Musculoskeletal Injuries

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

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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.

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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)

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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

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Risk Factors

• Three primary risk factors that contribute to
  WRMSD
• Posture
• Force
• Repetition

www.back-pain.management-relief.com
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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

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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
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Common Work-Related Injuries To Sonographers

• Shoulder (Rotator Cuff)
• Elbow
• Neck
• Lower Back Pain
• Wrist Pain

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Anatomical Sites of Discomfort
Eyes 45
Neck 74
Upper Back 58
Shoulder 76
Upper Arm 38
Middle Back 33
Forearm 31
Low Back 58
Hip 25
Wrist 59
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
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Symptoms

• Pain
• Clumsiness
• Numbness
• Burning or tingling
• Tenderness
• Swelling
• Loss of sensation
• Loss of function
• Muscle spasm
• Muscle Weakness

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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

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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

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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.

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Scanning Ergonomics

• Sowhat 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
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Prevention

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

www.spectrumtherapy.com
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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

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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.

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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.

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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.

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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?

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Musculoskeletal and Physical Affects From
Transducer Use
3D/4D OB Transducer
2D OB Transducer
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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.
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Musculoskeletal and Physical Affects From
Transducer UseMs Jeri GrayCentral Georgia
Perinatal Associates
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Interview with Renee Delzeith Winn Army
Hospital June 27, 2008
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Interview with Renee Delzeith Winn Army
Hospital June 27, 2008
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Interview with Renee Delzeith Winn Army Hospital
June 27, 2008
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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.