Yusef Sayeed, MD, MPH, MEng1
Keziah Sully, MD2
Kristine Robinson MD3
1 Assistant Professor, Director of Pain Medicine and Functional Rehabiliation Eglin
Air Force Base, Intrepid Spirit Center, Assistant Professor, Department of Physical
Medicine and Rehabilitation, Department of Family Medicine, Uniformed Services University
of the Health Sciences, Bethesda, MD
2 Interventional Physiatrist, Veteran’s Administration, Department of Physical Medicine
and Rehabilitation, Biloxi, MS
3 Veteran’s Health Administration, Department of Emergency Medicine, Assistant Professor,
Department of Emergency Medicine, West Virginia University, Morgantown, WV
Correspondence:
Yusef Sayeed MD
96MDG/AMDS SGPF(IWC)
Eglin AFB, FL 32 542
Email: yusef.a.sayeed.civ@mail.mil
Financial disclosure statements have been obtained, and no conflicts of interest have
been reported by the authors or by any individuals in control of the content of this
article.
These views do not represent the views of the United States Air Force, the United
States Veterans Health Administration or the United States Department of Defense
Work related musculoskeletal disorders (WRMSD) has been widely reported among several
occupations, and has taken a toll amongst sonographers as well. WRMSD disorders among
sonographers had an incidence of up to 90 %, with shoulder pain being the most prevalent
complaint [1]. WRMSD are under-reported among the more experienced sonographers, as well as among
those in training. Recent survey data among Emergency Medicine Ultrasound Fellows
has indicated similar injury patterns among physician counterparts in the United States.
In reviewing the United States Bureau of Labor Statistics database (2018 is the most
recent dataset) for injury/illness of Diagnostic Medical Sonographers (29-2032) and
summarizing the findings:
Number of lost time injury/illness cases for Diagnostic Medical Sonographers (29-2032)
is relatively constant from 2014–2017 but with an increase in 2018. No useful rate
data. As expected, primarily upper extremity sprain/strain/pain due to overexertion
due to worker positioning or motion. High level of disability (lost days) relative
to other occupations [2].
Understanding the etiology of WRMSD helps address and prevent the issue. The United
States Occupational Safety and Health Administration (OSHA) recognizes repetitive
motions, bending, reaching overhead and working in awkward positions as known risk
factors for musculoskeletal disorders, increasing the risk for a WRMSD. When these
strains are not accommodated, WRMSD manifest as tendonitis, sprains, strains, bursitis,
spondylosis, degenerative disc disease, and arthralgias. Continued repetition with
relatively little recovery time results in chronic injury patterns. In fact, it has
long been established that the primary perpetuating factor for WRMSD in the profession
is poor positioning. Due to health care economics there has been a shift to increased
productivity with sonographers having to provide increased exams with less rest cycles
and decreased time to ergonomically accommodate the examination room [3].
There has long been a discussion both within the United States and Europe on how to
best address these disorders. In fact the United States Centers for Disease Control
and Prevention National Institute of Occupational Safety and Health has published
guidelines to reduce WRMSD [4]. However, despite these best efforts there has not been a change in the injury patterns
in the United States. The growing concern as the point of care ultrasound model continues
to build these injury patterns will translate to our physician and provider counterparts
in multiple specialties.
WRMSD has contributed to both personal and occupational impairment and disability
for both individuals and employers including pain, difficulties with ADLs, lost work
time (both absenteeism and presenteeism), costs incurred from lost work time (training/retraining,
short term coverage employees, workers compensation insurance premium changes, and
loss of productivity) and refractory cases have resulted in early retirements. Employer
related costs, from both direct and indirect measures, has been estimated to be 120
billion US dollars each year. In fact, just absenteeism and lost work time alone cost
employers approximately $21 153/week according to Roll et al. [5]. Recognition of this condition is vital, as it can only be prevented and addressed
once it is acknowledged and prioritized. In this role, multiple national and international
organizations and stakeholders have come together to form the 2020 Grand Challenge
“Stop Work Related Musculoskeletal Disorders (WRMSD) Resulting from the Performance
of Diagnostic Medical Ultrasound.“ [6]
This Grand Challenge has been designed with a grass roots initiative among stakeholders
with efforts across three main pillars: research, education, and advocacy. It has
brought together leading experts in the field of sonography, manufacturing, accreditation,
occupational medicine, regulatory agencies, and those stakeholders who can best advocate
for change at both the national and international level. This effort will require
a multifaceted approach, much like what the nursing industry was able to do with safe
patient handling initiatives. This international effort will join partners including
the World Federation of Ultrasound in Medicine and Biology, the American Institute
of Ultrasound in Medicine, the American Registry for Diagnostic Medical Sonography,
the American College of Occupational and Environmental Medicine etc. … with the hopes
of changing the culture, work environment, applied ergonomics, and features of hazard
controls so that our friends, colleagues, and peers continue to practice what they
love and continue to make a difference in our patients lives.
