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Original Research (Original Article) 


Alshehri Shaker et al, 2020;4(3):652–659.

International Journal of Medicine in Developing Countries

Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia

Alshehri Shaker1*, Ala’a Abdulrhman Almazzah1, Arwa Hassan Asiri1, Mohammed Saad Alamri1, Mohammed Ali M. AlQahtani1, Maram Ali Abdullah Al-Mteer1, Mona Hassan M. Alkhayri1, Zainab Sultan Alamri1

Correspondence to: Alshehri Shaker

*Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia.

Email: bobamedo86 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 09 December 2019 | Accepted: 18 January 2020


ABSTRACT

Background:

Surgeons are more exposed to long-standing and hard work which results in pain development, especially the musculoskeletal (MS) pain that interferes with the performance of their job. Accordingly, this study aims to estimate the prevalence of MS pain and to find out the pattern of MS pain among surgeons. Moreover, it aims to identify the determinants of MS pain among surgeons and define the effects of MS pain on surgeons’ daily life and career.


Methodology:

A cross-sectional study was carried out in the governmental hospitals in Abha and Khamis Mushet city, Saudi Arabia. A minimum sample of 150 surgeons was required to estimate the expected prevalence of MS pain among surgeon staff. The data were collected using the visual analog scale and structured interview questionnaire and analyzed using the Statistical Package for the Social Sciences


Results:

The data were collected from 225 surgeons. About 48% reported that they experienced pain caused due to the long time taken in wearing a lead apron. Nearly 50% reported back pain as the most repeated pain occurred due to the operations involving the long duration of neck flexion, bending and twisting and lifting transport, and positioning the patients as the main causes. The most common reported symptoms included pain among 32.9% and fatigue among 20% of the subjects. Among all the tested determinants, only profession, years of work, and time of wearing lead apron were correlated with the degree of pain.


Conclusion:

The study concluded that MS pain was mainly caused by the long duration of neck flexion, and it commonly occurs in the back with pain and fatigue as main symptoms. The study defined the profession, years of work, and time of wearing a lead apron as the determinants of the degree of pain.


Keywords:

Musculoskeletal pain, Saudi Arabia, determinants, surgeons.


Introduction

Musculoskeletal disorders (MSDs) are defined as musculoskeletal (MS) complaints, MS symptoms, or MS pain that reflect several conditions, such as neck pain, back pain, shoulder pain, the pain of limbs, carpal tunnel syndrome, myofascial dysfunction syndrome, atypical facial pain, and so on [1]. MS pain affects the bones, muscles, ligaments, tendons, and nerves. Doctors, especially surgeons, are facing a serious high risk of MS pain due to the exposure to a range of work-related risk factors that may result in various occupational diseases, of which MSDs are common [2]. MS pain can be mild, infrequent, severe, chronic, and debilitating. However, little is known about these types of injuries among surgeons [3]. In general, the aggravating factors of MS pain are overweight, sedentary lifestyle, stress, and static stretching. Neck, low-back, wrist, and hand pain [4] that rooted to common factors were being stood in long surgery duration, extremely long period time of neck flexion, length of service, keeping the same posture for a long time, no enough rest time, tool size not suitable for the hand, coldness, and job stress and also wearing lead aprons in radiology (for protection), static postures, repetitive tasks, awkward, and high cognitive load [1,5,6]. MS pain also differs according to age, gender, and body built [7]. Among surgeons, the prevalence of MS pain is 37% [8], 83.3% among dental surgeons [9], 51.8% among ophthalmologists [1], 47.4% among ENT surgeons [10], and 87.3% among plastic surgeons [3]. In the United Kingdom, 78.7% found that operation exacerbated their pain [11]. Surgeons are a critical category in the medical field who are more exposed to long-standing and hard work which results in pain development, especially MS pain that interferes with the performance of their job. The researchers conducted this research to identify the magnitude of this problem and its consequences on job performance among surgeons in Abha and Khamis Mushet hospitals.


