Ways to prevent repetitive musculoskeletal injuries in sonographers

With increased workload and little time to recover, sonographers are exposed to excess biomechanical stress. Unsurprisingly, the most commonly reported symptoms are aches and stiffness of the joints.

Obstetrical and cardiac sonographers are at even higher risk. The wrist flexion and extension, neck or trunk twisting, and arm abduction repeated over a sustained period that their work involves can cause increased muscle strain and stress.

Even though our muscles and tendons are designed to stretch and to be used regularly, working long hours affects the ability of the muscles to adapt. Extensive overuse of the muscles and tendons increases the risk of inflammation, which is responsible for degeneration, micro tears and scar formation,⁶ such as found in sonographer shoulder injury, bursitis and tendonitis.

Likewise, long periods maintaining a static posture, such as prolonged pinch gripping of the transducer with insufficient recovery time, can also lead to musculoskeletal pain and numbness. (This is because of reduced blood flow toward the muscles and joints).^5,7

With these professional conditions, it’s no wonder that work-related musculoskeletal disorders are so common in sonographers.

If we unpack these workplace conditions, we see that repetitive musculoskeletal injuries in sonographers can be caused by 2 main factors: ^2,4,6–10

1. Poor workflow such as low staff rotation and crowded exam scheduling is a major contributor to sonographer injuries. Prolonged periods of performing the same scan on different patients, with no breaks can severely affect the physical and mental wellbeing of the sonographer.
2. Poor posture during a scan may contribute to repetitive musculoskeletal injuries in sonographers as well. Sonographers may not use (or be aware of) the correct posture and body positioning during scans and instead resort to repetitive, forceful and awkward movements.

WRMSDs are by nature cumulative disorders in which apparently minor symptoms can progress over time to more serious and debilitating ones. For this reason, it is important to recognize sonographer injury symptoms11 early on.

The symptoms of repetitive work-related injuries can be broadly divided into 3 stages:

• Early-stage: aching and tiredness that disappears at night.
• Intermediate stage: numbness, tension, tingling feeling that persists at night.
• Late-stage: continuous pain, affects sleep and performance of light tasks.

Awareness of these stages can help the sonographer take action as soon as possible. It is particularly crucial to recognize the first stage because symptoms like aching and tiredness are often overlooked as general fatigue and not as symptoms of a more serious work-related injury.

Mutual ownership of the employer and the sonographer is key to sonographer injury prevention. Raising awareness about the damages of incorrect posture and poor working habits through education and training may improve outcomes.

Experts at the Society of Diagnostic Medical Sonography have outlined industry standards to prevent sonographer work-related injuries. These recommendations (listed below) provide strategies that will help sonographers improve both their workflow and posture.^{6,12 13}

One of the most efficient ways to prevent sonographer work-related injuries is to improve workflow. Workflow changes may include:

1. Better scheduling of patients to allow gaps between scanning sessions and avoid repetitive scanning or back-to-back assessment of difficult-to-examine patients (e.g., obese, limited mobility, and/or intensive care equipment).
2. Staff shifts no longer than 8 hours.
3. Regular breaks for staff.
4. Staff rotation.
5. Workplaces can be proactive in learning more about symptoms and prevention guidelines, such as signing staff up for courses on WRMSD  as well as training workshops.
6. Sonographers can familiarize themselves with employer reporting procedures of injuries and WRMSD symptoms.

Ultrasound users can prevent work-related musculoskeletal disorders by aiming to adopt a neutral posture during examinations. To attain a neutral position, it’s important to avoid:
 

1. Excess reach and abduction of both arms.
2. Working with the arm behind the midline.
3. Excess grip force and transducer pressure.
4. Prolonged awkward or static posture. 
5. Sustained reaching, bending and twisting of the trunk.
6. Excess neck flexion, extension and rotation.⁸

Here are a few ways sonographers can prevent physical strain:

1. Using foot and elbow support when appropriate.
2. Proper handling of the patient, such as asking them to come closer, or using a team of assistants to lift or move a patient.
3. Taking the time to optimize the settings of adjustable workstations, such as EPIQ CVx, for optimum comfort during scans.
4. Familiarising themselves with the automated capabilities of the ultrasound machine settings to decrease exposure to risk factors.

Sonographers may also benefit from taking regular risk assessments and by keeping up to date with the current guidance on workplace injuries. Body-mapping exercises, staying fit and being mindful will also help to prevent injury.