Preventing Sonographer Musculoskeletal Injury

How to Avoid Carpal Tunnel, Tendonitis, and Disk Problems Among Sonographers

Egregious Ergonomics Create Olympic-sized problems for Australian Sonographers

SDMS Member’s Testimony

American College of Cardiology Workshop on 2-D and Doppler Echocardiography

The British Columbia Ultrasonographers’ Society

Preventing Sonographer Musculoskeletal Injury

How to Avoid Carpal Tunnel, Tendonitis, and Disk Problems Among Sonographers

Egregious Ergonomics Create Olympic-sized problems for Australian Sonographers

SDMS Member’s Testimony

American College of Cardiology Workshop on 2-D and Doppler Echocardiography

The British Columbia Ultrasonographers’ Society

Recommendations for Quantitations of the Left Ventricle by Two-Dimensional Echocardiology

Sonographer Occupational Musculoskeletal Disorders: What Are They And How Can They Be Prevented


Excerpt from:

How to Avoid Carpal Tunnel, Tendonitis, and Disk Problems Among Sonographers Staff Writer

May 11, 2000

While sonographers take great pains to make sure their patients are comfortable, they may be sacrificing their own health in the process by not practicing good ergonomics, according to occupational health and safety experts.

As a result, long-term biomechanical problems such as carpal tunnel syndrome and tendonitis could plague ultrasound practitioners and cost employers up to $75,000 per employee for lost time and treatment.

Paula Woletz, a sonographer at the University of Medicine and Dentistry of New Jersey in Brunswick, spearheaded an ergonomics evaluation at her workplace in the hopes of quantifying the aches and pains that had, thus far, been anecdotal.

Specialists from the affiliated Robert Wood Johnson Medical School paid a visit to the department of gynecology, obstetrics, and reproductive services to observe and interview 11 sonographers and one physician.

“The findings from that small group showed that there was physical evidence of cervical disk disease in 4 out of 12 individuals. Two employees who had reported neck problems had shoulder abnormalities documented. Four employees had problems in the hands and wrists, including carpal tunnel syndrome.”

“A breakdown by the hospital’s risks and claims department put the cost of modifying each workstation with adjustable equipment at about $4,200 per exam room. In comparison, the costs of treating various injuries ranged from $10,000 to $75,000,” Woletz said.

“In other words, maybe it makes sense to look at the big picture and stop being penny-wise and pound foolish,” she added.

Excerpt from:

Egregious Ergonomics Create Olympic-sized Problems for Australian Sonographers
Bachelor, J, Staff Writer

September 21, 2000

Approximately 78% of sonographers in Australia report musculoskeletal injuries (MSI) as a result of their employment, according to the results of a survey conducted by Val Gregory of the Royal Prince Alfred Hospital in Sydney. Gregory said that he sees MSI as a serious health problem for the profession, and he believes that its incidence is increasing.

“There are a number of sonographers who have had to seek alternative employment, as they can no longer perform ultrasound. Others have had to reduce their hours of work or change work practices to continue to work,” he wrote in Sound Effects, the quarterly bulletin of the Australian Sonographers Association.

Of Australian sonographers surveyed, the incidence of musculoskeletal pain and discomfort experienced by sonographers since starting scanning was 95.4%.

Many sonographers experienced pain and discomfort in more than one area, with 91% reporting shoulder pain, neck 84%, upper back 73%, wrist 61%, lower back 61%, eyes 59%, hands and fingers 56%, upper arm 53%, middle back 43%, and forearm 41%. Hip and leg pain was also reported.

Classification of the symptoms include:

Most sonographers suffer a combination of these symptoms. The injuries are caused or aggravated by the repetitive movement, forceful exertions, and unnatural posture adopted by sonographers during their jobs.

There are two main processes that cause MSI in sonographers:

The pain and discomfort occurred mainly at the end of the working day and after work. The mean average time that sonographers had suffered pain and discomfort was 52 months.

According to Gregory, the main factors that contribute to MSI in Australian sonographers are:

Excerpt from:

SDMS Member’s Testimony

June 6, 2000

Hello, my name is Jane Doe.* I am a Diagnostic Medical Sonographer, and I have come to this hearing today in Oregon to share with you my experiences stemming from an occupational injury. This injury has taken from me my professional career and my dream. Even more sadly, it has limited my ability to use my training and experience to help people, the very reason that I was drawn to a health care career in the first place. Unfortunately, my experiences are all too common because the health care industry has failed to take a number of precautions to prevent the kinds of occupational injuries that I have suffered.

My occupational health problems have a long history spanning more than two years. Initially I experienced pain along my right forearm with difficulty holding the transducer during long or difficult ultrasound procedures. Eventually, I experienced pain during all my scanning procedures. Pain then became my constant companion during my waking and nighttime hours.

My career is over.

Other factors contributed to my injury and could have been prevented.

All of these factors, and others, meant that my body was constantly in a tensed, strained and awkward position. My physicians have stated that my injuries are the inevitable result of those contortions and that constant strain. I hope that my experiences and my pain will demonstrate the need for real change in the way that ultrasound services are provided in this nation.

