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Diagnostic Medical Ultrasound: Challenges and WRMSD

Introduction

In the diagnostic imaging done in the contemporary settings, the most dynamic area of growth is the diagnostic medical ultrasound. There is purporting of the ultrasound in accounting for more than one in four examinations of imaging in world and have been impacting the increased number of clinical specialties. Individuals who perform the ultrasound scans have been evolving from technical backgrounds and multiplicity of professionals including radiologist, physicists, nurses, radiographers and other clinicians. Currently, there is storage of experienced sonographers in coping with the demand that has been growing for examinations. This factor and other financial constraints currently prevalent with the NHS have been resulting in increase of workloads for the existent staff along with greater magnitude of pressure in completing greater number of scans during a working day. The scenario is responsible for giving rise to numerous problems related to the practitioners of sonography with the major one being WRMSD (work-related musculoskeletal disorder).

Background

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There is acknowledgement by the Health and Safety Executive that the MSD (musculoskeletal disorders) has been the most common illness that is work related in United Kingdom. This affects more than one million individuals per year. The disorders are inclusive of joint injury, low back pain, and a range of repetitive strain injuries. Approximately 3.5 percent of the total workforce whose population touches 29.01 million has been affected by WRMSD. Therefore, the statement of discussion holds true as indicated by the information provided above. This paper will further examine the validity of the statement: Work Related Musculo skeletal Injuries are an inevitable consequence of ultrasound scanning practice

There have been several studies conducted that looks into the WRMSD incidences among the sonographers. The survey of Arrowsmith published in 2000 showed that sonographers to the tune of 79 percent who experiences adverse symptoms from the activities which are work related (Morton and Delf, 2008).

The studies conducted by Soundergonomics showed that 80 percent of the sonographers scans in pain with increased numbers retires on the consideration of ill health. Other studies showed incidences that are even higher, 86 percent and 89 percent respectively (Evans et al., 2009). These figures show the prevalence of WRMSD in alarming degree among sonographers, especially in comparison to the reported incidences with respect to the total working population. This is suggestive that problems can be attributed to the specific conditions of working for the sonographers. Therefore, these figures further reinvigorate the validity of the statement of discussion: Work Related Musculo skeletal Injuries are an inevitable consequence of ultrasound scanning practice.

WRMSD symptoms are inclusive of numbness and reduced mobility, stiffness, and pain that affect wrist, shoulder, back and neck. There are several practitioners of sonography reporting symptoms to certain magnitude. However, in the chronic condition, there can be serious consequences. The reporting is done by increased numbers of sonographers that they suffer from disability to pain to the extent so as to forcing those in giving up work or being redeployed (Janga and Akinfenwa, 2012). This has been distressing for the concerned individuals along with being an expensive proposition to NHS Trusts as and when they have been losing staff members that are valuable to them.

The WRMSD’s causes have the consideration that is multi-factorial with the suspected number of reasons. The UKAS (United Kingdom Association of Sonographers) is suggestive of the condition that the two major factors that cause the increasing health problems among sonographers are the rising patient referrals numbers for ultrasound scanning and augment of patient population’s body mass index (Brown, 2012).

The waiting times are targeted to be reduced by the government along with ultrasound scan’s non-invasive nature. This has led to considerable rise in demand, and thereby, putting pressure on the departments which are already overstretched in increasing the patients’ daily throughputs.

There is requirement for the sonographers in concentrating on monitors of visual display for long periods. This is the time when they strive in obtaining good images along with making diagnosis. During this period, often there is unawareness from their part regarding the position of their body. Till the completion of the examination, they are not conscious of strains and aches that take place from the fixed position of their torso, arm, and hand. Before the time obtained in recovering their body, the process is repeated with the scanning of the next patient. It is suggestive that sonographers performing over 100 scanning are at higher risk of WRMSD (Coffin, 2014). Most of the sonogrpahers have performed at least three times the figure given making it inevitable that there is occurrence of this problem at such a large scale. Thus, the chance of Work Related Musculo skeletal Injuries because of the practice of sonography or ultrasound scanning practice is enhanced several times that borders on the inevitability.

The Alexander Technique

The indications received from the randomized controlled trial tell us about the Alexander Technique which is cost effective and clinical for chronic back pain. The method related to neuromuscular reeducation is the Alexander Technique (AT) that Frederick Alexander introduced in the late nineteenth century. The involvement of an association between the thought and the resultant muscular activity is seen in relation to AT.

