Study shows alarming injury rate amongst ultrasonographers

The Report: February / March 2000 vol.21 num.1

The final report of the BC Ultrasonographers' study reveals that 91% of survey respondents have experienced musculoskeletal pain and discomfort at some point during their sonography career.

The final results of the BC Ultrasonographers study are in and theypresent a disturbing picture of the dangers associated with sonography. The final reportreveals that ninety one percent of survey respondents have experienced musculoskeletalpain and discomfort at some point during their sonography career.

One injury isone too many
The study of BCs sonographers was designed by a multidisciplinary group consistingof sonographers, employers, ergonomists, unions and professional associations. Of the 232sonographers in BC, 211 (92 per cent) of them completed the survey.

A full sixty per cent of respondents reported having sought medicalattention for complaints related to their work in sonography. A further 30 per cent ofrespondents reported experiencing pain but not seeking medical attention.

Twenty percent of respondents had filed claims with the WCB for painrelated to their work. The rate of injury claims amongst all workers in BC is five percent. That means that sonographers are being injured at a rate which is four times greaterthan the provincial average.

Sonographers report that the areas of their bodies which are most atrisk for injury are the shoulder (84%), neck (83%), upper back (77%), wrist (61%), lowerback (58%), hand (56%), eyes (52%), and upper arm (50%). Severe symptoms were most likelyto be reported in the shoulder, neck and upper back.

The activities that were most likely to be identified as triggering oraggravating symptoms included shoulder abduction, the application of sustained pressurewith the transducer, and the sustained or repetitive twisting of the neck and trunk. Interms of the equipment they used, the Acuson machine was identified as the leastcomfortable while the ATL machine was identified as the most comfortable.

The report concluded:

It should be emphasised that the prevalence rates are self reported and the investigation of risk factors for musculoskeletal symptoms is descriptive in nature. However, the excellent response rate among the population provides a strong, representative description of musculoskeletal symptoms and associations with the work of sonography. The prevalence of musculoskeletal disorders is high amongst this population. The findings suggest that musculoskeletal symptoms be related to the work of scanning, in particular, the tasks related to sustained shoulder abduction, manipulating the transducer while sustaining applied pressure, sustained twisting of the neck/trunk and performing repetitive twisting.

Now that this problem has been so clearly identified, the next taskfacing both the union and the employer is to develop and implement ways to prevent furtherinjury. The employer must commit to doing whatever possible to redesign the equipment, thework environment and the work schedule associated with ultrasound work to protectsonographers. Meanwhile, the union and its members must devise new strategies to compelthe employer to take action.

Injured sonographers speak out
Andrea McCallum, a former sonographer at BC Womens Hospital and Health Centre, hadto give up the career she loved after only six years in the field. "Imdepressed, and Im in a lot of pain," she said. "And Im grievingabout losing my job that I really really loved. It was a really great place to work. And Ireally feel for my supervisor, who has three people off injured right now, whentheres already a shortage of sonographers."

To add insult to injury, the Workers Compensation Board isrefusing to accept her claim of workplace injury. "I was working in a particular area... vaginal ultrasound ... where you scan in a different position from otherpeople," she said. "Its a very repetitive motion, and it involvesextension of the arm, with a static contraction. And it just caught up with me."

McCallum had to go on Medical Employment Insurance because the WCBrejected her claim. "And then I had to go on Long Term Disability," she said.This was devastating for McCallum, a fit, active swimmer who used to compete. "I was33. And now I only have ten months left on LTD, and I have no idea whats going tohappen to me when Im no longer on claim."

McCallum has chilling advice for those who are hoping for a career insonography: "Dont expect this to be your lifetime job ... because itwont be, unless you then go into management. Document your injuries. Itsfrightening, but after all that time and money invested in becoming a sonographer, it onlylasted six years for me. And I know other people are getting injured, too."

As a result of her injury, she still can not do simple daily activitieslike lift groceries or do the laundry without pain and risk of further inflammation."Im lucky I have a great family to support me," she said. "This isvery stressful for my partner. Im lucky hes here."

With the aid of the union, McCallum is appealing the WCBsdecision. And with the help of HSAs Madden Scholarship Fund, she is enrolled in acertificate program in Occupational Health and Safety. "I hope I can find a job as anOH&S Officer, maybe in a hospital, where Ill be able to work with people whomight one day be in my position," she said. "Im very grateful for theunions support and guidance."

One factor that McCallum thinks helped stave off her injury for a whileis the advice and support she received from fellow sonographers in her department."People in the department talk to each other if they thought you could be scanningmore comfortably. I dont know what I would have done if I had been the onesonographer in an isolated community."

Beth Webb found herself in exactly this situation when she beganperforming ultrasounds in Golden, BC. "Were a small hospital, so we have to beversatile," she said. "Its very rewarding. Being in a small community, weget to know everyone really well ... we really become quite close to our patients. Webecome very involved in their care: they are often your friends and co-workers."

Webb says part of the challenge of being the only sonographer in townis the added responsibility. "We dont have a radiologist on-site," shesaid.

"We have to make judgements or decisions that other sonographersin centres that have radiologists would not be forced to make, and consequently I feelthat I have to try harder to do a good job and provide quality images," she said."I have to make sure that I can answer questions, and take it one step further toprovide all possible information to the radiologist so that the patient gets the bestpossible care."

Webbs injury began as a "burning pain" in her elbowwhile at work. "I had recurring pain following exams that were particularly difficultto do ... these would usually be larger patients, when I had to apply extra pressureover a prolonged period. You have to compress the tissue and apply force to bring theimage into the focal zone, and make it sharper."

Over time, however, she found that she was beginning to "bringhome the pain." "I found that even in lifting a gallon jug of milk from thefridge I wouldnt do it with my right arm," she said. "If I had to pick upmy purse or carry my groceries with my right arm, it would cause pain."

Finally, she went to her doctor. "I went to go see my doctor whenI felt that the strength in my arm was diminished," she said. "I was concernedthat this was related to work." Her doctor prescribed anti-inflammatory medication,and sent her to see a physiotherapist. The physio suggested that Webb was using the"wrong" grip to use her transducer. "She saw that I was using whatscalled a ‘pincher grip, and had me change my grip to more of a‘grasp," Webb said.

"And she assessed that I was scanning in an awkward position, withmy arm far away from my body ... with my arm fully extended, my elbow locked ... andthat was bad. She told me to keep my arm as close to me as possible, and always bring thepatient in as close as possible."

With the help of the medication, ‘tennis-elbow splints,strengthening exercises, and ergonomic education, Webb is steadily recovering from herinjury. But like McCallum, she is having difficulty getting WCB to recognize her injury ashaving been caused as a result of her work.

"I think part of the reason I got injured is because I work inisolation and I dont have contact with other sonographers," she said."Im guessing that in a larger centre, they would have been more aware of betterscanning technique; someone would have noticed, and would have told me to try and modifyhow Im doing the scans."

"Another reason is that instead of a scanning bed, weremaking do with an old inpatient hospital bed thats too wide and not easily adjusted.And though the transducer heads are much better than they were, they are still heavy andawkward to hold."

She is still concerned that even with her new knowledge about theimportance of more comfortable scanning positions, she may experience another injury."Im 42 now. If Im looking at retirement at 60 or 65, thats a lotmore years to be putting in. If the current workload continues, whos to say Imnot going to have a relapse or reoccurrence with this?

"You want your retirement years to be enjoyable. You dontonly want to be able to use one hand."

Watch future editions of The Report for more information onprevention initiatives and the strategies for dealing with the employer on this importanthealth and safety issue.