Essential Tremor and Ortho

[tbrep]

Hi guys,

I have been thinking a lot about switching to orthopaedic surgery as a career - it was my first choice and I sort of gave up on it because I didn't think it was possible. Now, I'm having second thoughts and want to chase the dream (excuse the cliche).

Thing is: I have moderate essential tremor, which is a degenerative condition and means my hands always have a slight tremor (which can be more pronounced every now and then). I am on beta-blocker (propranolol) but this is sort of just maintenance therapy (doesn't make the tremor go away completely). To give you an idea, sometimes when it plays up, I need to stabilise the scissors with one hand while using the other hand to cut off sutures (this resulted in me getting a lot of weird looks from attendings in theatre).

1. In your experience as orthopaedic residents/attendings/students, have you come across ortho surgeons with significant tremor? Were they still able to practise?

2. If my tremors get significantly worse with age, as a consultant are there certain subspecialties of ortho that I could still perform safely? (e.g. arthroscopic surgery, hip/knee replacements)

3. Are there any aspects of residency that I would not be able to successfully complete? (Obviously microscopic and spine are big no-nos for later practice but how heavily are residents involved when these are being performed?)

I really appreciate the time and effort anyone takes to read and reply.

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[Kazaki]

All I can say is that I had an anatomy lecturer in basic sciences who is an orthopaedic surgeon. She couldn't practice due to her essential tremor so she started teaching anatomy. If it's that bad now, I think look into something non-surgical.

 

[tbrep]

All I can say is that I had an anatomy lecturer in basic sciences who is an orthopaedic surgeon. She couldn't practice due to her essential tremor so she started teaching anatomy. If it's that bad now, I think look into something non-surgical.

How old was she when she stopped practising? And do you remember how bad her tremors were?

(I realize it's unlikely you remember either of these)

 

[Grurik]

It's very difficult to tell. I had a lot of questions about this earlier because of my tremor (mild). This tremor suddenly disappeared, I relate it to stress during a period when I first noticed it. Don't know if it will come back, I'm heading for surgery anyway, if it would come back and become crazy, I would go for academic/research instead.

Also, it's different whether it is a resting/action/intention tremor. I would say that steadying the scissor with one hand is not necessarily any sign of weakness. I use to do so if I'm going to cut deep down with important structures nearby. Not because I do have a tremor, instead I just want to reduce the risk of doing anything harmful to the patient. Then there are surgeons having been in the OR for several hours and shakes like hell but don't steady their hands and they seem to do just fine. There are certain people that could manage to do microsurgery with hands free in the air, but most people choose to go for resting the hand against something.

Sometimes you hear about surgeons quitting do some/all surgeries prematurely because of tremor. Don't know if it is good self-perception or if some surgeons with pronounced tremor have other qualities that can compensate it and some don't and hence has to retire only because of anything between minor and major tremor.

We have one surgeon who has to hold his cups when drinking with both his hands, still does complex surgeries even though it is not microsurgery. The biggest problem is probably that the patients won't "trust you" if you fumble around too much when examining them or whatever.

 

[tbrep]

Thanks for the detailed reply Grurik. The uncertainty is really annoying - having essential tremor, you just don't know how it's going to worsen over time so it's hard to plan your career. Really sucks.

 

[droliver]

You realistically can't be a surgeon or proceduralist of other sorts with any significant tremor