AT improves the organization of intentions and sensations of movement with the help extended to the individuals in becoming more conscious to body and mind (Monnington et al., 2012). There is requirement for a skilled teacher in observing individuals as there is translating of the mental activity to the muscle activity changes, coordination and balance. The individuals are provided with feedback and the practice of mental procedures that have been guided and makes pupil to be learning in recognizing the improvement in strategies for controlling the balance and movement.

There can be adaptation of the AT to various scenarios with respect to workplaces. Some practitioners of AT use this technique in helping the treatment’s chronic pain conditions. Albeit, the evidence based research is limited that exists currently, the suggestions from anecdotal evidence points towards positive results which are achieved often. Thus, Alexander Technique provides relief to the Work Related Musculo skeletal Injuries through an approach of pain management.

Consequences and prevalence of Musculoskeletal Disorders amongst Sonographers

There have been many studies revealing the musculoskeletal disorders to be prevalent to the tune of estimated 63 percent to 91 percent amongst the sonographers compared to 13 percent to 22 percent amongst the general population (Gibbs and Edwards, 2012). Their representation is mainly in the form of back pain and in upper limb. In a population of 118 members in the French College of Fetal Ultrasound, the shoulder pain is experienced by 76 percent, hand and wrist pain by 20 percent, elbow pain by 28 percent, back pain by 43 percent, and neck pain by 65 percent. The symptoms mentioned above may have similarity to burning sensation, itching, weakness, or numbness. There is necessity in taking into account the exposure of the practitioner. The wrist joint, elbow, and the shoulder pain are more amongst the full practitioners two times more compared to the part time sonographers. The figure of the full timers is 51.7 percent, whereas the part timers’ figure is 25.3 percent. The difference between the full timers and the part timers amongst the female predominance is 44.1 percent and 27.7 percent respectively. However, with regards to the back pain, it is independent of sex and exposure. Apart from the joint problems, the second most common condition reported is deterioration of visual acuity to the tune of 19.2 percent (Forrester, 2012).

These disorders’ consequences can be ranging from life impairment quality to early and complete end of professional activity. A study conducted by Gibbs and Edwards (2012) (2004) involving sonographers having musculoskeletal disorders with the recognition that these symptoms have had affect in their daily lives for psychosocial, sleep, and household chores wellbeing. Nonetheless, because of these disorders, 12 percent have temporarily left their jobs, and only in 9.4 percent of the sonographers have changed their lifestyles. The symptoms’ severity can have led to surgical and medical treatments. Coffin (2014) involved in his study 133 professionals. Out of them, 3.8 percent have the report of surgical treatments, 11.3 percent have the acknowledgement to have taken analgesics for the relief of pain, and 15 percent have used mesotherapy. The shoulder surgery and the carpal tunnel release are the procedures most common.

The information provided in the previous sections was suggestive enough that the chances of Work Related Musculo skeletal Injuries are high in the practice of ultrasound scanning. The data provided in this section is almost conclusive that injuries related to the ultrasound scanning or sonography is almost inevitable in the work related Musculo skeletal injuries.

Musculoskeletal Disorders’ Risk Factors

The operators that exposed most are the ones who perform 100 sonographic examinations to the least per month. The average duration of the examination of a time period which more than 25 minutes seemingly is the risk factor. The orientation and the gripping of the probe have the requirement repeated isometric postures that have been taken as the risk factors. In the time of the examination, there is permanent contraction of the arm without the rest period’s benefit. There is positive correlation between the forceful gripping and the onset of the symptoms. Wolf (2011) revealed that discomfort emanating from the transducer design has been the best predictor of wrist and hand disorders.

In the overwhelming majority of the scanning time to the tune of 90 percent, the force applicable is 1 kg to the minimum. This has the provision of few opportunities for the wrist and the hand to recover and rest. The mean force is 3.96 kg is usable to grip the transducer over entirely the scanning period and can be going up for the obese patients up to 27.6 kg. According to the report by Evans, Roll and Hutmire (2010) increase of risk related to the wrist and hand disorders occurs when pinch grips are used by the workers that exceeds 0.9 kg and power grips exceeds 4.5 kg. The pressure’s long duration having association with peak pressure considerably enhances the joint injuries risk, particularly in the case when the patient is obese. Additionally, the abduction of the shoulder that is more than 30 degree is the risk factor recognized for ischemic tendons and infra-spinatus and supraspinatus muscles. Nonetheless, most sonographers have resorted in spending 66 percent of their time with humeral abduction in more than 30 degree. Along with this, they also spend 45 percent of their time with abduction that has been more than 45 degree. These are the reasons that corroborate the inevitability of the Work Related Musculo skeletal Injuries among the sonographers and the ultrasound scanning practitioners.

