Work-Related Injuries in Sonographers
The prevalence of work-related musculoskeletal injuries among diagnostic medical sonographers has been reported as high as 90%. 74% of these professionals experienced shoulder pain, 66% reported neck pain, and 44% indicated having upper back pain while providing sonographic services. Working in sustained poor postures with the arm away from the body, holding and applying pressure through the transducer, and performing an increasing number of scans per day, have all been associated with these symptoms.
Unfortunately, ergonomics training in sonography education is limited and inconsistent, there are no sonography-specific ergonomic evaluations that assess both personal and organizational factors contributing to work-related musculoskeletal injuries, and there have been no large-scale efforts to evaluate the effects of preventive interventions in this profession.
To address these dire needs, the MSOP lab has partnered with the Laboratory of Investigatory Imaging at The Ohio State University. In addition to exploring risk factors and continuing to document the problem, the long-term goal of our work is to develop and validate real-world solutions for enhancing ergonomics training and improve translation into the workplace to reduce the incidence and prevalence of WRMSI in sonographers.
Dhyani, M., Roll, S. C., Gilbertson, M. W., Orlowski, M., Anvari, A., Li, Q., Anthony, B., & Samir, A. E. (2017). Direct and precise quantification of forces applied by sonographers during abdominal imaging. Work, 52(2), 241-247. https://doi.org/10.3233/WOR-172611 Show abstract
Background. There is a significantly high rate of work-related musculsokeletal injuries in sonography professionals. To date, assessment of risk factors for work-related injuries in sonographers has been based primarily on surveys, subjective reports, and observational methods. There is a need to develop quantitative techniques to better understand risk factors and develop preventive interventions.
Objective. We pilot tested a high-resolution force-measuring probe capable of precisely measuring forces applied through the transducer by sonographers and used this novel direct measurement technique to evaluate forces during abdominal imaging.
Methods. Twelve sonographers with varied experience, ranging from 1-33 years, performed routine abdominal scans on 10 healthy volunteers who had varied body mass indices (BMI). Imaging was conducted using the force-measuring probe, which provided real-time measurement of forces, and angles. Data were compared by sonographer years of experience and subject BMI.
Results. In total, 47 abdominal examinations were performed as part of this study, and all images met standards for clinical diagnostic quality. The mean contact force applied across all exams was 8.2±4.3 Newtons (N) (range: 1.2-36.5N). For subjects in the high BMI group (BMI>25, n=4) the mean force was 10.5N (range: 8.9-13.2N) compared to 7.9N (range: 5.9-10.9N) for subjects with normal BMI (BMI=18.5-25, n=6). Similarly, the mean maximum force applied for subjects with high BMI (25.3N) was significantly higher than force applied for subjects with normal BMI (17.4N). No significant difference was noted in the amount of force applied by sonographers with more than 5 years of experience (n=6) at 8.2N (Range: 5.1-10.0N) compared to less experienced sonographers (n=6), whose forces averaged 8.1N (Range: 5.8-10.0N).
Conclusions. It is feasible to directly measure forces applied by sonographers using a high-resolution force measurement system. Forces applied during abdominal imaging vary widely, are significantly higher when scanning subjects with high BMI, and are not related to sonographer years of experience. This force measurement system has the potential to provide an additional quantitative data point to explore the impact of applied forces on sonographer related musculoskeletal injury, particularly in conjunction with various body positions, exam types and force durations.
Roll, S. C., Selhorst, L., & Evans, K. D. (2014). Contribution of positioning to work-related musculoskeletal discomfort in diagnostic medical sonographers. Work, 47(2), 253-260. https://doi.org/10.3233/WOR-121579 Show abstract
Background. Musculoskeletal pain and discomfort due to work exposure is experienced by 90% of sonographers. Survey research has provided a wealth of information to document this problem, but few studies have attempted to directly measure and identify the source of these disorders.
Objective. This pilot observational study was conducted to obtain direct measures of the relationship of sonographers to their environment during the completion of sonographic examinations.
Methods. The Rapid Upper Limb Assessment (RULA) was used to evaluate the positions of five sonographers during 24 sonographic examinations. The observed positions were compared among the various examinations and the association of these observed postures to discomfort, sonographer height, and exam table height was evaluated.
Results. All participants reported an increase in musculoskeletal discomfort at the end of the workday. Overall RULA scores ranged from 3.11 to 5.00 with upper extremity venous Doppler and transvaginal pelvic examinations averaging the highest. Increasingly poor upper extremity positioning was positively associated with increased musculoskeletal discomfort (r = 0.53, p < 0.01).
Conclusions. Regardless of the examination being performed, sonographers are working in positions that require further evaluation and intervention. Longitudinal studies are needed that evaluate the inter-relationship of biopsychosocial risk factors of musculoskeletal injuries.
Roll, S. C., Evans, K. D., Hutmire, C. D., & Baker, J. P. (2012). An analysis of occupational factors related to shoulder discomfort in diagnostic medical sonographers and vascular technologists. Work, 42(3), 355-365. https://doi.org/10.3233/WOR-2012-1434 Show abstract
Objective. Three-fourths of diagnostic medical sonographers (DMS) and vascular technologists (VT) experiencing discomfort due to job demands indicate having discomfort in the shoulder region. An analysis of factors related to shoulder discomfort highlighted salient factors requiring further investigation and intervention.
