Deborah Ruediger, ASAR, DipHlthSc, MHlthSc Manager Non-Invasive Cardiology Lab Heart Centre King Faisal Specialist Hospital & Research Centre
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1 Deborah Ruediger, ASAR, DipHlthSc, MHlthSc Manager Non-Invasive Cardiology Lab Heart Centre King Faisal Specialist Hospital & Research Centre 1
2 No Disclosures 2
3 Musculoskeletal Injury (MSI) refers to damage of muscular or skeletal systems, (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.) and is usually due to strenuous activity. Also known as: Musculoskeletal Disorders (MSDs) Work-Related Musculoskeletal Disorders (WRMSD) Repetitive Strain Injury (RSI) Cumulative Trauma Disorder (CTD) 3
4 MSI was described for many years in other professions but only more recently in sonographers. Between 63% and 91% of sonographers develop some sort of MSI compared to between 13% and 22% of the overall population (Rousseau et al., 2013). More than 80% of sonographers feel pain when performing ultrasound procedures (Rousseau et al., 2013). An Australian survey reported that 95.4% of sonographers experience MSI (Cursaro et al., 2014). Wuebben & Roozen, 2015 suggested that 9/10 sonographers report having neck, shoulder and/or back pain that prevent them from performing optimally. 4
5 5
6 Common Injuries in Sonographers Carpel tunnel Trigger finger DeQuervain s syndrome - pain, swelling and inflammation of tendons at the base of the thumb Pain and strain in the neck, back and shoulder tendon inflammation, shoulder bursitis, tennis elbow, rotor cuff tears, degenerative disc disease. Cubital tunnel syndrome result of extrinsic pressure on the cubital tunnel region of the elbow. Eye strain 6
7 General Symptoms Muscle and joint stress and/or weakness and fatigue Pain or Aching Swelling Numbness/ Loss of sensation MSI Inflammation Tenderness Deterioration of tendons and ligaments Muscle spasm Clumsiness 7
8 MSI Contributing Factors Biomechanical Factors Poor scanning posture Awkward scanning techniques - using excessive wrist flexion/deviation, shoulder abduction Sustained exertion, excess force, and excessive transducer grip Prolonged Scan time with repetitive and sustained movements Poor work place ergonomics - work space/equipment design Body habitus, age and gender Work Organization Factors Long hours without breaks insufficient recovery time Increased work load/reduced staffing Poor training to use equipment properly Reporting of Injury Factors Delayed reporting of injury Inappropriate management of injury 8
9 Prevention Who needs to be involved? Department manager/healthcare organizations Equipment manufacturers Sonographer 9
10 Prevention DEPARTMENT MANAGER Staff scheduling - in order to allow staff to take short breaks. Staff work load. Ergonomic design of procedure rooms. Ergonomic design of equipment when considering new purchases. Facilitating injury reporting and the initiation of treatment. Introduction of a Preventive Maintenance Program for sonographers about corrective exercise. 10
11 Prevention EQUIPMENT MANUFACTURERS Feedback from end-users regarding ergonomic design. Designing easily manoeuvrable ultrasound equipment with adjustable monitors and keyboards. Designing transducers wide enough to allow a comfortable grip and with lightweight cables. Designing chairs with back support and foot rests and that can be easily height adjusted. Designing examination tables of appropriate width and length, with drop-out sections, that can be height adjusted with hand or foot controls. 11
12 Prevention SONOGRAPHER Be aware of activities that cause pain and how to modify them. Arrange the work area to prevent injury. Request ergonomic adaptable equipment. Use equipment properly. E.g. position the monitor at eye level, adjust chair and bed to appropriate height for optimal posture. Position and reposition the patient and themselves. Use available adaptive equipment for support e.g. cushions, wedges etc. Try to learn to scan with both hands and alternate scanning hand. If possible vary procedures e.g. difficult and lengthy cases with easier, shorter cases. Limit the number of procedures performed portably. 12
13 Prevention SONOGRAPHER Take micro-breaks - release tension on scanning hand for a few seconds. Take mini-breaks remove the probe from the scanning hand, stretch the hand, arm and shoulders and glance periodically away from the monitor to release eye tension. Take a break from scanning while typing reports. Must maintain good physical fitness - learn and perform stretching and strengthening exercises. Must report symptoms of MSI as soon as they occur. Consider having a self check list posted in procedure room. 13
14 Prevention -Exercise Program Should be developed with physiotherapy and occupational therapy representatives in order that muscle groups important for sonographers are targeted. Should include stretches that can be performed easily in the workplace (hence no floor exercises). Daily exercises should take minimum time, approximately 5 minutes, and should be performed at the start of the day and as often as possible during the day. 14
15 Prevention - Exercise Program Ideally a program should include: 1. Static Stretch Exercises that can be performed daily every hour if possible. 2. Whole Body Program that includes a set of exercises to be performed 3 times a week for ~30 minutes. 15
16 Prevention - Stretch Exercises 1. Static Stretch Daily Involves slow, gradual pulling, holding, and releasing of specific muscle groups that are at risk of MSI including: Wrist and forearms Neck Shoulders Chest Back Improves flexibility of muscles and helps protect against muscle soreness and injury. Note - Stretches should pull but not hurt! 16
17 Prevention - Stretch Exercises 2. Whole Body Program exercises 3 times a week for ~30 minutes and should include: Stretching exercises for the shoulders, back and chest muscles. Strengthening resistance exercises for the whole body using light weights, elastic exercise bands or the body itself. 17
18 It is a good idea to post exercise plans in procedure rooms to remind sonographers of what they should do to prevent MSI. 18
19 Prevention -Self Check List Sonographer s may also wish to use a check list and post it in their procedure room. For example: 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 examination bed according to the body habitus of my patient in relationship to my height? 3. Is my posture comfortable and correct so as not to cause undue 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. Am I supporting my limbs properly throughout the entire examination? 7. When I stand, am I carrying my body weight equally on both feet? 8. Did I take a micro break? 9. Did I take a mini-break? 10. Am I aware of any unusual symptoms, such as numbness, swelling or pain? (Gregory, 1998) 19
20 Useful Links There are lots of materials available to help the sonographer: 20
21 Useful Links Ergonomic Stretching for Sonographers MedicalPositioning Chair Yoga for Diagnostic Cardiac Sonographers Jaclyn Bridges The Ultrasound Trap CQUninews 21
22 The Ultrasound Trap 22
23 SONOGRAPHERS! In order to help reduce the rate of MSI arrange your working space, use well-designed equipment properly, make sure you practice good posture while imaging, and take brief breaks to stand and stretch. Protect yourself and you will enjoy a long career as a sonographer! (Presented by a sonographer who has been in the profession for over 30 years!) 23
24 24
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