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What are musculoskeletal disorders and how do they affect sonographers?

The terms “work related musculoskeletal disorders (WRMSDs)”, “musculoskeletal strain injuries”, and “cumulative trauma disorders” are used to describe conditions that are caused or aggravated by workplace activities.

Work Related Musculoskeletal Disorders (WRMSDs):

Are painful disorders affecting the muscles, nerves, ligaments, and tendons
Develop gradually over a period of time from repeated exposure
Result from work activities are among the most frequently reported causes of restricted or lost work
In sonography, workforce shortages can affect patient access to care in addition to the physical health and well-being of staff

Excerpt from: Work Related Musculoskeletal Disorders In Sonography; SDMS 2018

90% of clinical sonographers experience symptoms of WRMSDs*

20% of sonographers who were symptomatic suffered career-ending injuries*

International literature shows that 80% to 90% of sonographers experience pain while performing scans at some stage in their career. Of these, approximately 20% will have a career changing and life changing injury.

* Excerpt from: Sonographer Safety Workplace Considerations

Where do we hurt?

1. Shoulder

2. Neck

3. Wrist

What Can We Do?

Begin with Prevention

Watch & Learn Best Practices From the Experts

A Quick Mental Checklist

Is the patient close enough to me?
Are my arms and elbows tucked in?
Did I adjust my chair and exam bed according to the exam?
Am I working from the patient or the system?

Introduction to Being a Healthy Sonographer

Scanning From The Patient
Versus The System

How do we achieve both a “sonographer neutral position” and a “patient engagement position”? First, start by setting up your work position from the patient’s perspective, not that of the ultrasound system. You will be facing the patient &, thus, in a “patient engagement position”.

Excerpt from Sound Ergonomics newsletter, February 2018.

Sonographer Box

Scanning from the System

Magic Triangle

Scanning from the Patient

How to Scan In The Magic Triangle

Your body should align similar to driving (looking forward, reaching forward to steering wheel and stick shift)

Rotate console away from bed to align trackball with elbow & wrist
Float monitor towards patient

Left Handed
Cardiac

Right Handed
Abdominal

Setup Correctly

Always adjust the setup before beginning an exam.

Scanning Station Setup

Top 10 List for Sonographer Work Safety

Learn Best Practices

System and Patient Setup for the Most Common Exams

General Abdomen Exam Setup

Carotid Exam Setup

Echocardiogram Setup

Lower Extremity Exam Setup

Endovaginal Exam Setup

Shoulder Exam Setup

Daily Exercises

1. Arm Stretch

Place arm on doorway and rotate trunk away from arm. Hold 30 seconds; perform stretch to both arms.

2. Shoulder Rolls

Lift both shoulder and perform circular movements. Perform 10 repetitions accompanied with deep breathing.

3. Cross Arm Stretch

Hold the elbow with the opposite hand in front of the body and slowly pull the elbow across the body until you feel a comfortable stretch. Hold 30 seconds; perform stretch to both arms.

4. Head Tilts

From a sitting position, slowly tilt head forward until chin reached chest, hold for 5 seconds. Then tilt head backward until you are looking up at ceiling, hold for 5 sec. Perform 10 times.

5. Hamstring Stretch

Scoot to edge of chair, extend leg in front of you with toes pointed upward. Slowly lean trunk forward until you feel a comfortable stretch. Hold 30 seconds; perform stretch to both legs.

6. Piriformis Stretch

Cross ankle over opposite knee. Slowly lean trunk forward until you feel a comfortable stretch. Hold 30 seconds; perform stretch to both legs.

7. Hand-Wrist Stretch

Place palm of hands together with fingers pointing upward and slowly raise elbows upward while maintaining contact at the palms. Hold 30 seconds.

Walking Break Challenge: When making the decision to drink water or use the restroom while at work, I challenge you to take that opportunity to walk for a total of 5 minutes. You can choose a water fountain which is further away from your work area, or walk to the bathroom that’s on the other side of your work facility. Whatever it takes, find a way to make walking a part of your work day. Dr. Matthew Hernandez, DPT, B.SC, CSCS, Physical Therapist

Use the Ergonomic Features of the Ultrasound System

System console should be fully adjustable for seated or standing use
Monitor should adjust separately from user interface
User interface should rotate allowing alignment of elbow, wrist & trackball
System should allow sonographer to position themselves close to table and patient
System height should accommodate various users