Subjects and Methods

This study is a cross-sectional study over the governmental hospitals in Abha and Khamis Mushet city, Saudi Arabia. Surgeons who are working in or within government hospitals in the study settings were included in the study. However, it excludes surgeons who have disk prolapse, back injuries, previous spinal surgery, pelvic deformity, tumors, and osteoporosis. A minimum sample of 150 surgeons is required to estimate the expected prevalence of MS pain among surgeon staff = 74% [12], with confident level = 95% and precision = 7%. Physicians were selected from the different hospitals using a simple random sampling technique. The number of physicians who were included from each hospital depends on sample propionate to the size method. The visual analog scale (VAS) [13] and structured interview questionnaire were distributed to surgeons in Abha and Khamis Mushet, Saudi Arabia.

VAS consists of a line, usually 100-mm long, whose ends are labeled as the extremes (no pain and worst pain imaginable); the rest of the line is blank. The patient is asked to put a mark on the line indicating their pain intensity (at present, over the past week, or the past 2 weeks). The distance between that mark and the origin is measured to obtain the patients’ score. The addition of markers to the traditional pain VAS forms a graphic rating scale (GRS). This scale includes a horizontal line with the vertical bars of increasing height and anchors at both the ends (no pain and worst possible pain). The line is graded from 0 to 10 (or from 0 to 100). The numerical rating scale involves asking patients to rate their pain intensity by selecting a number on a scale from 0 to 10 (11-point scale), 0 to 20 (21-point scale), or 0 to 100 by filling in a questionnaire or stating verbally a numerical level (please indicate on the line below the number between 0 and 10 that best describes your pain. A 0 would mean no pain and a 10 would mean worst pain imaginable). Sometimes, descriptive terms, such as none, mild, moderate, and severe, are provided along the scale (this forms a verbal rating scale) for guidance, as shown, and the scale is then referred as GRS. The questionnaires are coded, all the questionnaires are saved in a secured place and stored in a coded system on an Excel sheet, and then, the analysis was performed using the Statistical Package for the Social Sciences program. All the data collected are anonymous, and the anonymous process will be kept out through our process with no identification of the participant (Figure 1).

Figure 1. The VAS.


Results

The data were collected from 225 surgeons, of whom 87.6% were females and 12.4% were males. The majority less than 30 years old represents 34.2% of the sample. Around 79% of the sampled surgeons were married and around 45% were overweight. Furthermore, 71% of them reported that they sometimes do exercises. The analysis also shows that 73.3% are nonsmokers and 81.5% do not have any chronic diseases. Table 1gives more details on the biodemographic data of the sampled surgeons. The results show that the most common specialty among the sampled surgeons was general surgery (22.7%) followed by specialized in obstetrician and gynecologist (13.8%). Out of the total sample, 31.6% were consultants. Around 49% of the samples have worked between 5 and 9 years. In addition, 67.6% of the sampled surgeons spend an average of 1–2 hours in an operation. About 73.2% reported that they always work with assistance. Moreover, around 47% reported that they sometimes take rest during the operations. About 81.7% perform operations while they are standing and 93.3% reported that the size of surgery tools is suitable for their hands. Table 2 shows more details concerning the work data of the sampled surgeons. Of the total sample (100), 44.4% reported that they need to wear a lead apron during surgery. Of those 100 surgeons, 69% reported that they use trunk shielding and 58.6% reported that they wear them between 1 and 3 hours. Accordingly, 48% reported that they experienced pain caused by a long-time wearing the lead apron (Table 3). Nearly 50% reported back pain as the most repeated pain occurred due to the operations. Figure 2 represents the main causes of MS pain as reported by the sampled surgeons. It appears that long duration of neck flexion, bending and twisting and lifting transport, and positioning the patients are the main causes as they represented relatively close percentages with 74%, 72.4%, and 72.2%, respectively. As represented in Figure 3, the most prevalent degree of pain is moderate (48.9%), whereas the mild pain represents 46.2% and the sever represents 3.1%. The most common pain symptoms are pain with 32.9% and fatigue with 20% (Table 4). Furthermore, 18.7% of the sampled surgeons reported discomfort. More than half of the sampled surgeons recorded incorrect posture as the aggravating factor of pain, whereas 12.4% recorded a prolonged sitting (Table 5). The surgeons recorded the relieving factors of pain (Table 6): 27.1% of them recorded the rest, followed by 16% recorded correct posture and 6.2% recorded analgesic. As shown in Table 7, concerning pain management methods used by the surgeons, 23.6% use medical methods, 18.7% use physiotherapy, and 12.9% use the gym to manage pain. As shown in Table 8, 37.8% reported that this pain causes troubles during the past 12 months, 26.7% reported that this pain recurred in the daily procedure, 20.4% reported that this pain interferes with the procedure, and 23.6% reported that the pain affects their daily life. Table 9 represents the determinants of pain degree. It appears that among all the tested determinants, only profession, years of work, and time of wearing a lead apron are correlated with the degree of the pain as they have a p-value of 0.049, 0.048, and 0.045, respectively.

