Ergonomic Evaluation of Musculoskeletal Risk in Sonographers
This paper presents a cross-sectional ergonomic evaluation of ultrasound sonographers working in an obstetric and gynecological scanning department. Using the Rapid Upper Limb Assessment (RULA) tool and an adapted Nordic Musculoskeletal Questionnaire (NMQ), the study assessed fourteen sonographers for postural risk, static muscle loading, and self-reported musculoskeletal symptoms. RULA analysis identified patient scanning as the highest-risk task element, occupying 31–39% of a typical 26-hour working week. Questionnaire results revealed that 93% of participants reported at least one musculoskeletal symptom, with the shoulder (57%), cervical spine (50%), and wrist/hands (50%) most frequently affected. The paper discusses contributing factors including equipment design, non-adjustable seating, and prolonged static postures, and proposes recommendations to reduce workplace injury risk among sonographers.
- Introduction: History of diagnostic ultrasound and prior injury research
- Methodology: RULA assessment and Nordic Questionnaire design
- Results: RULA scores, time-on-task data, and symptom prevalence
- Discussion: Risk factors, equipment design, and workplace limitations
- Conclusion: Summary of findings and recommendations for practice
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What makes this paper effective
- Combines two validated instruments — the RULA postural assessment tool and the Nordic Musculoskeletal Questionnaire — to triangulate findings from both observational and self-reported data sources, strengthening the credibility of conclusions despite a small sample.
- Grounds the study in a well-structured literature review that situates findings within comparable occupational groups, including cardiac sonographers, breast screening radiographers, and general radiographers, giving the reader comparative context.
- Presents quantitative data clearly through task-element tables and percentage time-on-task figures, making abstract risk scores concrete and interpretable for a clinical audience.
Key academic technique demonstrated
The paper demonstrates effective mixed-method convergence: observational workplace assessment (RULA) is paired with structured self-report interviews (NMQ) so that objectively measured postural risk scores can be directly compared with participant-reported symptom prevalence. This convergence validates each method's findings and compensates for the limitations inherent in each approach used in isolation.
Structure breakdown
The paper follows a conventional research report structure: an introduction that reviews the historical development of diagnostic ultrasound and prior injury literature; a methodology section explaining participant selection, RULA protocol, and questionnaire design; a results section presenting RULA grand scores by task element alongside NMQ prevalence tables; a discussion that contextualizes findings, acknowledges the small sample, and addresses equipment and workplace design factors; and a brief conclusion that synthesizes findings and outlines practical recommendations.
Introduction
The aim of this study was to conduct an ergonomic evaluation to identify contributing factors in the development of musculoskeletal pain and discomfort in ultrasound sonographers involved in obstetric and gynecological scanning. The methodology involved a cross-sectional study of sonographers in one hospital. The Rapid Upper Limb Assessment (RULA) was used to identify exposure to postural risk, static muscle work, and repetition, while an adapted Musculoskeletal Questionnaire was used to evaluate the frequency and distribution of musculoskeletal problems. Fourteen participants were assessed in the workplace. The RULA analysis identified that the task element with the highest risk factor was scanning patients, with participants spending between 31% and 39% of their working time doing this in a 26-hour week. Results from the questionnaire found that 64% had experienced one or more combined physical problems over the previous 12 months, with the shoulder joint (57%), cervical spine (50%), and wrist and hands (50%) identified as the most frequently reported problems. The study highlights the prevalence of self-reported symptoms among sonographers and the postural constraints individuals must adopt while working. Suggestions are proposed to reduce risks via adjustable work equipment, education in using adjustable equipment, work organization changes, and the use of arm supports.
Diagnostic ultrasound (DU) was first introduced to the medical world in 1942 by Austrian physician Dr. Karl Dussik (Levi, 2007). It was initially used to detect gallstones in 1950 by Ludwig and Stutler, but was subsequently developed for use in gynecology, where there was a profound need for safer imaging techniques (Levi, 2007). DU was first used in an applied clinical setting in 1958 by Professor Ian Donald from Glasgow, who used ultrasound to examine gynecological patients for pelvic lesions (Levi, 2007). It was used on a more regular basis within the clinical environment during the 1960s, gaining recognition by the American Medical Association in 1974 (Vanderpool, 1993).
