Transcutaneous electrical nerve stimulation: Intervention for pain and disability associated with ultrasonography

AND DISABILITY ASSOCIATED WITH ULTRASONOGRAPHY NORA DOYLE, MILDRED M. RAMIREZ, MICHAEL GARDNER, JOAN M. MASTROBATTISTA, University of Texas Health Science Center at Houston, Obstetrics, Gynecology, and Reproductive Sciences, Houston, Texas, Baylor College of Medicine, Obstetrics and Gynecology, Houston, Texas OBJECTIVE: The incidence of musculoskeletal injuries (MSI) among sonographers and sonologists is increasing with resultant lost work days having a significant negative impact on the delivery of ultrasound services. Transcutaneous electrical nerve stimulation (TENS) is used clinically by a variety of health care professionals for pain reduction. Mechanism of action is supported by the gate control pain theory and release of endogenous opioids. We sought to evaluate the efficacy and practicality of using a TENS unit by obstetrical sonographers in the workplace. STUDY DESIGN: Baseline demographic information, ergonomics survey and Upper Extremity Function Scale (Pransky) (UES) was obtained from all participants (n = 8) prior to device application. TENS unit was used by participants during a normal work day with subject control of intensity and duration. Post use information was then collected. RESULTS: Participants were female, age 25-57, with mean BMI 26.2 for the group. Ethnicity was 6 white and 2 Hispanic. All engaged in regular physical activity and reported good to excellent health. All performed ultrasounds 5 days/ week with >30 scans/week with no interventions currently being used at work. All were right hand dominant and scanned using their right hand. All reported wearing comfortable shoes and adjusting patient bed height when possible, with no other ergonomic interventions used. All reported pain after becoming a sonographer, with 2 missing work because of the pain. Satisfaction with using the TENS during work for relief of pain symptoms was high with all 8 saying they would use it again and 6 saying they would recommend it to others. CONCLUSION: Repetitive use injuries are a growing concern in sonographers and sonologists. TENS is a low cost, noninvasive modality that is easy to apply with few contraindications. Our study suggests it can sensibly be used in the workplace to relieve pain symptoms associated with performance of ultrasound. 648 ULTRASONOGRAPHIC MEASUREMENT OF FETAL NASAL BONE IN THE KOREAN POPULATION AT THE FIRST AND SECOND TRIMESTER EUI JUNG, HYE-SUNG WON, JUNG-SUN KIM, JAE-YOON SHIM, PIL RYANG LEE, AHM KIM, Asan Medical Center, University of Ulsan, Obstetrics and Gynecology, Seoul, South Korea, Asan Medical Center, University of Ulsan, Pathology, Seoul, South Korea OBJECTIVE: To establish the reference range of fetal nasal bone length(NBL) at the 1st and 2nd trimester in the Korean population and to determine the accuracy of prenatal NBL by postmortem examination including radiographs and autopsy. STUDY DESIGN: A total of 404 consecutive ultrasound examinations were performed at 11-14 weeks of gestation for nuchal translucency and nasal bone measurement and 820 consecutive fetuses underwent ultrasound examination at 18-26 weeks of gestation in Asan Medical Center. And the association between chromosomal abnormality and nasal bone absence or hypoplasia(smaller than 2.5th percentile) was analysed. Twenty-two fetuses with congenital anomaly or intrauterine death had undergone sonographic measurement of NBL before termination of pregnancy and were examined by radiographs and autopsy following termination. RESULTS: At the 1st trimester, the visualization of fetal profile was obtained in 398 fetuses (98.5%), and linear regression was performed. The incidence of nasal bone absence was 3/398 (0.75%). One fetus had T.21, one with T.18 and the other was acrania with euploidy. At the 2nd trimester, fetal profile was successfully examined in 818 fetuses(99.8%) and the NBL increased linearly with gestation. During this period, 6 fetuses with chromosomal abnormality (including 2 T.21) were detected and only one fetus with T.21 had hypoplastic nasal bone. Hypoplastic nasal bones was seen in 14/812 (1.7%) chromosomally normal fetuses. NBL measured by ultrasound was similar to that confirmed by autopsy and longer than by postmortem radiograph. CONCLUSION: We present the normal range of NBL at the 1st and 2nd trimester and their linear relationship with CRL and gestational age. Although numerically limited, our experience shows that the NBL in the 2nd trimester in Korean seems to be shorter than that of Caucasian and similar to Chinese. So different normal ranges for different races are required, and relative percentile is more reliable than absolute value. And the accuracy of the NBL measured by ultrasonography was confirmed by postmortem autopsy.