Preventing Work-­Related Musculoskeleta

Disorders in Sonography

Summary

Sonographers are at risk 

for developing work-related musculoskeletal disorders such as inflammation 

of the tendons (tendonitis) 

or tendon sheaths (tenosynovitis), bursitis, muscle 

strains, and pathology of 

the nerves in the upper extremities, neck, and back. 

NIOSH recommends appropriate engineering controls, 

work practices, hazard communication, and training to 

prevent these work-related 

musculoskeletal disorders.

Description of

Exposure

Work-related musculoskeletal disorders currently account for onethird of all occupational injuries 

and illnesses reported to the Bureau of Labor Statistics (BLS) by 

employers every year. 

The following are factors that, in 

combination and over time, lead 

to musculoskeletal injuries:

Static and awkward postures 

and movement resulting from 

the use of the transducer and 

positioning of both patients and 

equipment

Persistent and continual pressure for sustained periods of 

time during exams 

Poor workplace ergonomics in 

the design of equipment, chairs, 

tables, and lighting

Increased exam scheduling 

Sonographer height, age, and 

gender

Case Stud

NIOSH [1999] conducted an investigation at a hospital antenatal 

unit in which most of the sonographers had reported neck, 

shoulder, and arm pain while 

performing ultrasound. NIOSH 

investigators interviewed several 

workers and assessed the jobs using video analysis. The following 

findings were noted: 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health

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The main risk factors noted 

during trans-abdominal ultrasound procedures were awkward postures (mainly right 

shoulder flexion and abduction), sustained static forces, and various types of pinch 

grips while maneuvering the 

transducer. Extreme wrist postures varied because of the way 

sonographers had to move the 

transducer to accommodate 

different patient sizes. Small 

patient abdomens mainly led 

to the use of shoulder movements while large abdomens 

led to greater wrist flexion and 

extension.

Standard positioning of the 

equipment resulted in twisting 

of the neck to view the monitor, flexion and abduction of 

the shoulder, and extension of 

the elbow while operating the 

controls.

The shape of the abdominal 

transducer resulted in several distinct types of grips, 

ranging from a pinch grip to a 

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power grip to an intermediate type of grip (the 

most commonly seen is with the 3rd and 4th fingers on one side and the thumb on another). The 

power grip—the most comfortable over the long 

term was used when the hand could be spread 

along the wide (3-inch) edge of the transducer.

Controls

NIOSH recommends the following controls to reduce the risk of musculoskeletal injury for sonographers: 

Equipment

Provide adequate work space for personnel, sonography equipment, the patient table, and other equipment.

Ensure that sonography equipment is fitted with 

a high-resolution screen that has a high refresh 

rate (85 Hertz or higher), a noninterlaced monitor and an easily adjustable “brightness control” 

to reduce eye strain. Position the equipment 

monitor directly in front of the sonographer.

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. A laptop computer may enable the sonographer to achieve a 

favorable position with respect to the patient. 

However, be aware that laptops can present other problems because the keyboard and monitor cannot be positioned separately, which make 

them difficult to handle at the bedside.

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.

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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The table should be as narrow as possible 

(­preferably 24 to 27 inches wide) to allow fo

proximity to the patient and to reduce the 

amount of shoulder abduction needed to reach 

the patient’s far side.

Work Practices

Decrease the duration of static posturing:

Vary postures throughout the day.

Sit or stand, depending on the exam.

Decrease hand-grip pressure:

Alternate the scanning hand and vary the 

grip used.

Take short breaks.

Loosen grip on the transducer.

Minimize awkward and extreme postures.

Increase tissue tolerances through exercise and 

adequate rest.

Scheduling

Schedule different types of exams for each sonographer in a workday to decrease strain on 

musculoskeletal tissues specific to one type of 

exam. 

Limit the number of portable exams to help minimize those tasks with higher number of pinch 

grips and increased static or awkward postures. 

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. 

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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Training

Periodic training and reassessment regarding the 

above ergonomic interventions should include the 

following: 

Setting up the equipment, bed, and chair 

Modifying the equipment positioning during 

scanning

Positioning patients

Using adaptive equipment or devices, such as 

cushions and wedges and the patient’s limbs for 

resting the elbows during scans

Taking rest breaks during the procedures

Maintaining good physical fitness and conditioning

Optimal handling of specialized tests such as 

trans-vaginal examinations

Having symptoms promptly evaluated by a licensed 

health care provider.

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Acknowledgments

The principal contributors to this publication were 

Robin Epp MD, MPH, University of Iowa, Department of Occupational and Environmental Medicine; 

Bruce Bernard, MD, MPH and Daniel Habes, National Institute for Occupational Safety and Health; 

Ashok Nimgarde, MD, Harvard University; and Joan 

Baker, Society of Diagnostic Medical Sonography.

References

NIOSH [1999]. Hazard evaluation and technical assistance report: University of Medicine and Dentistry of New Jersey, St. Peter’s University Hospital, Piscataway, New Jersey. Cincinnati, OH: U.S. Department of 

Health and Human Services, Centers for Disease Control 

and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA 99–0093–2749, Health 

Hazard Evaluation Report No. 99–0093. Available at: 

www.cdc.gov/niosh/hhe/.
DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

4676 Columbia Parkway

Cincinnati, OH 45226–1998

For More Information

For more information about work-related musculoskeletal 

disorders in sonographers, see

NIOSH, Society of Diagnostic Medical Sonography [2003]. 

Industry Standards for the Prevention of Work-Related Musculoskeletal Disorders in Sonography. Plano, TX.

To receive documents or other information about occupational safety and health, contact NIOSH at

NIOSH—Publications Dissemination

4676 Columbia Parkway

Cincinnati, OH 45226–1998

Telephone: 1–800–35–NIOSH (1–800–356–4674)

Fax: 513–533–8573 ■ E-mail: pubstaft@cdc.gov 

or visit the NIOSH Web site at www.cdc.gov/niosh

For a monthly update on news at NIOSH, subscribe to 

NIOSH eNews by visiting www.cdc.gov/niosh/eNews.

Mention of any company or product does not constitute endorsement by NIOSH. In addition, citations to Web sites external to 

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NIOSH is not responsible for the content of these Web sites.

This document is in the public domain and may be freely 

copied or reprinted. NIOSH encourages all readers of 

the Workplace Solutions to make them available to all 

interested employers and workers.

As part of the Centers for Disease Control and Prevention, 

NIOSH is the Federal agency responsible for conducting research and making recommendations to prevent work-related illnesses and injuries. All Workplace Solutions are based on 

research studies that show how worker exposures to hazardous agents or activities can be significantly reduced.

Preventing Work-Related Musculoskeletal

Disorders in Sonography

DHHS (NIOSH) Publication No. 2006–148

Safer • Healthier • PeopleTM September 2006