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It has been proven in several studies that there is a significant history of work- related musculoskeletal disorders among diagnostic medical sonographers

It has been proven in several studies that there is a significant history of work- related musculoskeletal disorders among diagnostic medical sonographers. Injuries and sick-leave is a common feature for sonographers today, this is mainly due to the fact that sonographers work is done in an exposed environment with many stress factors and highly repetitive work. Scanning takes place in a dimmed room and patient lying on the table and sonographer working with a ultrasound transducer I one hand and managing the control panel on the other side with other hand whilst observing the images on screen. These operations are often carried out in unsuitable working positions, where those create a major burden on the bones and joints and causes micro- damages on muscles. With repetitive work these injuries are not given time to heal properly and will gradually become worse. The body will not be able to handle the stress of working in a work environment such as this and musculoskeletal disorders can be a result of this. The injury will make itself known as pain in the musculoskeletal system and causes reduced movability; the injured worker will therefore not be able to perform the same work tasks as before.
Sonographers are encouraged to position their bodies and the machine to ensure they have comfortable posture to reduce the stresses placed on their bodies. Sometimes, this is not possible, and when awkward, poor posture is sustained for long periods of time, the risk of musculoskeletal injury is higher. Evans and Baker (2009) proves that when a poor scanning position is used it causes significant stress on the upper body, particularly the shoulders, neck and back which can lead to injury.

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Discussion

Several studies have determined that sonographers have an increased risk of developing musculoskeletal disorder, including wrist dysfunction (carpal tunnel syndrome, carpal instability, tendonitis), back pain, neck pain, shoulder pain, and upper-extremity pain.
Sonographers reported an increase in musculoskeletal discomfort at the end of their workday. As a result of physical discomfort, it lead to changes in sleep patterns, changes in home life and psychosocial wellbeing (Roll, Selhorst and Evans, 2014). In this study, almost 90% of sonographers were performing a scan in pain., where shoulder pain was the most common resulting in 73% out of 90% of the sonographer in the study. Next highest was lower back pain and with 69% reporting that issue and over 50% had hand and wrist problems. Unfortunately, majority of sonographers accept that musculoskeletal pain is part of their daily routine and most of them try to manage the situation on their own rather than reporting it (Roll et al, 2014).
Similar results have been observed by Evans, Roll and Baker in 2009, where the authors made a survey with over five thousand registered diagnostic medical sonographers (DMS) and vascular technologists (VT). Those results also showed that 90% of participants were working in pain.

Those performing upper extremity and transvaginal pelvic examination have had the most problematic postures causing discomfort and pain. In addition to this Evans et al. (2009). During the scan, the sonographer is often required to extend and abduct the arm away from the body to hold the transducer in the required position and then use fine controlled movements to obtain an ideal image. During this scanning action, they simultaneously operate the keyboard with their other hand and rotate their head back and forth between the patient and monitor. Study reveals that throughout all demographics shoulder pain was the most common issue, 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. Further to predisposing and perpetuating factors such as poor positioning, sonographers experience of musculoskeletal discomfort was often related to an increasing number of examinations every day with less breaks in between examinations (Roll, Selhorst and Evans, 2014).
A corresponding theory was shown earlier by Muir, Hrynkov, Chase, Boyce and McLean (2004) where it has been found that bad posture, twisting and bending of the wrist, reaching too far and taking very few breaks in between scan could contribute to permanent disability.
Even though sonographers mostly reported work related musculoskeletal disorders as pain in the neck and shoulders, lumbar spine discomfort is also commonly reported (Roll et al, 2014), followed by hand and wrist pain. Also, weakness in one or both extremities, numbness in hands and clumsy fingers (Bagley et al, 2017). In the study a questionnaire was given to 230 sonographers specialized in different areas and also in this study the most common area of pain was shoulders and neck with 53% overall scanning in pain. Surprisingly, the study found no correlation between sonographers age and report of injury or pain. On the contrary Evans and Baker (2008) showed that aging work force had an effect of increasing the incidents of musculoskeletal disorders from 84% in 1997 to 90% in 2008.

Besides scanning patients, sonographers must on regular basis type reports and review their images on a computer. Carrying out this type of movement for more than 4 hours per day significantly increases a persons risk of acquiring a work related musculoskeletal disorder (Bolton and Cox 2015). Musculoskeletal disorders amongst sonographers are also related to inability to adjust workstation monitors or a keyboard tray resulting in straining of neck and shoulders (Evans et al. 2009).

However, there is a strong evidence in literature that muscle-strengthening exercises seem to be a significant aspect of WRMSD prevention. Often sonographers are used to scan with one hand, but simply changing the sonographer’s hand can reduce the stress on the musculoskeletal system (Seto and Biclar, 2008). They investigated possibility of introducing ambidextrous method to reduce Repetitive strain injury (RSI). In this small study with eight sonographers participating, the authors suggested that a combination of techniques and ambidextrous scanning could potentially reduce RSI. Balancing the body and reducing the repetitive movement could be one way to reduce work-related injuries.
Also Bolton and Cox (2015) concluded that sonographers might be putting themselves in jeopardy and risking WRMSDs by implementing poor working posture, working while in pain and not taking enough breaks. Bolton and Cox (2015) described a clear awareness that prevention taught trainee sonographers was proportional to WRMSD prevention when put into practice. They believe that ….
Also Begley et al (2017) found that access to ergonomic equipment is a necessity to improve good posture to lower the risk of injuries. It is believed that the most promising method to deliver education is through lectures and articles.
Sonographers should remember that optimizing the examination should not affect their health in a negative way. Some hints and tips such as power grip of the transducer, moving the patient closer to the operator to reduce arm abduction and spine rotation or adjusting the ultrasound monitor could make a significant difference (Harrison and Harris, 2015).
Baker and Coffin (2015) pointed out that correct posture whilst scanning depends on more than one factor, and minimizing the risks for musculoskeletal disorders requires modification of combination of examination table, ultrasound system and chair together with other equipment to achieve good posture. Bagley at al. (2017) proved that the cause if work related injuries for sonographers are multifactorial and require several different methods to decrease the risks. Simple tasks such as alternating between sitting and standing or adjusting the monitor can make a significant difference.

Conclusion
All things considered several studies throughout many years shows that sonographers are particularly exposed to suffer from muscle related injuries. It is up to sonographers to actively reducing the risks by optimizing their work environment. It is inevitable to sustain a musculoskeletal injury if not working ergonomically. Aging is one of the factors that can’t be stopped and has a fair impact on obtaining those injuries as we age. But by being more aware of working posture, environment, taking short breaks on between scanning or even stretching exercise could postpone the injury itself. Knowing your own body limitations is the key for preventing an injury. As a well knowing saying prevention is better than cure.
Bagley at al. (2017) The ergonomic features of your examination room equipment are only as good as your willingness to use them. The key to the effectiveness of these features is changing your work

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