting the prevalence of musculoskeletal (MSK) pain among Otolaryngology, Head and Neck (OHN) surgeons and outline validated ergonomic risk assessment tools. Strategies for equipment and posture optimization are organized by visualization modality-open, endoscopic/exoscopic, microscopic, and robotic. We conclude with effective interventions to prevent and manage MSK disorders in the surgical workforce.

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Work-related musculoskeletal pain is common among surgeons, with up to 68% experiencing pain, mainly in the lower back, neck, and shoulders. Minimally invasive procedures increase the risk compared with open surgery, while robot-assisted techniques appear less harmful. Key physical risk factors include static postures, awkward positions, and long-lasting surgeries. Productivity, career longevity, and healthcare efficiency may be impacted. Preventive strategies lack strong evidence, highlighting the need for further research to develop effective and cost-efficient solutions as argued in this review.

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IMPORTANCE: Many surgeons experience work-related musculoskeletal disorders (MSD) throughout their career. Incorporating evidence-based strategies to prevent and manage MSDs would benefit both trainees and those in practice. The present narrative review seeks to evaluate the effectiveness of current strategies to manage and prevent musculoskeletal (MSK) occupational pain among surgeons and trainees. OBSERVATIONS: Eleven studies were identified. Included studies covered 3 broad interventions: ergonomics (n = 5), intraoperative breaks/pauses (n = 7), and physical fitness (n = 1). Intraoperative breaks demonstrated improved pain, fatigue, stress, and a decrease in intraoperative errors without increasing overall surgical time. Residents that were specifically instructed in ergonomics exhibited better posture and decreased musculoskeletal (MSK) symptoms and recommended incorporating this information into their curriculum. In a program combining ergonomics, microbreaks, and stretching, 85% of residents experienced reduced discomfort, and 93% felt this training would help them "perform better in the operating room". Overall, the surgical physical fitness programs reduced surgery/occupational-related pain and increased performance measures in the OR. The study participants also found the interventions valuable and were able to use learned principles in practice. CONCLUSIONS AND RELEVANCE: The existing body of literature supports the positive impact of fitness programs in preventing and managing occupational-related pain. We propose the implementation of a comprehensive program that integrates education, intraoperative breaks, ergonomic adjustment, and physical fitness, with initiation during the first year of surgical residency. To facilitate practical integration, we propose a pilot program that may be integrated into the regular surgical work week, encompassing recommendations from the reviewed studies. Future research is recommended to explore aspects such as program effectiveness, feasibility, mental health impacts, and gender-specific differences.

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PURPOSE OF REVIEW: The present review explores the prevalence of musculoskeletal work-related injuries associated with endoscopic treatment of benign prostatic hyperplasia, ergonomic factors and potential current and future solutions. RECENT FINDINGS: Work-related musculoskeletal pain and injuries are prevalent in urology, with modifiable risk factors identified in the endoscopic treatment of benign prostatic hyperplasia. Future endeavors should focus on instrument design, formalized ergonomic training curricula and cultural shifts among the surgeon community. The combination of advancements in urology and a growing aging population has led to a rising volume of endoscopic treatments for benign prostatic hyperplasia. Ergonomic considerations are especially critical in endourology, where surgeons perform prolonged procedures requiring repetitive, precise movements. Optimizing ergonomics through surgeon education, training, improved operating room and instrument design, and ongoing research is essential to mitigating work-related musculoskeletal strain and enhancing surgical performance.

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BACKGROUND: Several countries have participated in WHO COPCORD. The Global Disease Burden program (GBD) reports selected MSK disorders. We used a COPCORD India protocol to estimate the national burden of MSK disorders. MATERIALS AND METHODS: Trained paramedics used standard questionnaires to screen the population and identify respondents with current and/or past MSK pain (non-traumatic) in 12 survey sites (8 rural); cross-sectional design and prospective data. Several standard measures were recorded; MSK pain was self-reported (on human manikin). The site rheumatologist examined each respondent and provided a clinical diagnosis. Pooled data (anonymized) from all sites was analyzed using standard statistical software. Standardized point prevalence rates (adjusted to Indian Census) and odds ratios (risk factors) were calculated: 95% confidence intervals in parentheses. RESULTS: 56 548 population (60% rural, response rate > 70%) was screened; 10 273 respondents (18%, 65% women). The prevalence of MSK pain was 16.14 (14.2, 18.3) and higher in the rural population (20% vs. 10.3%); rheumatoid arthritis 0.34%, undifferentiated inflammatory arthritis 0.22%, spondyloarthritis 0.23%, osteoarthritis 4.39%, Gout 0.05%, chikungunya arthritis 1.2%. Non-specific arthralgias, soft tissue pains, and degenerative arthritis were dominant disorders; 12% of respondents reported inflammatory arthritis. Significant risk factors associated with MSK pain included female gender, poor literacy, non-vegetarian diet, chronic non-MSK illness, past trauma, and tobacco use. Limitations included non-random selection, clinical diagnosis, and limited investigations. However, in comparison to GBD, the COPCORD outcome seemed all-inclusive and clinically meaningful. CONCLUSION: The high prevalence of MSK pain and arthritis indicates a huge disease burden in India and prioritizes the need for a national control program.

