Eighty percent (80%) to 90% of sonographers and ultrasound providers across disciplines indicate they experience pain from musculoskeletal injuries, 1–3 which is a much larger percentage than in just about any other specialty within healthcare. Work-related musculoskeletal disorders (WRMSDs), however, frequently go unreported and can lead to a career-ending injury, so an alliance of 8 organizations* have come together to create the WRSMD Grand Challenge with the intent to stop work-related musculoskeletal disorders resulting from the performance of diagnostic medical ultrasound.
As a part of this alliance, Dr Yusef Sayeed recently spoke about this topic, encouraging us to help promote our specialty, to progress, and to take care of this work-related issue at the very onset before things become pathology. Unfortunately, one of the largest problems within the sonographer community is official reporting of the issue and transparency. Sonographers most commonly don’t report their injuries because they fear it could cost them their job, or they are afraid of the stigma doing so could cause; this reasoning also applies to ultrasound providers and fellows, as well as is true within the healthcare field overall.
Of those injuries that do get reported, the Department of Bureau and Labor Statistics reported that the vast majority of the lost-work-time occurrences in 2016 resulted in major lost work time (11 or more days) with a median of 13 days of lost work time.
The risk factors for work-related musculoskeletal disorders have been identified as the following:
- Awkward posture
- Repetitive movements
- Pinch grips
- Wrist flexion and extension Placement of the monitor/screen
Musculoskeletal disorders are cumulative trauma disorders and develop gradually over time from repetitive activity (micro tears in the anatomy). To reduce these occurrences, alternate the side from which you scan; always standing on the right puts your right side at risk because of the repetitive motion. Step around rather than reaching across obese patients, because reaching results in you being most abducted, which also predisposes you to injury. And avoid holding the transducer in a pinch grip. In additiona, when your shoulder is abducted and your elbow extended, this puts a great deal of repetitive force on both the cervical spine as well as the shoulder joint.
Employers of sonographers also need to be cognizant of the risk factors they can prevent, such as performing more than 100 scans per month, getting less than 10 hours of rest between shifts, requiring 13 or more hours per day on shift, and night shifts (in general, night shift workers suffer more injuries on the job and have worse metabolic outcomes, ie, they suffer cardiac disease, have higher rates of CVA and MI, etc). Current business models tend to mean more scans and less time between them so sonographers are predisposed to higher rates of work-related injuries. Employees should also be able to report injuries without reprecussions. Another way employers should mitigate risk is by providing personal protective equipment such as cable straps, ergonomic tables, ergonomic chairs, etc.
Changes made in manufacturing would also help, such as making screens mobile and able to rotate and creating lighter-weight and wireless transducers, etc.
To make sonography a more sustainable profession, we need to ensure WRMSD education reaches not just sonographers and their employers but also regulatory agencies and the medical community as a whole. We need to:
- Increase awareness, education, and transparency;
- Understand risk factors;
- Provide tools to prevent and reduce injuries, including forms of hazard control;
- Engage in research to better understand occupational repetitive motion injuries; and
- Advocate for our colleagues, patients, and friends.
View Dr Sayeed’s full webinar on YouTube to learn more about the injuries that can be a result of these risk factors:
- Wareluk P and Jakubowski W. Evaluation of musculoskeletal symptoms among physicians performing ultrasound. J Ultrason 2017; 17:154–159.
- Al-Rammah TY, et al. The prevalence of work-related musculoskeletal disorders among sonographers. Work 2017; 57:211–219.
- Horkey J and King P. Ergonomic recommendations and their role in cardiac sonography. Work 2004; 22:207–218.
- AIUM Official Statement. Statement on preventing work-related musculoskeletal disorders. Available at: https://www.aium.org/officialStatements/69.
- Sayeed Y, Sully K, Robinson K. Work related musculoskeletal injuries in sonographers and providers: the Grand Challenge. Ultraschall in Med 2020; 41: 1–10.
* The WRMSD Grand Challenge Alliance of Organizations:
- American Institute of Ultrasound in Medicine (AIUM)
- American Registry for Diagnostic Medical Sonography (ARDMS) and Inteleos
- American Society of Echocardiography (ASE)
- Intersocietal Accreditation Commission (IAC)
- Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT)
- Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS)
- Society for Vascular Ultrasound (SVU)
- Society of Diagnostic Medical Sonography (SDMS)
Interested in learning more about preventing musculoskeletal injuries? Check out the following posts from the Scan: