Diagnostic Medical Sonographers who are experts in musculoskeletal imaging will frequently produce sonographic images of patient tendons, ligaments, joints and muscle abnormalities. The images help physicians diagnose the problem that may include tears, sprains, fluid collection, nerve entrapment, cysts and foreign bodies. The sonography student who is attending a CAAHEP accredited program learns proper ultrasound imaging techniques and strategies, but it is easy to forget that the student is also subject to developing soft tissue abnormalities, called overuse injuries in an ultrasound technician career.
Overuse injuries are different than acute injuries or strains due to events like accidents or heavy lifting (Read the related article Easing the Sonographer’s Pain). The occupational overuse syndrome or cumulative trauma disorders is tissue damage that develops from repetitive motions, which in some parts of the body are often made worse by improper positioning, forceful movements and excessive pressure. Repetitive motions are especially common when sonographers have little variety in the type of exams performed throughout the day.
Twisting, Flexing and Bending
Overuse injuries most commonly occur in the hands, wrist, and elbow. However, they may also impact the neck and shoulders from repetitive twisting or other parts of the body, depending on the sonographer’s behaviors and working conditions.
Duration of pressure is a major contributor to overuse injuries in the hands and wrists. Long duration is particularly found in scanning procedures like those performed on high-risk obstetrical patients, cardiac patients, and exams involving obese patients. Long duration refers to the transducer time or the time the transducer is in the sonographer’s hand. Related to this is the amount of pressure of the sonographer is placing on the transducer while scanning. An obese patient may require up to 40 pounds of pressure, which is significant. Scanning of peripheral venous structures requires extremity pressure.
Carolyn T. Coffin with the Department of Diagnostic Ultrasound at Seattle University addresses the topic of overuse injuries in the article, “Work-related musculoskeletal disorders in sonographers: a review of causes and types of injury and best practices for reducing injury risk,” (Reports in Medical Imaging, Dovepress, Feb 15, 2014). She mentions a number of other factors that may contribute to making overuse injuries worse:
- Poor posture
- Neck twisting
- Next extension
- Improper wrist flexion and extension
- Arm abduction
- Excessive reaching
Inflammation is Painful
Inflammation of the tendons in the hands and wrist is one of the most common overuse injuries. The tendon sheath in the hands and wrist is also common. There are different types of tendonitis including “trigger finger” and De Quervain syndrome, both of which are transducer gripping injuries. Nerve entrapment is another overuse injury. Sonographers may develop carpal tunnel syndrome, thoracic outlet syndrome, and cubital syndrome. These conditions are associated with gripping, flexing and extending the hand and wrist, or repeatedly resting the elbow on the exam table.
Micro-trauma to the nerves, tendons, ligaments, and muscles in the hands and wrist usually takes a while to develop. Being aware of these common overuse injuries is important for avoiding them. The classes and clinical training in the CAAHEP accredited Diagnostic Medical Sonography programs will discuss techniques for preventing them. The student should also develop an awareness of personal factors that may also contribute to overuse injuries. They include joint imbalances, grip behaviors, body positioning habits, musculoskeletal imbalances that influence body positioning, and so on.
Paying Attention to Equipment, Body and Mind
Of course, the type of equipment also matters. For example, narrow transducers can lead to a pinch grip. Heavy cables or scan heads that are not ergonomically designed may contribute to overuse injuries. While attending school, the student learns equipment operation and should develop an acute awareness of how they are positioning and using their bodies, including extremities, to compensate for the style of equipment.
Fortunately, the latest technology in ultrasound imaging equipment is reducing the chances of overuse injuries developing. The newest equipment has features like voice activation, heads-up displays, and so on. Supporting equipment like stretchers, chairs and cushions are ergonomic and more easily adjustable to fit the sonographer’s height and procedural needs. Of course, getting the greatest benefit from the newest equipment requires the sonographer to take the time to learn its features and how to adjust it to minimize the potential for injuries.
Sonography students and working professionals should also follow a regular exercise program to maintain good health and strengthen the parts of the body most subject to overuse injuries. It is always important to pay attention to the body as well as the mind when building an ultrasound technician career.