By the beginning of the twenty-first century, more than three fourths of the sonography workforce reported experiencing pain while scanning, and one in four sonographers sustained career-ending injuries.¹ Although their injuries were varied, a major contributing cause was the poor conditions in which they worked. The sonography community is now aware of the importance of ergonomics, the creation of a safe working environment, and is devoted to finding solutions to the work-related injuries and job-related problems encountered by sonographers.

Causation and mechanisms of injury

Sonographers often are subjected to high-performance job pressures at workstations that were not specifically designed for them. Sonographers who can work in a safe, efficient, and relaxed manner enjoy increased productivity and are at a lower risk of developing work-related injuries.

Although it is true specific workloads can be adapted to or tolerated by most individuals, if the individuals are not conditioned to the task and are overloaded constantly with work without sufficient rest or recovery, they risk pain and injury. Sonographers now appreciate that musculoskeletal injuries (MSIs) result from minuscule, cumulative trauma to human tissue and that it takes a combination of biologic and biomechanical factors to cause tissue breakdown. Studies have shown that a frequent source of muscle fatigue and potential injury exists whenever low levels of muscle contraction must be maintained for a long duration. These are the types of body demands often required when performing ultrasound studies. Besides the ergonomic and environmental stresses that may be present in the sonography workplace, additional risk factors that have been identified are stress, age, and gender.

Ergonomics and work-related sonographer injury

The most common work-related injuries among sonographers are tendonitis and tenosynovitis of the shoulder, cervical spine, neck, wrist, and lower back. These injuries are related directly to prolonged periods of arm abduction and muscle loading coupled with constant transducer pressure during scanning. Contributing to these repetitive strain injuries (RSIs) are (1) the use of poorly designed ultrasound equipment and stretchers; (2) improper body mechanics while scanning; (3) procedure duration; (4) inappropriate force; (5) insufficient rest/breaks; and (6) repetition of the same type of study for long periods during the workday. Clearly, changes and modifications in equipment and the duration and frequency of sonographic examinations are essential to prevent or significantly reduce such injuries. Sonographers must learn to protect themselves by avoiding situations that lead to MSIs, and sonography training should include instruction in safe scanning techniques and information about injury and prevention (Box 4-1).

Box 4-1 Workplace Causes of Musculoskeletal and Repetitive Strain Injuries

The incidence of musculoskeletal and repetitive strain injuries increases with the presence of the following workplace conditions:

• Poorly designed ultrasound equipment

• Crowded scanning areas

• Poorly designed stretchers

• Use of awkward postures while scanning

• Awkward static and dynamic arm positions

• Use of excessive force when grasping a transducer

• Day-long repetition of the same types of scans

• Reaching injuries

• Prolonged standing

• Frequency and duration of procedures

• Insufficient rest/breaks during workday

The most common sites of sonographer pain or injury are the neck, back, hips, shoulder, wrist, hands, fingers, and feet (Box 4-2). The primary causes of all of these injuries are associated with one or more of the following activities: repetition, force, and awkward postures. Awkward posture refers to the deviation of the skeletal bones and joints from a neutral or natural position (Box 4-3). The risk of injury increases with the number of times and the greater length of time that a joint deviates from its natural position. Specific activities that lead to pain and injury are as follows: