ECHO

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ECHO A pain in the neck.

• Alan Caulfield. Chief Cardiac Physiologist.
  Causeway Hospital

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The Echo Lab Friday 5pm
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Sonographers and Occupational Overuse Syndrome

• CAUSE
• EFFECT
• SOLUTIONS

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RESEARCH

• Shows that 84 of Clinical Sonographers
• experience pain related to their profession.
• Of those, 20 suffer career ending injury.
• At present ,workforce shortages are affecting
  productivity ,patient care and targets.
• 
  (Pike, Russo, Berkovitz, Baker
  and Lessoway )

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AREAS OF BODY MOST OFTEN INVOLVED IN INJURY
WITHIN THE SONOGRAPHY PROFESSION

• Shoulder 84
• Neck 83
• Wrist 61
• Back 58
• Hands 56

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LEGISLATION

• Health and Safety at Work (NI) Order, 1978
• Management of Health Safety Regs
• Workplace, Health Safety Welfare Regs
• Provision and use of Work Equipment Regs
• Manual Handling Operations Regs
• Personal Protection Equipment at Work Regs
• Display Screen Equipment Regs

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WORK RELATED MUSCULOSKELETAL DISORDERS

• The causes of WRMSD can be attributed to three
  groups of factors
• 1.BIOMECHANICAL awkward scanning postures,
  excessive force used in performing exam, poor
  workspace design

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2.POOR WORK ORGANIZATION

• Inadequate employee training
• Too many studies.
• Infrequent breaks.
• Pressure to meet targets leading to increased
• overtime demands.

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3.INJURY MANAGEMENT

• Delayed reporting and diagnosis of injuries.
• Improper injury management.
• Too quick a return of Sonographer to an injury
  producing environment.

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ERGONOMICS

• No change in education, environment, equipment or
  work schedule will improve the ergonomics
  situation if the Sonographer fails to take
  advantage of preventative measures.

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Equipment

• Use motorized adjustable tables (including those
  equipped with drop-down side rails) to optimize
  the positions of the patient and the sonographer

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RISK FACTORS

• Poor workplace ergonomics in the design of
  equipment, chairs, tables, and lighting

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• The table should be as narrow as possible
  (preferably 24 to 27 inches wide) to allow for
  proximity to the patient and to reduce the amount
  of shoulder abduction needed to reach the
  patients far side.

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• Use a posture-enhancing adjustable chair to
  accommodate the sonographer through adjustable
  footrests, seat heights, and lock and release
  casters.
• Casters should allow for rolling between
  patients and the ultrasound machine when
  necessary, yet prevent rolling backwards when
  performing necessary procedures

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EQUIPMENT

• Position the keyboard to allow the arm to be in a
  relaxed position with the upper arm close to the
  body (minimal flexion and abduction) and the
  elbow at a 90-degree angle.

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Work Practices

• Decrease the duration of static posturing
• Vary postures throughout the day.
• Sit or stand, depending on the exam.

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Scheduling

• Schedule different types of exams for each
  sonographer in a workday to decrease strain on
  musculoskeletal tissues specific to one type of
  exam.

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scheduling

• Limit the number of portable exams to help
  minimize those tasks with higher number of pinch
  grips and increased static or awkward postures.

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scheduling

• Consider a maximum number of scheduled exams for
  sonographers. Take into account existing
  ergonomic conditions and equipment, the type of
  exams performed, experience of the sonographer,
  and the duration of the individual exams.

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scheduling

• Because of the complexity of each diagnostic
  situation, it is difficult to specify an
  allowable limit to the number of exams per day.
  Until better information is obtained, take into
  account the total examination time per day (more
  exams of shorter duration or fewer exams of
  longer duration).

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BAD PRACTICE

• NON ADJUSTABLE CHAIRS / STOOLS AND EXAMINATION
  COUCHES FORCE THE SONOGRAPHER TO REACH AND TWIST
  HIS OR HER TRUNK.
• GREATER DEMANDS ON THE MUSCLES RESULT IN FATIGUE
  AND STRAIN.
• PERSISTENT AND CONTINUAL PRESSURE FOR SUSTAINED
  PERIODS OF TIME DURING THE EXAMINATIONS SHOULD BE
  AVOIDED.

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NOT LIKE THIS !!!!!

• Whats wrong ?

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CAREFUL postioning

• Couch is too high.
• Chair is too low.
• This causes the operator to abduct his arm 90o
  from his body.
• Monitor is too high.
• Patient is too far away causing
• Operator to bend his trunk and lean out to the
  right

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WRONG BETTER
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• MUCH BETTER

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Best Practice

• Exam chair properly positioned.
• The chairs position allows the Sonographer to
  view the monitor without neck extension.
• Positioning the patient closer to the Sonographer
  eliminates the Sonographers trunk twist and
  reduces his arm abduction to 30o.

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OPTIMAL POSITIONING.

• Here is the optimal posture to perform
  echocardiography
• right handed - a table with a drop section
  opening
• for the sonographer to sit (or stand) allows the
• sonographer to keep the back straight and rest
  the
• feet on the table frame. The ultrasound unit is
  moved
• in close proximity to the sonographer so she can
  keep
• her left elbow close to her side with minimal
  reach to
• the control panel. The monitor is positioned
  level
• with her line of sight to reduce tilting or
  twisting of
• the head or neck.

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Body Parts Sonographers Reported Using in
Repetitive Motions

• Prevalence Reported Repetitive Movements by
  Sonographers
• Wrist/hand motion
• Repetitive 92
• Awkward position or bending 100
• Twisting 62
• Arms/shoulders
• Repetitive 100
• General
• Sustained positions 92
• Repeated stretching/reaching 84
• Repeated pressing/twisting 77

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Useful velcro arm / cable support

• Stops cable drag
• and offers support to hand and wrist.

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Breast Sling

• Makes access to apical windows easier.

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Reporting Station.
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A bright idea?

• Some propose scanning right handed sitting or
  standing next to the patients head, with the
  patient facing the sonographer and the ultrasound
  system placed toward the patients feet.
• That posture poses two situations which are both
  bad. Either the head or neck are twisted to view
  the monitor or there is too much wrist flexion.
• 1

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AMBIDEXTROUS ?

• Ambidextrous scanning is helpful in that it
  allows one set of muscles and joints to rest
  and recover from strain.
• Training to scan with both hands may help prolong
  the length of many careers by resting muscles for
  50 of working time.

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Sonographer CHECK LIST

• How close/far is the patient from me?
• Is my chair / couch adjusted properly for my
  height and the patients body habitus?
• Is my posture straight or is it awkward enough
  to be hazardous to my back and neck?
• Is my wrist supported and in a neutral position?

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checklist

• Do I have easy access to the monitor and keyboard
  without having to stretch?
• Are my limbs properly supported during the entire
  examination?
• Am I taking micro-breaks releasing tension of
  the scanning hand for a few seconds at a time?
• Am I having any symptoms that could be warning
  signs of potential injury such as numbness ,
  burning, swelling, clumsiness or pain.

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IN SUMMARY -

• Experienced Sonographers are a valuable resource
  to
• healthcare facilities around the world.
  Unfortunately, they
• are also more at risk for musculoskeletal
  disorders.
• Sonographers who are beginning their careers can
  benefit from the
• knowledge that has been gained through difficult
  circumstances
• by their predecessors.
• By focusing on those factors that they can
  control, and working
• together with others to effect change in their
  work environment all
• Sonographers can be proactive in generating a
  transformation that will
• improve their ergonomic environment and reduce
  their risk for injury.

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Go Ireland Go

• Sorry u Brits !

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