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Discussion

Several studies have determined that sonographers have an increased risk of developing musculoskeletal disorder, including wrist dysfunction (carpal tunnel syndrome, carpal instability, tendonitis), back pain, neck pain, shoulder pain, and upper-extremity pain.
Sonographers reported an increase in musculoskeletal discomfort at the end of their workday. As a result of physical discomfort, it lead to changes in sleep patterns, changes in home life and psychosocial wellbeing (Roll, Selhorst & Evans, 2014). In this study, almost 90% of sonographers were performing a scan in pain., where shoulder pain was the most common resulting in 73% out of 90% of the sonographer in the study. Next highest was lower back pain and with 69% reporting that issue and over 50% had hand and wrist problems. Unfortunately, majority of sonographers accept that musculoskeletal pain is part of their daily routine and most of them try to manage the situation on their own rather than reporting it (Roll et al, 2014).
Similar results has been observed by Evans, Roll& Baker in 2009, where the authors made a survey with over five thousand registered diagnostic medical sonographers (DMS) and vascular technologists (VT). Those results also showed that 90% of participants were working in pain.

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Those performing upper extremity and transvaginal pelvic examination have had the most problematic postures causing discomfort and pain. In addition to this Evans et al. (2009). During the scan, the sonographer is often required to extend and abduct the arm away from the body to hold the transducer in the required position and then use fine controlled movements to obtain an ideal image. During this scanning action, they simultaneously operate the keyboard with their other hand and rotate their head back and forth between the patient and monitor. Study reveals that throughout all demographics shoulder pain was the most common issue, with older and more experienced sonographers having more finger, hand, and wrist pain than other groups. Pain continues to be related to pressure applied to the transducer, abduction of the arm, and twisting of the neck and trunk. Further to predisposing and perpetuating factors such as poor positioning, sonographers experience of musculoskeletal discomfort was often related to an increasing number of examinations every day with less breaks in between examinations (Roll, Selhorst & Evans, 2014).
A corresponding theory was shown by Muir, Hrynkov, Chase, Boyce & McLean (2004) where it has been found that bad posture, twisting and bending of the wrist, reaching too far and taking very few breaks in between scan could contribute to permanent disability. Even though sonographers mostly reported work related musculoskeletal disorders as pain in the neck and shoulders, lumbar spine discomfort is also commonly reported, followed by hand and wrist pain. Also, weakness in one or both extremities, numbness in hands and clumsy fingers (Bagley, J., Barnett, J., Baldwin, J., DiGiacinto, D., & Anderson, M. P., 2017).

Besides scanning patients, sonographers must on regular basis type reports and review their images on a computer. Carrying out this type of movement for more than 4 hours per day significantly increases a persons risk of acquiring a work related musculoskeletal disorder (Bolton and Cox 2015). Musculoskeletal disorders amongst sonographers are also related to inability to adjust workstation monitors or a keyboard tray resulting in straining of neck and shoulders (Evans et al. 2009).

However, there is a strong evidence in literature that muscle-strengthening exercises seem to be an significant aspect of WRMSD prevention.

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