Shaky hands while suturing

[SweetCaroline508]

I normally have fairly steady hands and can suture well on my own, but when I have to do it in front of people my hands get very shaky. I know a lot of this is probably psychological, but I don’t feel nervous when I’m suturing. I’m really worried about how this will affect me on my rotations, especially surgery. Is this something others have experienced, or have advice about?

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[Smurfette]

I normally have fairly steady hands and can suture well on my own, but when I have to do it in front of people my hands get very shaky. I know a lot of this is probably psychological, but I don’t feel nervous when I’m suturing. I’m really worried about how this will affect me on my rotations, especially surgery. Is this something others have experienced, or have advice about?

Pretty much every student I get shakes trying to suture at first. It's basically performance anxiety and for some, a bit of adrenaline kicking in. Most people have the tremors go away as they get more comfortable on the rotation.

 

[dieABRdie]

I normally have fairly steady hands and can suture well on my own, but when I have to do it in front of people my hands get very shaky. I know a lot of this is probably psychological, but I don’t feel nervous when I’m suturing. I’m really worried about how this will affect me on my rotations, especially surgery. Is this something others have experienced, or have advice about?

I had the same issue. Its much different when you know everyone in the room is staring at you.... and quietly groaning as they wait for you to close.

Propanalol worked wonders for me. Get an Rx from your PCP for performance anxiety.

 

[Matthew9Thirtyfive]

It goes away with confidence. Practice at home and then jump on every opportunity you have to do it for real. We just had our mid rotation eval for surgery and I got told my surgical skills are great, and my hands were shaking like a leaf the first time I went to close a port incision lol. I just took every opportunity I had and practiced at home.

 

[Dral]

Pretty much every student I get shakes trying to suture at first. It's basically performance anxiety and for some, a bit of adrenaline kicking in. Most people have the tremors go away as they get more comfortable on the rotation.

Yep. After my first one or two of procedure days during the start of residency, my attending told me I need to lay off the coffee before clinic. Heh. Not even remotely an issue now when I'm doing excisions as an attending...no shaking regardless of if I have coffee or not.

 

[Oligodinero]

I had the same issue. Its much different when you know everyone in the room is staring at you.... and quietly groaning as they wait for you to close.

Propanalol worked wonders for me. Get an Rx from your PCP for performance anxiety.

Yup...if you're not asthmatic, ask your PCP for an Rx for Inderal LA 60mg 1 po qd.

 

[blastokine]

Had the same issues as you. I didn't feel nervous either but for some reasons my hands were shaking. Caffeine makes a huge difference. I cut it out on days I was in the OR and I drastically improved, my hands were completely still.

I know its tough, but I think once you become more comfortable suturing in the OR you can reintroduce caffeine.

 

[CherryRedDracul]

- practice and be comfortable with the steps of suturing; deliberately think about what motion you will make until it's second nature
- anchor your arm against something like your sides for example
- find way to relax and get in the zone/be mindful; this is largely pre-procedure practice. Examples include deep breathing, yoga, and meditation.

 

[deleted1100659]

I was terrible at suturing.

I became a psychiatrist, and never looked back

 

[operaman]

Yeah this happens to everyone. Still happens to me sometimes even now, especially if there was a harrowing moment right before or something. Usually deep breaths and stabilizing my hands takes care of it. Ooh yeah that’s also a common issue for newbies - they tend to freeball it rather than stabilize themselves and grasp the instruments well so it makes tremor worse.

I do have to be careful with my caffeine intake if I’m doing micro work. Made that mistake once and felt like a newborn deer trying to walk. So now I avoid it before micro cases. I’ve used prn propranolol too and it works well but I would prefer not to be dependent on it to work. For now, laying off the caffeine before the OR has the same effect.

 

[WinslowPringle]

When are the hands shaking? When you load the needle? When you approach the tissue with the needle driver/pickup? Is it both hands or just the pickup or needle driver? Different strategies. If it’s just when loading, it’s probably from trying to load in mid air. If it’s all the times probably just nerves, so just practice/take propranolol/ recite a mantra in your head/do a breathing technique.

My general technique: stand up straight, roll your shoulders back, tuck your elbows to your sides gently. Feet shoulder width apart and legs relaxed. Load your needle on the field, and in fact load it on the patient not in mid air. If you are working with a castro type needle holder and finer suture, move your fingers the most, then your wrists, and your elbows and shoulder shouldn’t move very much at all within a bite (might have to move to reposition in between bites). With the large needle drivers, the turning motion is made between opposite movements of fingers 3-5 together and your thumb, with a gentle turn of the wrist. The pickup of your choice is held more like a pencil between your thumb and first two fingers. Don’t forget to breathe!

And I agree, coffee (particularly on an empty stomach) makes it much harder.

 

[flasheroonie]

I suture on a daily basis and I still get shaky on occasion. On introspection, I think it's just a manifestation of my physical exhaustion after performing a long procedure. However, my level of shakiness doesn't affect my ability to do the suturing. It just looks funny until I place needle to tissue, then I'm smooth. Reminds me of that scene when Jerry (the old guy who fixes toys) in Toy Story 2 is sewing Woody's arm back on. He's shaky as he approaches him, then is smooth on the way through.

 

[akwho]

Tuck your elbows by your side so you don't have to stabilize your hand with your shoulder girdle muscles as much. Suturing should be mostly in the wrist movements, with a little elbow, and no shoulder. Usually the first thing I teach the med students and they don't shake as much after.

Also echo the caffeine thing. I just have one cup when I wake up. Two cups or more and my hands shake too much to look smooth.

 

[heybrother]

When I learned to suture forever ago there was almost no mention anywhere about "gathering". When I search now it does seem to come up. For me beyond the craziness of suturing - if you don't have a game plan for controlling your suture volume you will struggle.

 

[Acapedia]

Are you drinking coffee the morning you noticed this? For me, that gives me shaky hands.

 

[Spetzler-Martin]

I had the same issue. Its much different when you know everyone in the room is staring at you.... and quietly groaning as they wait for you to close.

Propanalol worked wonders for me. Get an Rx from your PCP for performance anxiety.

I asked for anavar 20 mg instead. My PCP kicked me out.

 

[Severus21]

I was super shaky feeling as a student. And worried I wouldn’t be able to be a surgeon because of it.

I just kept practicing. And figured out what sleep schedule, caffeine, food mixture I needed to be my best in the OR. Can’t always hit the sweet spot because sometimes I’ll be operating for 20+ hours but over time your muscle memory keeps everything as it should be.

Bottom line… don’t give up! Just keep practicing!!