Excerpt from:

American College of Cardiology Workshop on 2-D and Doppler Echocardiography

January 10-14, 1994


Most modern echocardiographic units have excellent image quality and are capable of defining myocardial endocardium in the majority of patients. The following list of equipment will be necessary to perform quality stress echocardiography.

Ultrasound unit with VCR
Echo bed for imaging
Cable connection to treadmill
Digital image acquisition unit
Review station for floppy disk (optional)

Excerpt from:

The British Columbia Ultrasonographers’ Society

Approached Simon Fraser University’s School of Kinesiology with a concern regarding the high prevalence of musculoskeletal injuries associated with ultrasonography.

Results from the task analyses were analyzed from a biochemical standpoint, based on information gathered from the personal interviews. Firstly, four main areas of the body were identified as being at risk of injury from ultrasonography. Secondly, injurious factors associated with each body area were identified. Thirdly, these body positions were analyzed in action to determine the presence of the injurious factors, and subsequently a relationship between injurious factors and observed body positions was represented as a degree of risk to the sonographer. Lastly, the causes leading to the assumed body positions and the resultant effects on the musculoskeletal system of the body, were identified.

Recommendations / Modifications to Design

Hydraulic bed/chair
Adjustability of the equipment is essential in producing a working position which is neutral, comfortable, and places low stress on the musculoskeletal system of the sonographer.

Excerpt from:

Recommendations for quantitation of the left ventricle by two dimensional echocardiography

American Society of Echocardiography Committee on standards, subcommittee on quantitation of two-dimensional echocardiograms.

Because the patient is often in a sleep lateral position, it is frequently difficult to transect the true apex unless there is a mattress with a scoop or excavation at the point where the apex impulse is generally located. An alternate technique is to use a narrow examination table that allows free access of the transducer to the apex impulse without mechanical interface. These approaches are especially important with large transducers. Lack of specialized examining tables makes quantitive measurements more difficult in the critical care setting where modifying the bed is not practical.

Sonographer Occupational Musculoskeletal Disorders:
What Are They And How Can They Be Prevented

Sound Ergonomics, L.L.C. and
Biodex Medical Systems, Inc.


Musculoskeletal disorder, or MSD, refers to a group of disorders caused by or aggravated by workplace activities. These neuromusculoskeletal disorders are referred to by a number of names, such as musculoskeletal injury (MSI) and repetition repetitive strain injury (RSI), but the currently accepted term by OSHA is musculoskeletal disorder. Although MSD has been described for years in a number of other professions, it has only recently been identified in sonographers.

MSD accounts for between 40% and 60% of all recorded work-related illnesses. In the field of diagnostic medical sonography, 84% of sonographers surveyed suffer from some form of injury. It is the leading cause of long-term illness absence in health care workers. The incidence of MSD has increased ninefold over the last 10 years and may actually even be higher, since many cases remain unreported. The physical problems of MSD result from a combination of factors. There are biomechanical factors, which include inefficient scanning postures, frequent repetitive motions, exertion of excess force while performing these motions, wrist flexion or deviation, faulty work space and equipment design.

A second set of factors relates to work organization. Employees may work long hours without breaks, often enticed with bonuses and incentives. There is often a lack of training for employees in the proper ways to perform their duties or in the proper use of the equipment.

A third set of factors includes delayed reporting or diagnosis of injuries, and inappropriate injury management.

Some individual physical factors associated with MSD risk include age, gender, height & weight, body-mass index (BMI), systemic illnesses, level of physical fitness, and hand dominance.

The types of work activities known to cause MSD in sonographers include:


Advances in technologies, particularly automatic film developing and filmless storage devices have increased the time sonographers are actually scanning because these new devices have reduced the time needed between patients. Sonographers do not have sufficient “down time” to allow the muscles used during scanning to recover.

MSD causes pain, inflammation, swelling, and deterioration of tendons and ligaments. Muscles and joints become stressed once their support structures are weakened. The most commonly affected areas in sonographers are the shoulder and neck in those who scan right-handed and the wrist and elbows in left-handed cardiac sonographers.

ultrasoundgraph2Symptoms of MSD occur after months or years of overuse and usually occur away from the job, commonly at night. The symptoms most often reported are pain, loss of sensation, numbness, burning or tingling, tenderness, swelling, clumsiness, or muscle spasm. They range in severity from aching and fatigue that subside with overnight rest to constant pain that impacts work and leisure activities and may even be career-ending.

The injuries associated with MSD in sonographers include carpal and cubital tunnel, epicondylitis of the elbow, neck and back strains, shoulder capsulitis, tendonitis and tenosynovitis. Treatments for these injuries range from rest and analgesics to surgery. Alternative treatment methods, such as massage therapy, provide relief in some instances. However, the outcome for treatment of occupational MSD is poor – once treated it often recurs. The key, therefore, is to PREVENT the injury initially.

Prevention of MSD is multifactoral, involving sonographers, department managers, and equipment manufacturers.



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