Joan P. Baker

Work-Related Musculoskeletal Disorders (WRMSD) Among Registered Diagnostic Medical Sonographers and Vascular Technologists A Representative Sample

Literature indicates a significant history of work-related musculoskeletal disorders (WRMSD) among diagnostic medical sonographers (DMS) and vascular technologist (VTs). To gather current data related to this historical trend, the authors administered a survey to a random and convenient sample of 5200 registered DMS and VTs. The invitation to complete the survey on a secure Web site yielded the largest participant sample to date of 2963 completed surveys (57% response). Data relative to the prevalence of WRMSD were analyzed and compared to other WRMSD research over the past decade. Results indicated that 90% of respondents were scanning in pain, a 9% increase since the last large-scale survey in 1997. Across all demographics, shoulder pain is most common, 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. Ergonomic equipment and education are provided by application specialists, but the incidence of WRMSD appears to be unabated. Higher order research, including randomized trials, with education and ergonomic interventions is needed to protect DMS and VTs who are necessary to meet increasing health care demands.

Work-Related Musculoskeletal Disorders in Sonographers

The historical perspective of the problem ofwork-related musculoskeletal disorders (WRMSD)is outlined to understand why a newbiopsychosocial paradigm is required. The availableepidemiologic evidence is reviewed, and theclinical problem underlying the chronic pain thatmany sonographers experience is identified. Problem solving is broken down into identifyingobstacles to recovery. Causation is multifactorial, and therefore management must bemultimodal. A case that had a good outcome ispresented. New industry standards (May 2003)for the prevention of WRULD in sonographersare cited.

The Importance of an Ergonomic Workstation to Practicing Sonographers

Musculoskeletal disorders have been described in a number of professions over the years. They are defined as injuries that are caused by or aggravated by workplace activities, and they account for up to 60% of all workplace illnesses. They are known by different names, such as musculoskeletal disorder, repetitive strain injury, cumulative trauma disorder, and repetitive motion injury. Musculoskeletal disorders have only been identified in sonographers since 1997 but are increasing in incidence. Surveys done among American and Canadian sonographers in 1997 showed an 84% incidence; however, this incidence had increased to 90% by 2008. Understanding the importance of optimal body mechanics and how to maintain neutral postures will enable sonographers to reduce the risk factors associated with their profession. Even with the most advanced equipment, an ergonomic workstation is only as effective as the person using it.

An analysis of occupational factors related to shoulder discomfort in diagnostic medical sonographers and vascular technologists

OBJECTIVE Three-fourths of diagnostic medical sonographers (DMS) and vascular technologists (VT) experiencing discomfort due to job demands indicate having discomfort in the shoulder region. An analysis of factors related to shoulder discomfort highlighted salient factors requiring further investigation and intervention. PARTICIPANTS The respondents were a convenient sample of DMS and VT that answered a survey, hosted on a secure website. METHODS The responses of 2,163 DMS and VT from a survey of a representative sample were analyzed to determine personal factors, work demands, and workstation design characteristics of those experiencing discomfort in the shoulder region. Frequencies and response distributions were calculated and cross tabulation with chi-square analysis was completed. RESULTS A majority of respondents with shoulder discomfort have co-morbid reports of discomfort in other locations. While overall sonographer discomfort is linked to age and years of experience, shoulder discomfort was also noted to be linked to specific workstation characteristics. A lack of adjustability in equipment, picture archiving and communication system (PACS) workstations, and positions required to complete bedside exams contributes to discomfort due to sustained and repetitive shoulder abduction and twisting of the neck and trunk. CONCLUSIONS There is a need for studies investigating redesign of equipment and workstations or interventions with DMS and VT specifically focused on improving adjustability and improved positioning of sonographers in order to reduce shoulder discomfort while performing job demands.

Factors That Contribute to Wrist-Hand-Finger Discomfort in Diagnostic Medical Sonographers and Vascular Technologists

A cross-sectional representative sample of 1722 sonographers and vascular technologists was analyzed using quantitative/qualitative methods to reveal that 60% are experiencing wrist-hand-finger discomfort, believed to be from work-related repetitive injury. The years of scanning accumulated by the participants was chosen as a variable to determine the relationship to the range of discomforts reported. A strong statistical correlation was noted between years of experience and the side of discomfort as well as the severity of hand-wrist-finger discomfort. In this study, a strong statistical association was also noted between increasing years of scanning and decreasing aggravation due to the transducer. A complete linkage between work-related exposure and hand-wrist-finger discomfort is difficult to make because of the contribution of leisure-time activities. A controlled experimental study is needed to determine the contribution that grip and pushing on the transducer may have on the incidence of hand-wrist-finger discomfort, leading to diagnoses such as carpal tunnel syndrome.

Issues Facing Sonography

Critical issues facing the sonography profession in the 1990s and in the next millennium are legislation, reimbursement, accreditation, the “advanced practice sonographer” classification, and musculoskeletal strain injury. The Society of Diagnostic Medical Sonographers (SDMS) has identified these areas of concentration in order to assist its membership in addressing these issues. Members of the SDMS have been involved in legislation on behalf of the sonography profession and in an effort to protect their patients. The SDMS also addresses numerous reimbursement issues, including many that involve laboratory accreditation. The SDMS supports laboratory accreditation and personal credentialing. The advanced practice sonographer classification is a new and controversial issue, and the SDMS Board is in the early stages of exploration of this role. Musculoskeletal strain injury is a major problem affecting a significant number of members of the sonography profession. The SDMS is actively investigating forms of treatment and prevention. Finally, in this article, some insight is offered into future developments in the practice of sonography and the role of the SDMS in the 21st century.

History of Work-Related Musculoskeletal Disorders Among Sonographers:

This issue is dedicated to the topic of work-related musculoskeletal disorders (WRMSDs) in sonography. The topic of WRMSDs has been discussed extensively and also generated the need for a consensus conference to gather leaders from professional organizations, stakeholders, and commercial vendors. The first consensus conference was held in 2003 and was chaired by Joan P. Baker, a founder of the Society of Diagnostic Medical Sonography (SDMS) and the American Registry of Diagnostic Medical Sonographers (ARDMS). Ms Baker’s influence on this topic is significant, and for this reason it seemed important to have her reflect on the history of WRMSDs. Ms Baker’s own research into this topic continues to be the most cited Journal of Diagnostic Medical Sonography (JDMS) article and underscores that 90% of sonographers and vascular technologist are working in pain. Joan’s additional participation in a second consensus conference adds to her perspective on what has transpired with regard to the increasing risk of occupational injuries among sonographers and vascular technologists. The following are her thoughts on the history and outcome of WRMSDs among sonographers. History by Joan P. Baker