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There is a high prevalence of musculoskeletal pain among dermatological surgeons, particularly in the neck, upper and lower back, and shoulders. We performed an international survey which revealed a lack of ergonomic education and use of ergonomic tools in dermatological surgery. Most respondents were aware of bad posture during surgery, but few regularly checked their posture. Behavioural interventions, such as alternating between standing and sitting, and taking frequent breaks, are recommended to reduce pain. Ergonomic workstation adaptations, including the use of surgical loupes, good lighting and adjustable stools, are crucial for reducing strain.

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BACKGROUND: Aromatase inhibitor is associated with a high incidence of Aromatase Inhibitor-Associated Musculoskeletal Syndrome (AIMSS) in postmenopausal women with hormone-sensitive breast cancer. OBJECTIVE: This scoping review aims to identify available information regarding the frameworks, models, or strategies of adapted physical activity (APA) programs implemented for the prevention and management of AIMSS. METHODS: Search was realized by two independent reviewers in six databases following PRISMA-ScR guidelines. Data of included articles were extracted, and risk of bias analyzed. RESULTS: Finally, 14 were included. No study has examined APA in the prevention of AIMSS. There is no solid evidence supporting the impact of APA on the management of AIMSS. However, evidence suggests that an APA program can reduce the worst joint pain and improve the quality of life. CONCLUSION: Future research will enlighten clinical practices with the development of personalized APA programs in hormone-sensitive breast cancer.

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Objective: to analyze the effectiveness of individual coping strategies and hospital work environment adaptations for nurses with musculoskeletal pain. Method: a systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The search was performed in six databases, including experimental and pre-experimental studies. Risk of bias was assessed using the RoB2 (Risk of Bias 2) and ROBINS-I (Risk of Bias In Non-randomized Studies of Interventions) tools. Methodological quality was evaluated using the Joanna Briggs Institute model, the Jadad Scale and the Melnyk, Buck and Gallagher-Ford Levels of Evidence. Results: eight studies were included, identifying individual coping strategies such as stretching exercises, auriculotherapy and mindfulness. Workplace-based strategies were multidisciplinary, integrated and focused on training for identifying and preventing musculoskeletal risks while improving working conditions. Conclusion: the most effective strategies combine workers' individual actions with improvements in working conditions, addressing physical, psychosocial and ergonomic factors to adapt the work environment, prevent musculoskeletal pain progression and maintain job performance. PROSPERO registration number: CRD42024575014.

Objetivo: analisar a efetividade das estratégias de enfrentamento individual e de adaptação do ambiente laboral hospitalar para os profissionais de enfermagem com dor musculoesquelética. Método: revisão sistemática conduzida de acordo com os Preferred Reporting Items for Systematic reviews and Meta-Analyses. A busca foi realizada em seis bases de dados, incluindo estudos experimentais e pré-experimentais. O risco de viés foi avaliado por meio das ferramentas RoB2 (Risk of Bias 2) e ROBINS-I (Risk of Bias In Non-Randomized Studies of Interventions). A qualidade metodológica foi avaliada pelo modelo Joanna Briggs Institute, Escala de Jadad e Nível de Evidência Melnyk, Buck e Gallagher-Ford. Resultados: foram incluídos oito estudos, identificando-se as estratégias de enfrentamento individual: exercícios de alongamento, auriculoterapia, mindfulness. As estratégias aplicadas no ambiente laboral são multidisciplinares, integradas e orientadas para a capacitação na identificação e prevenção de riscos musculoesqueléticos e para o aprimoramento das condições do ambiente de trabalho. Conclusão: as estratégias mais efetivas são aquelas que combinam ações individuais dos trabalhadores com melhoria das condições de trabalho considerando aspectos físicos, psicossociais e ergonômicos para a adaptação do ambiente de trabalho, prevenir a progressão da dor musculoesquelética e manter o desempenho no trabalho. Registro PROSPERO CRD42024575014.

