Background Musculoskeletal symptoms and injuries among surgeons are underestimated but are increasingly recognized to constitute a major problem. However, it has not been established when symptoms start and what factors contribute to the development of symptoms. Methods A 19-question survey approved by our institution's review board, and American Council of Academic Plastic Surgery was sent to all plastic surgery residents enrolled in Accreditation Council for Graduate Medical Education–accredited plastic surgery training programs in the United States. The presence of various musculoskeletal symptoms was calculated, and predictors of these symptoms were evaluated. Results We received 104 total responses. Ninety-four percent of residents had experienced musculoskeletal pain in the operating room. The neck was the most commonly affected area (54%) followed by the back (32%) and extremities (12%). Interestingly, 52% of responders developed these symptoms during the first 2 years of their residency. Furthermore, increasing postgraduate year level (P = 0.3) and independent versus integrated status (P = 0.6) had no correlation with pain, suggesting that symptoms began early in training. Pain symptoms were frequent for 47%, whereas 5% reported experiencing symptoms during every case. The use of a headlight correlated with frequent pain (odds ratio, 2.5; P = 0.027). The use of microscope and loupes did not correlate with frequent pain. Eighty-nine percent of responders were aware of having bad surgical posture, but only 22% had received some form of ergonomics training at their institution. Sixty-four percent of responders believe that the operating room culture does not allow them to report the onset of symptoms and ask for adjustments. This was more common among residents reporting frequent pain (odds ratio, 3.12; P = 0.009). Conclusions Plastic surgeons are at high risk for occupational symptoms and injuries. Surprisingly, symptoms start early during residency. Because residents are aware of the problem and looking for solutions, this suggests an opportunity for educational intervention to improve the health and career longevity of the next generation of surgeons.

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Primary compression of the tibial nerve beneath the fibromuscular sling of the origin of the soleus muscle is rarely discussed in the literature. To evaluate the location and characteristics of the soleal fibromuscular sling and its relationship to the tibial nerve, 36 cadaver limbs were dissected. The leg length, location of soleal fibromuscular sling, presence of a thickened fibrous band at the soleal sling, and narrowing in the tibial nerve were recorded. The average leg length was 47.8 cm (SD +/- 4.16). The fibromuscular soleal sling was 9.3 cm (SD +/- 1.44) distal to the medial tibial plateau. Although 56% (20/36) of specimens had a fibrous band, only 8% (3/36) demonstrated a focal narrowing directly under this fascial sling. This study demonstrates that the fibromuscular sling of the soleus muscle may act as a potential compression site of the tibial nerve. These findings offer insight and potential hope for those patients who have persistent plantar numbness after tarsal tunnel decompression and for those patients with plantar numbness who also have weakness of toe flexion.

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