Table 1. Biodemographic data of sampled surgeons.

Biodemographic data No %
Gender Male 197 87.6
Female 28 12.4
Age in yearsç <30 50 22.2
30+ 77 34.2
40+ 54 24.0
50+ 44 19.6
Are you married Yes 177 78.7
No 48 21.3
Body mass index Normal 76 33.8
Overweight 102 45.3
Obese 47 20.9
Exercise status Always 40 17.9
Sometimes 159 71.0
Never 25 11.2
Smoking status Current smoker 45 20.0
No 165 73.3
Ex-smoker 15 6.7
Do you have any chronic disease No 181 81.5
DM 7 3.2
HTN 23 10.4
Renal 1 0.5
Other 5 2.3
Asthma 2 0.9
DM and HTN 3 1.4

Table 2. Work data of sampled surgeons.

Work data No %
Specialty Cardiac surgery 7 3.1
Vascular 12 5.3
Neurosurgery 16 7.1
Plastic surgery 10 4.4
Urology 22 9.8
General surgery 51 22.7
Pediatric surgery 17 7.6
Orthopedic 25 11.1
Obstetrician and gynecologist 31 13.8
Ophthalmology 9 4.0
Maxillofacial 3 1.3
Otolaryngology 11 4.9
Other 11 4.9
Profession Junior resident 49 21.8
Senior resident 41 18.2
Registrar 64 28.4
Consultant 71 31.6
Years of work 1–4 69 30.7
5–9 47 20.9
10+ 109 48.4
Average time spent in each operation (hours) < 1 16 7.1
1–2 152 67.6
3–5 42 18.7
>5 15 6.7
Hours on average spent in OR per week 1–9 100 44.4
10–19 91 40.4
20+ 34 15.1
Do you work with the assistance Always 164 73.2
No 9 4.0
Sometimes 51 22.8
Usually, have you take rest during operation Always 17 7.6
Sometimes 105 46.9
Never 102 45.5
What is the most common position during operation Sitting 15 6.7
Standing 183 81.7
Alternating 26 11.6
Does surgery tools’ size is suitable for the hand Yes 208 93.3

Table 3. Personal protective equipment (PPE) wearing by surgeons.

PPE during surgery No %
Do you need to wear a lead apron during surgery Yes 100 44.4
No 125 55.6
Which kind of lead aprons you wear (n = 100) Trunk shielding 69 69.0
Eyeglass protection 6 6.0
All 11 11.0
Trunk and thyroid shielding 11 11.0
Trunk shielding and eyeglass 3 3.0
How long do you wear them (n = 100) Below one hour 13 13.1
1–3 hours 58 58.6
3–6 hours 20 20.2
Above 6 hours 8 8.1
Have you experience any pain caused by long-time wearing it (n = 100) Yes 48 48.0
No 19 19.0
Sometime 33 33.0
What is the most frequent location of pain occur due to operation (n = 100) Neck pain 7 7.1
Shoulder pain 21 21.4
Back pain 49 50.0
All 12 12.2
Neck and shoulder 4 4.1
Neck and back 2 2.0
Shoulder and back 3 3.1

Figure 2. Causes of MS pain as recorded by sampled physicians.

Figure 3. Degree of pain.

Table 4. Most common pain symptoms recorded among the study physicians.

Most common pain symptoms No %
Pain 74 32.9
Stiffness 14 6.2
Fatigue 45 20.0
Discomfort 42 18.7
Click 2 0.9
Pain and stiffness 3 1.3
Pain and fatigue 11 4.9
Pain and discomfort 10 4.4
Stiffness 1 0.4
Fatigue and discomfort 2 0.9
Discomfort and click 1 0.4
Pain, stiffness, and fatigue 4 1.8
Pain, stiffness, and discomfort 2 0.9
Pain, stiffness, and discomfort 10 4.4
Pain, discomfort, and click 1 0.4
Pain, stiffness, fatigue, and discomfort 3 1.3

Table 5. Aggravating factors of pain as recorded by sampled physicians.