Objetivo: analizar la efectividad de las estrategias de afrontamiento individual y de adaptación del ambiente laboral hospitalario para profesionales de Enfermería con dolor musculoesquelético. Método: revisión sistemática de acuerdo a los Preferred Reporting Items for Systematic reviews and Meta-Analyses. La búsqueda se realizó en seis bases de datos y se incluyeron estudios de diseño experimental y pre-experimental. El riesgo de sesgo se evaluó mediante las herramientas RoB2 (Risk of Bias 2) y ROBINS-I (Risk of Bias In Non-Randomized Studies of Interventions) mientras que la calidad metodológica a través del modelo del Joanna Briggs Institute, la Escala de Jadad y el Nivel de Evidencia Melnyk, Buck y Gallagher-Ford. Resultados: se incluyeron ocho estudios y se identificaron las siguientes estrategias de afrontamiento individual: ejercicios de estiramiento, auriculoterapia y mindfulness. Las estrategias aplicadas en el ambiente laboral son multidisciplinarias e integradas y están orientadas a la capacitación en identificar y prevenir riesgos musculoesqueléticos y a mejorar las condiciones del entorno de trabajo. Conclusión: las estrategias más efectivas son las que combinan las acciones individuales de cada trabajador y la mejora en las condiciones de trabajo considerando aspectos físicos, psicosociales y ergonómicos para adaptar el entorno laboral, prevenir la progresión del dolor musculoesquelético y mantener el desempeño profesional. Registro PROSPERO CRD42024575014.

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INTRODUCTION: Work-related musculoskeletal injuries are common in general surgeons, causing chronic pain and lost work. However, formal ergonomic curriculums in residency programs are rare. We aimed to assess the feasibility of an interprofessional educational approach to ergonomics in general surgery residents, in collaboration with occupational therapy (OT) students. METHODS: General surgery residents completed a survey regarding musculoskeletal pain and ergonomics. OT students captured photos of trainees performing open and laparoscopic abdominal surgery over a 4-wk period. Rapid entire body assessment (REBA) and the rapid upper limb assessment were used to assess ergonomic efficiency and postural risk. Higher scores represent unfavorable posture and correlate with the need for ergonomic change. RESULTS: There were 37/44 (84%) responses. Everyone reported some degree of pain related to surgery, most commonly neck pain (75%), shoulder (61%), and foot pain (53%). Most residents (66%) felt the pressure to perform surgery regardless of the pain. Ergonomic breaks directed by faculty were reported by less than 11% of residents. A total of 11 intraoperative observations were made by OT students of surgical trainees, with a mean rapid upper limb assessment score of 6.1 and a mean rapid entire body assessment score of 7.3. These scores demonstrated suboptimal posture with recommendations for prompt change. CONCLUSIONS: This study conveys a successful interprofessional educational approach to assessing surgical ergonomics in general surgery residents. Musculoskeletal symptoms and intraoperative ergonomic dysfunctions are prevalent among general surgery residents, without workplace measures for management or prevention. This needs assessment will be used to create an ergonomics initiative for the surgery residency.

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Orthopedic surgery is a physically demanding specialty. The factors contributing to musculoskeletal injury among surgeons often stem from positioning the patient, using non-ergonomic instruments, maintaining static postures, and performing repetitive movements. This article focuses on exercise techniques intended to combat the most common problematic static postures held during procedures. Each exercise explained in this article is organized into "preop," "intraop," and "postop" components. Preop includes strengthening movements, intraop provides postural recommendations, and postop focuses on mobilization and recovery. This article aims for efficient body conditioning, targeting the muscular posterior chain and supporting elements. [Orthopedics. 2024;47(4):e214-e216.].

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There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.

