MSK Health Concerns Sonographers must know

Almost all cardiac sonographers reported having work-related musculoskeletal pain at some point during their careers in a survey of six Mayo Clinic sites. Moreover, they were 11.6 times more likely to experience occupation-related pain than fellow workers in cardiology and radiology departments, excluding those in jobs where they wore lead aprons^[1].

In the study of 66 cardiac sonographers and 451 other workers, the cardiac sonographers were also more likely to have current work-related pain and to have previously sought medical help or missed work for this reason.

"People need to understand that it's a real problem," study author Dr Nicholas M Orme (Mayo Clinic, Rochester, MN) toldheartwire from Medscape at a poster session at the American Heart Association (AHA) 2015 Scientific Sessions.

Cardiac sonographers were even more likely to have musculoskeletal pain than technicians in the cath lab, a known high-risk group based on a previous study by their group, he noted^[2].

"If people are reliant on their cardiac sonographers to . . . perform these echos that we need [to make diagnoses], then we need to start thinking of ways to . . . keep them from dropping out" of the profession, according to Orme.

Although the study did not identify the type of pain, "anecdotally we know that people have carpal-tunnel syndrome, neck pain, and back pain," he said.

Is Obtaining Echo Images Hazardous to Health?

Transthoracic echocardiography is the mainstay of cardiac imaging, but the constrained body positions and repetitive movements that sonographers use to obtain these images can result in musculoskeletal pain.

Orme said he knows firsthand that "[your wrist and back] hurt after a long day of doing echos. It really wears on you. . . . You have to hold awkward positions for minutes and then crane your neck over."

Prior studies looking at work-related pain among staff in the echo lab had inadequate control groups or did not adjust for possible confounders. Thus, the researchers aimed to study a large cohort of healthcare professionals.

In 2013, they emailed a survey to 2682 physicians, trainees, nurses, and technicians working in cardiology and radiology departments at Mayo Clinic facilities (in Rochester, MN; Scottsdale, AZ; Jacksonville, FL; Mankato, MN; La Crosse, WI; and Eau Claire, WI), followed by weekly reminders for 6 weeks.

A total of 1532 employees (57%) responded, and 1016 were excluded because they performed a job that required the use of a lead apron.

Of the remaining 517 employees, 55 were cardiac sonographers; 451 other employees served as controls.

The cardiac sonographers and control group had a mean age of 42 years and a mean body mass index (BMI) of 25 kg/m², and 25% were men. Almost all (92%) reported having no preexisting musculoskeletal pain.

The cardiac sonographers had worked in their profession for less than 5 years (20%), 6 to 10 years (32%), 11 to 15 years (20%), 16 to 20 years (11%), and more than 20 years (18%). Similarly, other respondents had worked in their professions for less than 5 years (22%), 6 to 10 years (21%), 11 to 15 years (17%), 16 to 20 years (12%), and more than 20 years (28%).

Compared with other workers, cardiac sonographers were more likely to report that they had work-related musculoskeletal pain (88% vs 40%), had sought medical care for this pain (55% vs 21%), or had missed work for this reason (35% vs 12%) (P<0 .001="" all="" for="" p="">

After adjustment for age, sex, BMI, years in current position, and preexisting musculoskeletal pain, cardiac sonographers were much more likely to report work-related musculoskeletal pain (odds ratio 11.6, 95% CI 5.32-25.5; P<0 .001="" p="">

"As practices consider long-term ability to staff and care for patients, trying to understand what we can do to help our cardiac sonographers in the future is going to be important," Orme stressed.

Most sonographers "are able to do [this work] just fine," but in other cases sonographers are leaving the profession because "they feel that their body can't handle 30 years of strain," he added.

Stretching, massage, or left-handed scanning have been suggested to lessen potential musculoskeletal pain. "If we could find something that would lower this just a little bit, it would help," according to Orme.