Aggravating factors of pain No %
Incorrect posture 116 51.6
Prolonged sitting 28 12.4
Rotation 14 6.2
Lifting 16 7.1
Driving 5 2.2
Coldness 2 0.9
Prolonged sitting and incorrect posture 9 4.0
Prolonged sitting and lifting 1 0.4
Prolonged sitting and driving 1 0.4
Prolonged sitting and coldness 1 0.4
Incorrect posture and rotation 5 2.2
Incorrect posture and lifting 12 5.3
Incorrect posture and coldness 1 0.4
Rotation and driving 1 0.4
Prolonged sitting, incorrect, and rotation 2 0.9
Prolonged sitting, incorrect posture, and lifting 4 1.8
Prolonged sitting, incorrect posture, and coldness 2 0.9
Prolonged sitting, driving, and coldness 1 0.4
Incorrect, rotation, and lifting 2 0.9
Prolonged sitting, incorrect, rotation, and lifting 1 0.4
Prolonged sitting, incorrect, lifting, and driving 1 0.4

Table 6. Relieving factors of pain as recorded by sampled physicians.

Relieving factors of pain No %
Correct posture 36 16.0
Work pause 10 4.4
Exercise 12 5.3
Analgesic 14 6.2
Sitting 13 5.8
Bracing 2 0.9
Rest 61 27.1
Correct posture and work pause 2 0.9
Correct posture and exercise 2 0.9
Correct posture and analgesic 4 1.8
Correct posture and sitting 4 1.8
Correct posture and rest 12 5.3
Work pause and exercise 1 0.4
Work pause and analgesic 1 0.4
Work pause and rest 1 0.4
Exercise and analgesic 1 0.4
Exercise and rest 2 0.9
Analgesic and sitting 1 0.4
Analgesic and rest 10 4.4
Sitting and rest 3 1.3
Correct posture, work pause, and exercise 1 0.4
Correct posture, work pause, and analgesic 2 0.9
Correct posture, work pause, and sitting 1 0.4
Correct posture, work pause, and rest 3 1.3
Correct posture, exercise, and analgesic 4 1.8
Correct posture, exercise, and sitting 1 0.4
Correct posture, exercise, and rest 1 0.4
Correct posture, analgesic, and sitting 1 0.4
Correct posture, analgesic, and rest 1 0.4
Correct posture, sitting, and rest 4 1.8
Work pause, exercise, and rest 1 0.4
Work pause, sitting, and rest 1 0.4
Exercise, analgesic, and rest 1 0.4
Analgesic, sitting, and rest 2 0.9
Correct posture, work pause, exercise, and rest 1 0.4
Correct posture, work pause, analgesic, and sitting 1 0.4
Correct posture, work pause, analgesic, and rest 1 0.4
Correct posture, work pause, sitting, and rest 1 0.4
Correct posture, exercise, analgesic, and rest 1 0.4
Correct posture, analgesic, sitting, and rest 1 0.4
Correct posture, work pause, exercise, analgesic, and rest 1 0.4
Correct posture, work pause, exercise, sitting, and rest 1 0.4
Correct posture, work pause, exercise, analgesic, sitting, and rest 1 0.4

Table 7 Pain management methods.

Pain management methods No %
Medically 53 23.6
Gym 29 12.9
Physiotherapy 42 18.7
Surgery 5 2.2
Others 72 32.0
Medically and gym 2 0.9
Medically and physiotherapy 11 4.9
Medically and others 1 0.4
Gym and others 4 1.8
Physiotherapy and others 1 0.4
Medically, gym, and physiotherapy 4 1.8
Medically, physiotherapy, and surgery 1 0.4

Table 8. Pain effect.

Pain effect Yes No
No % No %
Does this pain cause troubles during the past 12 months 85 37.8 140 62.2
Does this pain recurrent in daily procedure 60 26.7 165 73.3
Does this pain interferes with the procedure 46 20.4 179 79.6
Does this pain affects the daily life 53 23.6 172 76.4

Table 9. Determinants of pain degree among the study physicians.