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An interactive seating system (IASS) was compared to a state-of-the-art massage seating system (MS) regarding the potential of reducing health risks from prolonged sitting in the vehicle. The study investigated if the systems (1) increase heart rate, which is associated with reduced metabolic and cardiovascular risks; (2) activate muscles with the potential to reduce musculoskeletal pain; (3) influence seating comfort and discomfort. The systems were compared in a passenger scenario in a laboratory study (30 male subjects). Only the use of the IASS significantly elevated the heart rate. Muscle activity showed tendencies to increase in the lower back only while using the MS. In comparison, the IASS activated all six captured muscles. Significantly less discomfort was found for the IASS compared to the MS. In comparison to the MS, the IASS showed a substantially higher potential for reducing health risks from static sitting in the vehicle.Practitioner summary: This laboratory study compared the effects of a novel automotive interactive seating system with those of a state-of-the-art massage seating system. Muscle activity, heart rate and discomfort indicated that the IASS has a significantly higher potential to reduce health risks associated with static seating in a vehicle.Abbreviations: AB: air bladder; AC: active condition; ADSS: active dynamic seating system; CLBP: chronic lumbar back pain; ECG: electrocardiography; EMG: electromyography; IASS: interactive seating system; MS: massage seating system; PC: passive condition; PDSS: passive dynamic seating system; RMS: rootmean-square; TI: time interval.

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OBJECTIVE: The purpose of this study was to examine the role intraoperative otolaryngology stretching microbreak (OSMB) has on musculoskeletal (MSK) pain and discomfort in otolaryngologists. BACKGROUND: Otolaryngology procedures subject surgeons to significant amounts of pain and strain over their years of training. MSK pain is a serious concern for otolaryngologists' career longevity as well as their general wellbeing. METHODS: Participants from two different hospitals and one private practice were recruited to participate in this study. An initial ergonomic survey was obtained to assess baseline MSK pain, and its subjective impact on operative performance. The participants then completed three control days without OSMB exercises, followed by three intervention days with OSMB exercises which were completed at 20-40 minute intervals. Preoperative and postoperative pain rating surveys were completed before and after each procedure and at the end of the day to determine changes in pain and/or discomfort. RESULTS: Ten otolaryngologists (50 % men, 50 % women; mean age 35.6 years) participated in this study. Half of the participants indicated that they were concerned their pain would limit their ability to operate in the future. 70 % of participants indicated that they have not attempted to treat this pain and 60 % did not try any stretching exercises outside the operating room (OR) to mitigate their symptoms. Participants reported neck, upper back, and lower back to be the primary MSK discomfort. OSMB improved participants' pain scores in neck, shoulders, hands, and lower back pain (p < 0.05). CONCLUSION: MSK pain has shown to be a serious concern for the ability of otolaryngologists to continue performing surgery in the future. OSMB may be an effective strategy that can be implemented by otolaryngologists intraoperatively to improve MSK pain and overall well being.

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Purpose: Retrograde intrarenal surgery (RIRS) requires urologists to adopt an awkward body posture for long durations. Few urologists receive training in ergonomics despite the availability of ergonomic best practices utilized by other surgical specialties. We characterize ergonomic practice patterns and rates of musculoskeletal (MSK) pain among urologists performing RIRS. Methods: A web-based survey was distributed through the Endourological Society, the European Association of Urology, and social media. Surgeon anthropometrics and ergonomic factors were compared with ergonomic best practices. Pain was assessed with the Nordic Musculoskeletal Questionnaire (NMQ). Results: Overall, 519 of 526 participants completed the survey (99% completion rate). Ninety-three percent of urologists consider ergonomic factors when performing RIRS to reduce fatigue (68%), increase performance (64%), improve efficiency (59%), and reduce pain (49%). Only 16% received training in ergonomics. Residents/fellows had significantly lower confidence in ergonomic techniques compared with attending surgeons with any career length. Adherence to proper ergonomic positioning for modifiable factors was highly variable. On the NMQ, 12-month rates of RIRS-associated pain in ≥1 body part, pain limiting activities of daily living (ADLs), and pain requiring medical evaluation were 81%, 51%, and 29%, respectively. Annual case volume >150 cases (odds ratio [OR] 0.55 [0.35-0.87]) and higher adherence to proper ergonomic techniques (OR 0.67 [0.46-0.97]) were independently associated with lower odds of pain. Limitations include a predominantly male cohort, which hindered the ability to assess gender disparities in pain and ergonomic preferences. Conclusions: Adherence to ergonomic best practices during RIRS is variable and may explain high rates of MSK pain among urologists. These results underscore the importance of utilizing proper ergonomic techniques and may serve as a framework for establishing ergonomic guidelines for RIRS.