See a complete list here:
Industry Standards For The Prevention Of Work Related Musculoskeletal Disorders In Sonography

Canon i-series the Healthy Sonographer Platform™
with adaptive ergonomics

Optimize

Equipment & Accessories

Work Station Equipment

Sound Work Environment

Examination Table

Scan Using an Electronic Height Adjustable Table
For endovaginal scanning, tables should have easily accessible and adjustable footboard and stirrups
For cardiac imaging, tables should have an easily operated cardiac access panel, drop away, or cut out section to access the apical region
For lower extremity venous reflux studies, tables must have the capability to achieve reverse Trendelenburg to a minimum of 15 degrees and up to 25 degrees, with a footboard for patient safety

Scanning Chair

We have found up to 70% of ultrasound departments employ the use of a specialized chair
Chairs should be height-adjustable with sufficient range to allow for neutral posture
Adjustable lumbar support
Adjustable seat depth for thigh support
Adjustable footrest

Accessories

Support devices for supporting the scanning arm in abduction
Wearable transducer cable support device
Properly fitting, textured exam gloves should be available to reduce the force required to grip the transducer
Anti-fatigue mats are recommended for workstations requiring prolonged standing
Wedge support cushions for cardiac and endovaginal exams (when stirrups aren’t available)

See expanded recommendations from the SMDS

Events

Host a Healthy Sonographer Presentation in your lab
or at a local ultrasound society meeting.

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Articles

Title	Author	File
Scheduling Ultrasound Examinations to Reduce the Risk of WRMSDs in Sonographers	JDMS	Link
AIUM Practice Principles for Work-Related Musculoskeletal Disorder	JUM Journal of Ultrasound in Medicine	Link
SONOGRAPHER SAFETY ALERT	SDMS	Link
Characteristics and Consequences of Work-Related Musculoskeletal Pain among Cardiac Sonographers Compared with Peer Employees: A Multisite Cross-Sectional Study	Mayo Clinic, Rochester, Minnesota	Link
Enhance Patient Engagement While Optimizing Sonographer Comfort The Canon Aplio i-series, Healthy Sonographer Platform	Canon Medical Systems USA, Sound Ergonomics, LLC	Download White Paper
Employer’s Cost for 1 Injured Sonographer = $771,500	Society of Diagnostic Medical Sonography	Link
AIUM: Ultrasound ergonomics key to quality care	Kate Madden Yee, AuntMinnie.com Staff Writer	Link
The Continuous Improvement Process and the Role of Ergonomics	Carolyn T. Coffin, MPH, RDMS, RVT, RDCS, BOEC, Seattle University, Sound Ergonomics, LLC	Link
Preventing Work-related Injuries Among Sonographers	Carolyn T. Coffin, MPH, RDMS, RVT, RDCS, FSDMS / Joan P. Baker, MSR, RDMS, RDCS, FSDMS	Link
10 Ergonomic training may help sonographers avoid MSK injury Oct. 2018	By Kate Madden Yee, AuntMinnie.com staff writer	Link
Sonographer Safety Workplace Considerations	Generated by the Sonographer Safety Initiative; South Australian Biomedical Engineering	Link
Work Related Musculoskeletal Disorders In Sonography; SDMS 2018	Society Of Diagnostic Medical Sonography	Link
Industry Standards For The Prevention Of Work Related Musculoskeletal Disorders In Sonography	Developed Through A 2016 Consensus Conference Hosted By The Society Of Diagnostic Medical Sonography	Link
Practice Guidelines for Prevention of Musculoskeletal Disorders in Obstetric Sonography	Thierry Rousseau MD, Nicolas Mottet MD, Guillaume Mace MD, Carole Franceschini MD, Paul Sagot MD	Link
Ultrasonographer’s wrist—an occupational hazard	Alex Schoenfeld, Ultrasound Obstet Gynecol 1998;11:313–316	Link
Get a Grip—Consider varying how you hold the transducer	Sound Ergonomics, LLC Solutions for Occupational Health	Link
Making It Right Ergonomically With What You Have!	Sound Ergonomics, LLC Solutions for Occupational Health	Link
Avoidance Of Musculo-skeletal Disorders During Ultrasound Scanning	Jan Dodgeon, Lecturer/Practitioner in Ultrasound; Freddie Bernard, Physiotherapist; Jill Wilde, Moving & Handling Co-ordinator; Ann Newton-Hughes, Lecturer	Link
Ergonomics—Taking Care of Yourself	Sonographers' Communication	Link

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