Determinants Degree of your pain on the scale p
Mild Moderate Sever
No % No % No %
Body mass index Normal 36 47.4 39 51.3 1 1.3 0.204
Overweight 50 49.0 50 49.0 2 2.0
Obese 22 46.8 21 44.7 4 8.5
Exercise status Always 20 50.0 19 47.5 1 2.5 0.675
Sometimes 76 47.8% 79 49.7% 4 2.5%
Never 12 48.0% 11 44.0% 2 8.0%
Smoking status Current smoker 21 46.7 22 48.9 2 4.4 0.632
No 82 49.7 78 47.3 5 3.0
Ex-smoker 5 33.3 10 66.7 0 0.0
Profession Junior resident 28 57.1 20 40.8 1 2.0 0.049*
Senior resident 17 41.5 22 53.7 2 4.9
Registrar 34 53.1 29 45.3 1 1.6
Consultant 29 40.8 39 54.9 3 4.2
Years of work 1–4 38 55.1 30 43.5 1 1.4 0.048*
5–9 24 51.1 21 44.7 2 4.3
10+ 46 42.2 59 54.1 4 3.7
Average time spent in each operation (hours) < 1 7 43.8 9 56.3 0 0.0 0.514
1–2 73 48.0 73 48.0 6 3.9
3–5 23 54.8 18 42.9 1 2.4
>5 5 33.3 10 66.7 0 0.0
Hours on average spent in OR per week 1–9 48 48.0 49 49.0 3 3.0 0.450
10–19 45 49.5 43 47.3 3 3.3
20+ 15 44.1 18 52.9 1 2.9
Do you work with the assistance Always 78 47.6 80 48.8 6 3.7 0.678
No 4 44.4 5 55.6 0 0.0
Sometimes 25 49.0 25 49.0 1 2.0
Usually, have you take rest during operation Always 7 41.2 8 47.1 2 11.8 0.543
Sometimes 44 41.9 58 55.2 3 2.9
Never 56 54.9 44 43.1 2 2.0
What is the most common position during operation Sitting 8 53.3 7 46.7 0 0.0 0.988
Standing 86 47.0 91 49.7 6 3.3
Alternating 13 50.0 12 46.2 1 3.8
Do you need to wear a lead apron during surgery Yes 48 48.0 49 49.0 3 3.0 0.942
No 60 48.0 61 48.8 4 3.2
How long do you wear them Below 1 hour 6 46.2 6 46.2 1 7.7 0.045*
1–3 hour 25 43.1 32 55.2 1 1.7
3–6 hour 12 60.0 8 40.0 0 0.0
Above 6 hour 5 62.5 2 25.0 1 12.5

Discussion

Similar to the aim of this study, a several number of medical studies aimed to discuss MS pain among medical practitioners whether surgeons, dentists, or other GPs. In one of the studies that sampled 241 dentists, the MS symptoms happened in 63.5% of the sample. Fatigue and pain were the most common MS symptoms among dentists (36.5% and 24.9%, respectively). Prolonged sitting appeared to be the most common aggravating factor (26.6%), whereas exercise successfully relieved symptoms in 35.3% of respondents. Neck, upper back, and lower back were the most common sites involved with prevalence of 25.7%, 22.4%, and 20.7%, respectively. The neck was also the most common site of the symptoms preventing normal work during the preceding 12 months (8.3%). The study also revealed that exercise and stress are correlated with the existence of MS symptoms (p = 0.01 and p < 0.01, respectively) [14]. In another study that targeted dentists, the results showed that 95.16% of respondents reported MSDs in the past. 54.84% reported at least one episode of backache, 51.61% reported neck pain, 19.35% reported pain in the shoulder, and 32.25% reported pain in the wrist and/or hand in the past 12 months. This study concluded a significant influence of the hours of work, use of assistant, and magnification on backache, neck pain, and wrist/hand pain [15]. A study that compared MS pain among dentists, physicians, and surgeons found that it was most prevalent among dentists (61%), followed by surgeons (37%) and physicians (20%). Nearly 15% of physicians, 40% of surgeons, and 60% of dentists had MSD problems in more than one site [16]. The result obtained from another study showed that there is a high prevalence of work-related MSDs among the studied population (43.3%), in which the shoulder region is the most frequently affected area with 39.6% of the total symptoms reported. The predominant risk factors were high repetitive motion (85.7%), prolonged sitting (95.5%), and a greater number of working hours. Among the samples, only 30 ever attended the hospital for medical attention against their complaints [17].