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BACKGROUND: Adjuvant aromatase inhibitors (AI) improve survival compared to tamoxifen in postmenopausal women with hormone receptor-positive stage I to III breast cancer. In approximately half of these women, AI are associated with aromatase inhibitor-induced musculoskeletal symptoms (AIMSS), often described as symmetrical pain and soreness in the joints, musculoskeletal pain and joint stiffness. AIMSS may have significant and prolonged impact on women's quality of life. AIMSS reduces adherence to AI therapy in up to a half of women, potentially compromising breast cancer outcomes. Differing systemic therapies have been investigated for the prevention and treatment of AIMSS, but the effectiveness of these therapies remains unclear. OBJECTIVES: To assess the effects of systemic therapies on the prevention or management of AIMSS in women with stage I to III hormone receptor-positive breast cancer. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, WHO International Clinical Trials Registry Platform (ICTRP) and Clinicaltrials.gov registries to September 2020 and the Cochrane Breast Cancer Group (CBCG) Specialised Register to March 2021.  SELECTION CRITERIA: We included all randomised controlled trials that compared systemic therapies to a comparator arm. Systemic therapy interventions included all pharmacological therapies, dietary supplements, and complementary and alternative medicines (CAM). All comparator arms were allowed including placebo or standard of care (or both) with analgesia alone. Published and non-peer-reviewed studies were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies, extracted data, and assessed risk of bias and certainty of the evidence using the GRADE approach. Outcomes assessed were pain, stiffness, grip strength, safety data, discontinuation of AI, health-related quality of life (HRQoL), breast cancer-specific quality of life (BCS-QoL), incidence of AIMSS, breast cancer-specific survival (BCSS) and overall survival (OS). For continuous outcomes, we used vote-counting by reporting how many studies reported a clinically significant benefit within the confidence intervals (CI) of the mean difference (MD) between treatment arms, as determined by the minimal clinically importance difference (MCID) for that outcome scale. For dichotomous outcomes, we reported outcomes as a risk ratio (RR) with 95% CI. MAIN RESULTS: We included 17 studies with 2034 randomised participants. Four studies assessed systemic therapies for the prevention of AIMSS and 13 studies investigated treatment of AIMSS. Due to the variation in systemic therapy studies, including pharmacological, and CAM, or unavailable data, meta-analysis was limited, and only two trials were combined for meta-analysis. The certainty of evidence for all outcomes was either low or very low certainty. Prevention studies The evidence is very uncertain about the effect of systemic therapies on pain (from baseline to the end of the intervention; 2 studies, 183 women). The two studies, investigating vitamin D and omega-3 fatty acids, showed a treatment effect with 95% CIs that did not include an MCID for pain. Systemic therapies may have little to no effect on grip strength (RR 1.08, 95% CI 0.37 to 3.17; 1 study, 137 women) or on women continuing to take their AI (RR 0.16, 95% 0.01 to 2.99; 1 study, 147 women). The evidence suggests little to no effect on HRQoL and BCS-QoL from baseline to the end of intervention (the same single study; 44 women, both quality of life outcomes showed a treatment effect with 95% CIs that did include an MCID). The evidence is very uncertain for outcomes assessing incidence of AIMSS (RR 0.82, 95% CI 0.63 to 1.06; 2 studies, 240 women) and the safety of systemic therapies (4 studies, 344 women; very low-certainty evidence). One study had a US Food and Drug Administration alert issued for the intervention (cyclo-oxygenase-2 inhibitor) during the study, but there were no serious adverse events in this or any study. There were no data on stiffness, BCSS or OS. Treatment studies The evidence is very uncertain about the effect of systemic therapies on pain from baseline to the end of intervention in the treatment of AIMSS (10 studies, 1099 women). Four studies showed an MCID in pain scores which fell within the 95% CI of the measured effect (vitamin D, bionic tiger bone, Yi Shen Jian Gu granules, calcitonin). Six studies showed a treatment effect with 95% CI that did not include an MCID (vitamin D, testosterone, omega-3 fatty acids, duloxetine, emu oil, cat's claw).  The evidence was very uncertain for the outcomes of change in stiffness (4 studies, 295 women), HRQoL (3 studies, 208 women) and BCS-QoL (2 studies, 147 women) from baseline to the end of intervention. The evidence suggests systemic therapies may have little to no effect on grip strength (1 study, 107 women). The evidence is very uncertain about the safety of systemic therapies (10 studies, 1250 women). There were no grade four/five adverse events reported in any of the studies. The study of duloxetine reported more all-grade adverse events in this treatment group than comparator group. There were no data on the incidence of AIMSS, the number of women continuing to take AI, BCCS or OS from the treatment studies. AUTHORS' CONCLUSIONS: AIMSS are chronic and complex symptoms with a significant impact on women with early breast cancer taking AI. To date, evidence for safe and effective systemic therapies for prevention or treatment of AIMSS has been minimal. Although this review identified 17 studies with 2034 randomised participants, the review was challenging due to the heterogeneous systemic therapy interventions and study methodologies, and the unavailability of certain trial data. Meta-analysis was thus limited and findings of the review were inconclusive. Further research is recommended into systemic therapy for AIMSS, including high-quality adequately powered RCT, comprehensive descriptions of the intervention/placebo, and robust definitions of the condition and the outcomes being studied.

