Musculoskeletal Injuries & Scanning Ergonomics in Sonography Anna Clifton, Gema Lambert and Jennifer Metts

Musculoskeletal Injury Facts In the field of sonography, musculoskeletal injuries affect approximately 80% of the workforce. One of every five sonographers (20%) is affected by a career ending injury. The average time a sonographer is working in the profession before experiencing pain is approximately five years. Many sonographers do not report their pain because the feel nothing can be done to improve the situation.

Musculoskeletal Injury Terms Musculoskeletal injuries among sonographers have been described with many terms: Work-Related Musculoskeletal Disorder (WRMSD) Musculoskeletal Disorder (MSD) Musculoskeletal Injury (MSI) Repetitive Strain Injury (RSI) Cumulative Trauma Disorder (CTD)

Physical Demands Sonographers must have full use of hands, wrists, and shoulders and they face many physical demands such as the following: Lift more than 30 pounds Push and pull Bend and stoop Work standing on their feet at least 80% of the time Assist patients on and off examining tables

Risk Factors Three primary risk factors that contribute to WRMSD: Posture Force Repetition www.back-pain.management-relief.com

Description of Exposure Repetitive motion Forceful and awkward movements Persistent continual pressure for long durations Poor posture and body mechanics Improper positioning Excessive force and strain Increased exam scheduling

Causes of WRMSD How does a musculoskeletal injury occur? Basically, thousands of forceful, awkward and repetitive movements eventually produce trauma to muscles, tendons and ligaments which leads to pain, inflammation, swelling and deterioration of tendons and ligaments. www.bahdy.com

Common Work-Related Injuries To Sonographers Shoulder (Rotator Cuff) Elbow Neck Lower Back Pain Wrist Pain www.cepu.ash.au

Anatomical Sites of Discomfort Eyes 45% Neck 74% Upper Back 58% Shoulder 76% Upper Arm 38% Middle Back 33% Forearm 31% Low Back 58% Wrist 59% Hip 25% Hand/Fingers 55% Upper Leg 7% Knee 17% Lower Leg 12% Ankle/Foot 20% Illustration re-created & information provided by: www.sdms.org/pdf/sonoergonomics.pdf

Symptoms Pain Clumsiness Numbness Burning or tingling Tenderness Swelling Loss of sensation Loss of function Muscle spasm Muscle Weakness www.superaloe.com

Tasks That Aggravate Musculoskeletal Symptoms Applying pressure with the transducer Shoulder abduction Sustained twisting of the neck & trunk Repetitive twisting of the neck & trunk Performing portable exams

Consequences of WRMSD Decreased and painful work activities Decreased and painful home activities Decreased and painful recreation activities Absent from work Redesign of work station Specialized equipment Fewer work hours Change in profession Physical disability

Raising Awareness Often, the risk for WRMSD is not the result of the work be performed, but rather how it is being performed. By increasing awareness of ergonomics, current and future sonographers can learn preventative measures associated with work-related injuries.

Scanning Ergonomics So…what are ergonomics? In general, ergonomics is the science or study of how people are affected by their work environment. Ergonomics help adapt and adjust products, tasks and environments to people to help reduce musculoskeletal disorders and workplace injuries. The most effective control measures to help prevent WRMSD include sonographer work methods and changes in workstations. www.safetyworld.com

Prevention Prevention of WRMSD requires a combination of changes involving sonographers, department managers and equipment manufacturers. www.spectrumtherapy.com

Recommendations To Reduce Risk Recommendations to reduce risk should include the following: Engineering controls - proper equipment and workstation design and layout Administrative controls – work organization and work practices Individual controls – risk identification and control, training and education

Sonographer Awareness Sonographers should learn the following: Be aware of activities that cause pain and learn to modify those activities. Learn the proper use of all exam room equipment. Utilize adaptive equipment when scanning, such as support cushions. Learn to perform stretching and strengthening exercises designed to prevent injury.

Sonographer Work Practices Decrease the duration of static posturing by varying postures throughout the day. Decrease hand grip pressure; loosen grip on the transducer, take short breaks, vary grip used on the transducer.

Sonographer Work Practices Minimize awkward and extreme postures. Increase muscle tissue strength and tolerance to injury through exercise and adequate rest. Minimize awkward and extreme postures. Increase muscle tissue strength and tolerance to injury through exercise and adequate rest.

Musculoskeletal Checklist Is the patient close enough to me? Is my arm and elbow tucked in closely to my body in a comfortable position. Did I adjust my chair or examination bed according to the body habitus of my patient in relationship to my height. Is my posture a comfortable and correct so as not to cause stress on my body? Am I working with my wrist and neck in a straight and supported position? Is the monitor and keyboard positioned so that I can easily see and reach them? Am I supporting my limbs properly throughout the entire examination? When I stand, am I carrying my body weight equally on both feet? Did I take a short break? Did I consciously release tension on the scanning hand for a few seconds? Did I take a longer break? Did I remove the probe from the scanning hand, stretching the hand, arm and shoulders. Am I aware of any unusual symptoms, such as numbness, swelling or pain?

Musculoskeletal and Physical Affects From Transducer Use 3D/4D OB Transducer 2D OB Transducer

Musculoskeletal and Physical Affects From Transducer Use “Heavy, inflexible transducer cables put additional strain on the wrist, forearm and elbow of the scanning arm requiring increased grip force to resist the torque created by the transducer cable.”

Musculoskeletal and Physical Affects From Transducer Use Ms Jeri Gray Central Georgia Perinatal Associates

Interview with Renee Delzeith Winn Army Hospital June 27, 2008

Interview with Renee Delzeith Winn Army Hospital June 27, 2008

Interview with Renee Delzeith Winn Army Hospital June 27, 2008

References Baker, J. & Murphey, S. Ultrasound ergonomics. Sound Ergonomics, 1-2. Batchelor, J. (2000, August 17). Employers can reduce repetitive strain injuries among sonographers. Retrieved on May 20,2008 from http:// www.auntminnie.com. Biosound Esaote. (2002). The value of ergonomically designed ultrasound systems. Murphey, S. & Coffin, C. David, S. (2005). Importance of sonographers reporting work-related musculoskeletal injury: A qualitative view. Journal of Diagnostic Medical Sonography, 21(3), 234-237. Epp, R. (2006, September). Preventing work-related musculoskeletal disorders in sonography. National Institute for Occupational Safety and Health, 148, 1-4. Environment of Care. (2006, March). Preventing occupational injury among diagnostic medical sonographers. Joint Commission on Accreditation of Healthcare Organizations, 9(3) 6-7. Murphey, S. (2008, April 30). Lean principles and ergonomics aid imaging management. Retrieved May 20, 2008 from http://www.auntminnie.com. Murphey, S. & Coffin, C. (2002, August). Ergonomics and sonographer well-being in practice. Sound Ergonomics, Article 102-sp-1046. Retrieved July 7, 2008, from www.healthpronet.wj/images/articlesound. Murphey, S. & Milkowski, A. (2006). Surface EMG evaluation of sonographer scanning postures. Journal of Diagnostic Medical Sonography, 22(5), 298-305. Employee Health and Safety Services. (2000, July). An update on ergonomic issues in sonography: Murphy, C. & Russo, A. Sound Ergonomics & Biodex Medical Systems. (1998). Sonographer occupational muculoskeletal disorders: What are they and how can they be prevented.