Work-related musculoskeletal disorders (MSD) are a common problem among sonographers, with prevalence in human sonographers of 80–90%. However, this problem appears to be largely neglected in the veterinary literature. Awareness of MSDs, ergonomic redesign, workplace management, and physical self-care are components to reducing the risk of developing MSDs. Work-place redesign and alterations in work flow management are discussed, and a template for a more ergonomically favorable echocardiogram table is provided.
Work related musculoskeletal disorders (MSDs) are infrequently discussed during training, in journals, or at cardiology meetings. However, professionals such as sonographers are at risk for developing work related MSDs due to repetitive use injury and the unfavorable body position required to perform echocardiography in patients. Consultation with a physical therapist and ergonomic specialist can provide vital information to prevent or reduce injury when performing echocardiography.
What is a work-related musculoskeletal disorder?
Work related MSDs are conditions that involve nerves, tendons, muscles, and supporting structures of the body, as a result of cumulative over-use, non-neutral body postures, sustained static postures, and repetitive motions.1, 2, 3, 4, 5 and 6 Initial injuries may be mild and include symptoms of dull pain or tingling sensation of the affected area, which improve with rest, and are characterized as reversible over-use injuries. If the condition is not addressed, moderate injury may occur, including recurrent pain, aching, and/or fatigue that occurs earlier in the work-day and persists at night. Moderate injuries may be reversible if complete rest for a period of time is given. Severe injuries consist of pain, weakness, and fatigue that can be felt even at rest, disturb sleep, and limit the ability to perform even mundane daily tasks, and may result in permanent damage.
The neck, upper back, shoulder, and wrist are the most common sites of pain reported among human sonographers. The pain associated with performing ultrasounds is innately linked with the awkward, unbalanced body position required in both human and veterinary sonographers. Non-neutral body positions intrinsic to performing ultrasounds include: a twisted or bent back, head, and neck, a flexed and/or twisted wrist, an unsupported and extended elbow, and an elevated abducted shoulder with an extended arm that concurrently applies upward- sustained pressure. Muscle strain and fatigue occur when the arm is abducted greater than thirty degrees from the front of the body, which is a common problem in sonographers. Veterinary echocardiographers typically scan from beneath the animal to optimize acoustic windows and minimize lung-air interference, which creates additional ergonomic strain on the shoulder muscles caused by pushing up while abducting the shoulder. Muscles held in a static position with applied sustained force fatigue quickly, and if not allowed to recover prior to repeating the same activity, microscopic injury may occur, which may lead to repetitive strain injury. Consistent among several studies, the following factors are correlated to development of work related MSDs: scan time and number of scans, number of hours and days a week worked, twisted posture, and maintaining a high-pressure handgrip.1, 2, 3 and 4
Veterinary echocardiographers are subjected to awkward and difficult to maintain body postures inherent in performing cardiac ultrasounds, and are commonly affected with MSDs. A main goal in ergonomic redesign is to minimize strain on the shoulder, neck, wrist, and back through assessment of the arrangement of animal, table, and echocardiogram machine, as well as assessing work-place flow and minimizing exposure to sustained difficult postures (Table 1).