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BACKGROUND: Aromatase Inhibitor induced Arthralgia (AIA) can cause noncompliance leading to decreased breast-cancer survival. Effective interventions for AIA are limited. Tart cherry (TC) showed beneficial effect on musculoskeletal pain. 48 patients (Pts) randomized to TC versus placebo over 6 weeks, TC (23pts) had 34.7% mean pain decrease versus 1.4% in Placebo (25pts). TC can improve AIA in nonmetastatic breast-cancer patients. METHODS: Randomized, placebo-controlled, double-blind trial. Eligible patients with NMHPBC on AI for at least 4 weeks were randomized to TC concentrate [50 tart cherries] vs. placebo (P) [syrup] in 1:1 model. Patients instructed to consume 1 Oz of concentrate in 8 Oz water daily for 6 weeks, and document their pain intensity at baseline, weekly and at study completion in a diary using Visual Analog Scale (VAS), with 0 mm indicating no pain, and 100 mm indicating highest pain. RESULTS: Sixty patients were enrolled. Two patients did not complete the study due to diarrhea, and 10 patients were noncompliant. Forty-eight patients were included in the final analysis. TC group (23 pts) had 34.7% mean decrease in pain compared to 1.4% in P group (25 pts). This difference was statistically significant (Mann-Whitney U Test, P = .034). CONCLUSIONS: Tart cherry can significantly improve AIA in nonmetastatic breast cancer patient.

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OBJECTIVES: While it is acknowledged that otolaryngologists performing microlaryngeal surgery can develop musculoskeletal symptoms due to suboptimal body positioning relative to the patient, flexible laryngoscopy and awake laryngeal surgeries (ALSs) can also pose ergonomic risk. This prospective study measured the effects of posture during ergonomically good and bad positions during laryngoscopy using ergonomic analysis, skin-surface electromyography (EMG), and self-reported pain ratings. STUDY DESIGN: Prospective cohort study. METHODS: Eight participants trained in laryngoscopy assumed four ergonomically distinct standing positions (side/near, side/far, front/near, front/far) at three different heights (neutral-top of patient's head in line with examiner's shoulder, high-6 inches above neutral, and low-6 inches below neutral) in relation to a simulated patient. Participants' postures were analyzed using the validated Rapid Upper Limb Assessment (RULA, 1 [best] to 7 [worst]) tool for the 12 positions. Participants then simulated ALS for 10 minutes in a bad position (low-side-far) and a good position (neutral-front-near) with 12 EMG sensors positioned on the limbs and torso. RESULTS: The position with the worst RULA score was the side/near/high (7.0), and the best was the front/near/neutral (4.5). EMG measurements revealed significant differences between simulated surgery in the bad and good positions, with bad position eliciting an average of 206% greater EMG root-mean-squared magnitude across all sampled muscles compared to the good posture (paired t-test, df = 7, P < .01), consistent with self-reported fatigue/pain when positioned poorly. CONCLUSION: Quantitative and qualitative measurements demonstrate the impact of surgeon posture during simulated laryngoscopy and suggest ergonomically beneficial posture that should facilitate ALSs. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2752-2758, 2021.