Conclusion

The study concluded that MS pain was mainly caused by the long duration of neck flexion and it commonly occurs to the back with pain and fatigue as main symptoms. The main way to manage pain was a medical solution. The study defined the profession, years of work, and time of wearing a lead apron as the determinants for the degree of pain.


List of Abbreviations

GRS Graphic rating scale
PPE Personal protective equipment
SPSS Statistical Package for the Social Sciences
VAS Visual analog scale
VRS Verbal rating scale

Conflict of Interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for Publication

Informed consent was obtained from all the participants.


Ethical Approval

The research was approved by ethics committee of King Khalid University on 30-May-2018 via letter no. HA-06-B-001.


Author details

Alshehri Shaker1, Ala’a Abdulrhman Almazzah1, Arwa Hassan Asiri1, Mohammed Saad Alamri1, Mohammed Ali M. AlQahtani1, Maram Ali Abdullah Al-Mteer1, Mona Hassan M. Alkhayri1, Zainab Sultan Alamri1

  1. Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia

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How to Cite this Article
Pubmed Style

Shaker A, Almazzah AA, Asiri AH, Alamri MS, AlQahtani MAM, Al-Mteer MAA, Alkhayri MHM, Alamri ZS. Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia. IJMDC. 2020; 4(3): 652-659. doi:10.24911/IJMDC.51-1575918196


Web Style

Shaker A, Almazzah AA, Asiri AH, Alamri MS, AlQahtani MAM, Al-Mteer MAA, Alkhayri MHM, Alamri ZS. Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia. http://www.ijmdc.com/?mno=77327 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1575918196


AMA (American Medical Association) Style

Shaker A, Almazzah AA, Asiri AH, Alamri MS, AlQahtani MAM, Al-Mteer MAA, Alkhayri MHM, Alamri ZS. Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia. IJMDC. 2020; 4(3): 652-659. doi:10.24911/IJMDC.51-1575918196



Vancouver/ICMJE Style

Shaker A, Almazzah AA, Asiri AH, Alamri MS, AlQahtani MAM, Al-Mteer MAA, Alkhayri MHM, Alamri ZS. Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia. IJMDC. (2020), [cited March 29, 2020]; 4(3): 652-659. doi:10.24911/IJMDC.51-1575918196



Harvard Style

Shaker, A., Almazzah, . A. A., Asiri, . A. H., Alamri, . M. S., AlQahtani, . M. A. M., Al-Mteer, . M. A. A., Alkhayri, . M. H. M. & Alamri, . Z. S. (2020) Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia. IJMDC, 4 (3), 652-659. doi:10.24911/IJMDC.51-1575918196



Turabian Style

Shaker, Alshehri, Alaa Abdulrhman Almazzah, Arwa Hassan Asiri, Mohammed Saad Alamri, Mohammed Ali M. AlQahtani, Maram Ali Abdullah Al-Mteer, Mona Hassan M. Alkhayri, and Zainab Sultan Alamri. 2020. Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 652-659. doi:10.24911/IJMDC.51-1575918196



Chicago Style

Shaker, Alshehri, Alaa Abdulrhman Almazzah, Arwa Hassan Asiri, Mohammed Saad Alamri, Mohammed Ali M. AlQahtani, Maram Ali Abdullah Al-Mteer, Mona Hassan M. Alkhayri, and Zainab Sultan Alamri. "Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia." International Journal of Medicine in Developing Countries 4 (2020), 652-659. doi:10.24911/IJMDC.51-1575918196



MLA (The Modern Language Association) Style

Shaker, Alshehri, Alaa Abdulrhman Almazzah, Arwa Hassan Asiri, Mohammed Saad Alamri, Mohammed Ali M. AlQahtani, Maram Ali Abdullah Al-Mteer, Mona Hassan M. Alkhayri, and Zainab Sultan Alamri. "Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia." International Journal of Medicine in Developing Countries 4.3 (2020), 652-659. Print. doi:10.24911/IJMDC.51-1575918196



APA (American Psychological Association) Style

Shaker, A., Almazzah, . A. A., Asiri, . A. H., Alamri, . M. S., AlQahtani, . M. A. M., Al-Mteer, . M. A. A., Alkhayri, . M. H. M. & Alamri, . Z. S. (2020) Pattern and determinants of musculoskeletal pain among surgeons in Abha and Khamis Mushet City, Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 652-659. doi:10.24911/IJMDC.51-1575918196