How To Treat Musculoskeletal Injury In Sonographers

What are work related musculoskeletal disorders (WR-MSDs)? The term WR-MSDs refers to injuries caused by thousands of repetitive, forceful, or awkward movements which produce microtrauma in muscles, tendons, ligaments. This leads to inflammation. The debris left by inflammation creates scar tissue which in turn causes adherence and contracting of the soft tissues. This increases the workload on the muscles, promoting more strain. 2

The cardiac ultrasound today survey of 2002 295 sonographers filled out this survey. 75 % of respondents were cardiac sonographers. Mean age of respondents was 42. 64% were scanning for over 10 years 37% were scanning for 10 years or less Results 3

The cardiac ultrasound today survey of 2002 Of the 295 sonographers 82 % (242) reported some level of discomfort (minor, major or disabling). 67% (162) of the total reporting major or disabling discomfort with 14% labeling their discomfort as disabling. 18% reported no discomfort. The cardiac ultrasound today survey of 2002 4

The cardiac ultrasound today survey of 2002 Medical treatment Medical treatment was sought by 48% (142) of the respondents. 56% reported that there treatment was successful. 43% believe that treatment was not helpful. Other studies confirm these findings Smith et al. conducted a similar survey in 1997 80 % of respondents reported musculoskeletal pain SDMS survey 80% of sonographers are scanning in pain. 20% have lost their careers due to RSI (Jakes C. Sonographers and occupational overuse syndrome: cause, effect, and solutions). 5

Symptoms of RSI in sonographers Symptoms suffered in the sonographer usually occur in the upper limb and torso. Back, hip and leg problems have also been reported. Involved is damage to the tendons, tendon sheaths, muscles, joints, blood vessels and peripheral nerves. (Hales T et al 1992) Symptoms of RSI in sonographers The symptoms include: pain - localized and/or general mainly in the neck, shoulder and arms. numbness - mainly in the hand, wrist and elbow. clumsiness tingling, itchy and burning sensations weakness in the arms swelling - particularly in the wrist and hand loss of function overdevelopment of muscle groups (Vanderpool H, 1993; Wihlidal L et al 1997) 6

Risk factors Three primary risk factors that contribute to work related RSI: Posture Force Repetition The main factors that contribute to these injuries in sonographers are: Poor equipment design: keyboard/screen height and position, equipment manoeuvrability, poor transducer grip, ill adjusted or non adjustable chairs and examination couches. 7

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The main factors that contribute to these injuries in sonographers are: Poor posture due to the type of work performed especially with the shoulder in sustained abduction and the spine in an unnatural alignment. Sustained pressure and force often used to optimise imaging. Repetitive movements particularly when performing sessions of similar examinations. The main factors that contribute to these injuries in sonographers are: Assisting with patient movement. Body habitus and gender some surveys reported that taller, heavier sonographers and males have fewer problems. Inadequate work breaks with insufficient recovery time. Echo technologists go portable more often than other sonographers. This means often transporting a machine that weighs more than 150 KGs and scanning bed ridden patients in awkward positions. 9

Manager s role Ensure that all ultrasound systems in their labs are ergonomically designed and give that a high priority when considering the purchase of new machines. Provision of adjustable chairs that support the back, legs and feet and promote an upright posture. All examination beds should be height adjustable, and allow staff to get as close as possible to the patient. Spread awareness of musculoskeletal disorders MSDs and educate staff on the ways to prevent them ( scanning techniques, posture, breaks etc ). 14

Manager s role Ensure staffing levels that are adequate for the work load. Encourage staff to promptly report injuries. Also work with occupational therapists to ensure a safe return to work for staff who have been off sick. Ensure that staff are taking adequate breaks. This include an adequate lunch break and a 5-10 minutes break between patients. Managing patient lists and ensuring work rotation. Portable studies are inherently more physically tasking and should be rotated justly amongst staff. Encourage exercise to reduce and relieve muscle stress. Seeking treatment Early treatment of MSD is crucial. Musculoskeletal injuries can be irreversible if left untreated for too long. An Australian study noted a recovery rate of 67% of the cases treated during the first six months after the onset of symptoms but only 31% recovery rate where treatment began six months after the onset of symptoms. So If you have an injury seek medical attention immediately!! 15

Treatments can include: - Rest and immobilization. - Anti-inflammatory and pain medications - Physiotherapy programs involving individual exercise programs for specific anatomical areas, deep friction massage, ice, and therapeutic ultrasound. - Stretching, hot and cold pack treatments, crossfriction massage. - Surgery. The Sonographer Musculo-skeletal Injury Checklist: Take a minute or two adjusting your environment ( you are more likely to miss things if you were uncomfortable). 1. Is the patient close enough to me? Is my arm and elbow tucked in closely to my body in a comfortable position? 2. Did I adjust my chair or examining table according to the body habitus of my patient in relationship to my height? 3. Is my posture a comfortable and correct one so as not to cause un due stress on my body? 4. Am I working with my wrist and neck in a straight and supported position? 5. Is the monitor and keyboard positioned so that I can easily see and reach them? 6. When I stand, am I carrying my body weight equally on both feet? 7. Did I take a micro-break? i.e. consciously releasing the tension on the scanning hand for a few seconds. 8. Did I take a mini-break? i.e. removing the probe from the scanning hand, stretching the hand, arm and shoulders and glancing periodically away from the monitor to release eye tension. 9. Am I aware of any unusual symptoms, such as numbness, swelling or pain? (Supplied by ASA Federal Council) 16

The consequences of MSDs. What failing to act means: The increasing loss of sonographers due to work related MSDs exacerbates the existing shortage of sonographers. An experienced sonographer is a valuable and rare commodity and we would be doing patients a disservice if we didn t maintain enough of them. The cost of treating work related MSDs can be a big burden on the healthcare system. Sonographers in many cases are legally entitled to compensation for their injuries. The British Society of Radiographers publicised a civil case where an ex-sonographer was awarded almost 230k ( 1.4 million Saudi Riyals!! ) for her career ending MSD. A sonographer who is scanning in pain is less likely to have the clarity of mind and the necessary concentration to conduct an adequate and error-free exam. Loss of Work satisfaction. THANK YOU 17