Methods. The responses of 2,163 DMS and VT from a survey of a representative sample were analyzed to determine personal factors, work demands, and workstation design characteristics of those experiencing discomfort in the shoulder region. Frequencies and response distributions were calculated and cross tabulation with chi-square analysis was completed.
Results. A majority of respondents with shoulder discomfort have co-morbid reports of discomfort in other locations. While overall sonographer discomfort is linked to age and years of experience, shoulder discomfort was also noted to be linked to specific workstation characteristics. A lack of adjustability in equipment, PACS workstations, and positions required to complete bedside exams contributes to discomfort due to sustained and repetitive shoulder abduction and twisting of the neck and trunk.
Conclusions. There is a need for studies investigating redesign of equipment and workstations or interventions with DMS and VT specifically focused on improving adjustability and improved positioning of sonographers in order to reduce shoulder discomfort while performing job demands.
Evans, K. D., Roll, S. C., Hutmire, C. D., & Baker, J. P. (2010). Factors that contribute to wrist-hand-finger discomfort in diagnostic medical sonographers and vascular technologists. Journal of Diagnostic Medical Sonography, 26(3), 121-129. https://doi.org/10.1177/8756479310366471 Show abstract
A cross-sectional representative sample of 1722 sonographers and vascular technologists was analyzed using quantitative/qualitative methods to reveal that 60% are experiencing wrist-hand-finger discomfort, believed to be from work-related repetitive injury. The years of scanning accumulated by the participants was chosen as a variable to determine the relationship to the range of discomforts reported. A strong statistical correlation was noted between years of experience and the side of discomfort as well as the severity of hand-wrist-finger discomfort. In this study, a strong statistical association was also noted between increasing years of scanning and decreasing aggravation due to the transducer. A complete linkage between work-related exposure and hand-wrist-finger discomfort is difficult to make because of the contribution of leisure-time activities. A controlled experimental study is needed to determine the contribution that grip and pushing on the transducer may have on the incidence of hand-wrist-finger discomfort, leading to diagnoses such as carpal tunnel syndrome.
Evans, K. D., Roll, S. C., Li, X., & Sammet, S. (2010). A holistic evaluation of risk factors for work related musculoskeletal distress among asymptomatic sonographers performing neurosonology: A pilot study. Journal of Diagnostic Medical Sonography, 26(2), 64-78. https://doi.org/10.1177/8756479309352360 Show abstract
A pilot study was conducted to gather holistic data points on female sonographers who executed neonatal neurosonography over four portable scanning sessions. The hypothesis was that specific risk factors contributed to work-related musculoskeletal distress in the hand and wrist as a result of neonatal neurosonography. A preexperimental pre-post research design was used to gather data on work demands, self-rated physical and mental health, posture/position during scanning, physiologic change, and pain scores. No statistically significant changes were detected between pre-post measures for work demands, physical and mental health, or pain scores as a result of portable scanning sessions. The physiologic changes, between scanning sessions, were recorded with the use of a hand-carried sonographic unit. Sonographic measures were less than the published criteria for carpal tunnel syndrome with a proximal cross-sectional area ≥10 mm2 and an anterior bulge of the retinaculum of >4 mm. Sonography documented a statistically significant cross-sectional area change, within the median nerve, at the distal radius only after the first scanning session. Power and spectral Doppler was used to document perineural vascular flow within the median nerve, but it was not consistently obtained to allow for a rigorous comparison between pre- and post-scanning sessions. This is the first pilot study to explore using a hand-carried sonographic unit to document change in the median nerve for an isolated sonographic examination. The results are only reflective of these particular participants, but much larger N and shorter scanning sessions are needed to confirm the hypothesis proposed.
Evans, K. D., Roll, S. C., & Baker, J. (2009). Work-related musculoskeletal disorders (WRMDS) among registered diagnostic medical sonographers and vascular technologists: A representative sample. Journal of Diagnostic Medical Sonography, 25(6), 287-299. https://doi.org/10.1177/8756479309351748 Show abstract
Literature indicates a significant history of workr-elated musculoskeletal disorders (WRMSD) among diagnostic medical sonographers (DMS) and vascular technologist (VTs). To gather current data related to this historical trend, the authors administered a survey to a random and convenient sample of 5200 registered DMS and VTs. The invitation to complete the survey on a secure Web site yielded the largest participant sample to date of 2963 completed surveys (57% response). Data relative to the prevalence of WRMSD were analyzed and compared to other WRMSD research over the past decade. Results indicated that 90% of respondents were scanning in pain, a 9% increase since the last large scale survey in 1997. Across all demographics, shoulder pain is most common, with older and more experienced sonographers having more finger, hand, and wrist pain than other groups. Pain continues to be related to pressure applied to the transducer, abduction of the arm, and twisting of the neck and trunk. Ergonomic equipment and education are provided by application specialists, but the incidence of WRMSD appears to be unabated. Higher order research, including randomized trials, with education and ergonomic interventions is needed to protect DMS and VTs who are necessary to meet increasing health care demands.
Roll, S. C., Cristino, A., & Mitchell, J. (2018, October). Characterizing changes in the median nerve during hand grip using dynamic sonographic imaging. Poster presented at Association of Reproductive Health Professionals Conference 2018, New Orleans, LA.
Roll, S. C., Selhorst, L., & Evans, K. D. (2013). Using the Rapid Upper Limb Assessment to associate upper extremity positioning with musculoskeletal discomfort. Research paper presentation at 93rd Annual Conference of the American Occupational Therapy Association, San Diego, CA.