In modern medicine, the use of ultrasound in both gynecology and obstetrics has become a normal part of the diagnostic and fetal assessment process. However, the increased use of ultrasound equipment has been identified as a source of workplace pain and discomfort in sonographers. Craig (2005) surveyed 100 sonographers with 5–20 years of experience. The results showed that the majority of respondents had experienced symptoms of musculoskeletal problems, including wrist and shoulder problems. The study, however, did not document exact figures concerning work-related problems, nor did it provide details pertaining to the methodology or response rate.
A study by Vanderpool (1993) surveyed 225 cardiac sonographers. A 47% response rate was achieved, with 72% of respondents female. Results found that 63% of respondents had experienced wrist problems during their career and 3% had been diagnosed specifically with Carpal Tunnel Syndrome.
Wihlidal and Kumar (2008) surveyed 156 sonographers in a postal survey in Alberta. A 61.5% (N=96) response rate was achieved, and 88.5% of respondents reported work-related symptoms either historically or on an ongoing basis. Clusters of symptoms included neck and intrascapular pain (54%), shoulder or upper arm pain (53%), low back pain (37.5%), and elbow pain (23.5%). Respondents were also asked about absence from work, and 16% reported that they had been forced to take time off due to symptoms (Wihlidal and Kumar, 2008).
In comparison with others involved in radiography work, May et al. (1994) surveyed breast screening radiographers in a UK national survey of 800 participants, receiving 320 responses. This study used two control groups: clerical staff (N=400) and general radiographers not involved in screening (N=400). Preliminary results found that those involved in general radiography reported the most muscular complaints (94.4%), while 76% of those involved in breast screening reported pain and 70% of clerical staff reported muscular discomfort. Although only descriptive data were reported, the study highlights the level of complaints within general and breast screening radiography.
Habes and Baron (2000) presented a case study of an ergonomic evaluation of ultrasound testing. The study highlighted the postural extremes sonographers had to adopt while using ultrasound equipment, the static loading from holding the scan heads, and the biomechanical loading on sonographers. Several recommendations from this study included the use of adjustable chairs including sit/stand seats and beds, the provision of elbow support, customizing one room for specific scanning types, and a secondary monitor positioned in the line of sight of the sonographer.
The results of these previous studies suggest that the use of ultrasonography equipment is accompanied by physical musculoskeletal problems. The following study was carried out following an initial ergonomics evaluation of work carried out in the radiography department of a hospital. The aim of the study was to identify the prevalence of musculoskeletal pain and discomfort, to identify postural risk factors when carrying out scanning tasks, and to evaluate the workplace and equipment design.
Bibliography
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Habes, D.J., Baron, S. 2000. Case studies: Ergonomic evaluation of antenatal ultrasound testing procedures. Applied Occupational and Environmental Hygiene, 15, 521–528.
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Levi, S. 2007. The history of ultrasound in gynecology 1950–2010. Ultrasound in Medicine and Biology, 23, 481–522.
May, J., Gale, A.G., Haslegrave, C.M., Castledine, J., Wilson, A.R.M. 1994. Musculoskeletal problems in breast screening radiographers. In S.A. Robertson (ed.) Contemporary Ergonomics 1994. Taylor and Francis, London, 247–252.
McAtamney, L., and Corlett, E.N. 2003. RULA: A survey method for the investigation of work-related upper limb disorders. Applied Ergonomics, 24, 91–99.
Vanderpool, M.P.T. 1993. Prevalence of Carpal Tunnel Syndrome and other work-related musculoskeletal problems in cardiac sonographers. Journal of Occupational Medicine, 35, 604–610.
Wihlidal, L.M., Kumar, S. 2008. An injury profile of practising diagnostic medical sonographers in Alberta. International Journal of Industrial Ergonomics, 19, 205–216.
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