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%
Shoulder 76%
Upper Arm 38%
Forearm 31%
Wrist 59%
Upper Back 58%
Middle Back 33%
Low Back 58%
Hip 25%
Hand/Fingers 55%
Upper Leg 7%
Knee 17%
Lower Leg 12%
Illustration re-created &
information provided by:
www.sdms.org/pdf/sonoergonomics.pdf
Ankle/Foot 20%
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:
1.
2.
3.
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
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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.