Analysis

Long period of time is spent by sonographers in the working day in a position that is fixed and asymmetrical. They also perform small repetitive movements with their arms, hands and head, while their mind is concentrated on the images of visual display. There is requirement of high concentration level in focusing on the interpretation of the images in this time. Often, the sonographers become unmindful to their body position.

The lasting of each examination is about 30 minutes on average before moving away by the sonographers from the equipment. The intervals between the scannings, when there is replacement of one patient with the other can be very short such as, five minutes. Then again there is beginning of the procedure, where the sessions of full scanning can be up to four hours.

The pattern like this is bound to be leading to problems for the practitioners if the minimization of the risks is not addressed and steps against them. The steps regarding the improvement of the working conditions are taken by some departments (Gibbs and Edwards, 2012). They have called the occupational health advisors in giving guidance and advice, for instance, to the sonographers. However, the workplace’s financial pressure is coping with increased service demand that offset often the undertaken positive initiatives.

Most sonographers have the acquisition of habit related to the direct control of muscular effort in scanning that has frequently being the aspect of practice leading to WRMSD. There is potentiality of the Alexander Technique (AT) in offering a different mental approach in facilitating improvement in the thought mechanism. In turn, this can be leading to the need of the employment of less effort during the scanning because of the reduction in the overall muscle tension and improvement in the postural balance. The AT session’s evaluation usually provides the demonstration of high enthusiasm level for the technique and the realization was there that there has been high relevance to sonography practice (Gibbs and Young, 2008).

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Conclusion

The local hospital department and professional body guide the sonographers in helping reducing the WRMSD incidences. The workplace demands have the nature in which the individuals are required in taking pre-emptive measures so that there can be reduction in the chance of the occurrence of severe problems in their bodies. The potential help is extended by AT in helping sonographers reducing their risk.

Mostly, there is employment of excessive muscle tension taking place over a period of time in daily activities. This can be leading to tiredness and muscle strain. The choice of the ultrasound machines, examination tables, chairs and other equipment and furniture should be considered in adjusting possibilities in suiting the requirements of installation in the best possible way. The positioning of the sonographer should be correct before he/she begin the examination. There is necessity of knowledge pertaining to musculoskeletal disorders in adapting the installations correctly and positions for working comfort that is optimal. These are the necessary preventive measures against an otherwise inevitability attached with the possibility of Work Related Musculo skeletal Injuries pertaining to the sonography or ultrasound scanning.

The guidelines that this paper presents should have encouraging effect of scientific research in this area in defining better with respect to musculoskeletal disorders’ epidemiologic characteristics in sonography. The quality of life being impaired may have the resultant musculoskeletal disorders in working closely for the development of better designed ultrasound units.

References:

  1. Brown, T. (2012). Hard hats for sonographers? Synergy News: 24–25.
  2. Coffin, C. (2014). 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 7: 15–26.
  3. Evans, K., Roll, S. and Baker, J. (2009). Work-related musculoskeletal disorders (WRMSD) among registered diagnostic medical sonographers and vascular technologists. A representative sample. J Diagn Med Sonog 25: 287–99.
  4. Evans, K., Roll, S. and Hutmire, C. (2010). Factors that contribute to wrist-hand-finger discomfort in diagnostic medical sonographers and vascular technologists. J Diagn Med Sonog 26: 121–9.
  5. Forrester, C. (2012). The osteopath’s role in the diagnosis and management of patients with the symptoms of repetitive strain injury in the upper extremities. London: The British School of Osteopathy.
  6. Gibbs, V. and Edwards, H. (2012). An investigation of sonographers unaffected by work-related musculoskeletal disorders. Ultrasound 20: 149–54.
  7. Gibbs, V. and Young, P. (2008). Work-related musculoskeletal disorders in sonography and the Alexander technique. Ultrasound 16: 213–9.
  8. Janga, D. and Akinfenwa, O. (2012). Work-related repetitive strain injuries amongst practitioners of obstetric and gynaecological ultrasound worldwide. Arch Gynecol Obstet 286: 353–6.
  9. Monnington, S., Dodd-Hughes, K. and Milnes, E. (2012). Risk management of musculoskeletal disorders in sonography work. Birmingham: Health & Safety Executive.
  10. Morton, B. and Delf, P. (2008). The prevalence and causes of MSI amongst sonographers. Radiography 14: 195–200.
  11. Wolf, J. (2011). Impact of joint laxity and hypermobility on the musculoskeletal system. J Am Acad Orthop Surg 19: 463–71.

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