Letter to the Editor: Can Teaching Ultrasound Ergonomics to Ultrasound Practitioners Reduce White Knuckles and Transducer Grip Force? By Harrison,Harrris,and Flinton

Dear Editor,

We note the article “Can Teaching Ultrasound Ergonomics to Ultrasound Practitioners Reduce White Knuckles and Transducer Grip Force?” by Harrison et al. ¹ was very well written. The authors’ keen interest in raising awareness of the potential increase in work-related musculoskeletal disorders (WRMSD) harm in diagnostic medical sonography (DMS) practice is applauded. The article is relevant with the internationally developing role of medical (such as critical care, emergency medicine, gynecology, and urology) and nonmedical (such as abdominal, cardiac, musculoskeletal, and vascular) DMS practitioners. ² We wish to share our comments to enhance the debate on this important topic.

We would like to suggest a more expansive discussion on the topic. One suggestion is to look at the term ergonomics. As quoted by Robson and Wolstenhulme, ³ ergonomics refers to “the ‘fit’ between an employee and their work place, which when optimized can reduce injury.” On evaluation of the term ergonomic training, as Harrison et al. implies, the National Institute for Occupational Safety and Health recommends that training should include optimization of posture and the use of supportive equipment. ⁴ However, the authors’ study intervention focuses on only a short ergonomic training session using an ergometer that emitted sound when muscles were stimulated and the use of visual feedback from videos and photos. For the evaluation of the intervention, the authors could be more helpful in describing where the ergometer was placed and which muscle groups where stimulated. The work by Sommerich et al. ⁵ suggests that electromyographic electrodes placed on the deltoid muscle, or a large superficial muscle that aides in abduction, will increase the sensitivity for taking measurements.

We feel that in the future, clinical and academic sonography educators should include ergonomic training interventions when designing a DMS curriculum, including the following:

• Transducer shape and design: These are major contributing factors to hand and wrist strains. ⁶ The pressure needed to hold the transducer is seen as dependent on the shape and size of the handle and grip preference. ⁷

• “Afternoon tea technique” ⁸ : To aid transducer stability, allow a reduction in grip force and potential improvement in image quality.

• Transducer grip and force: Allow the weight of the transducer to be distributed evenly across the whole hand and potentially reduce the risk of WRMSD. ⁹

• Increased time for ergonomic training, including clear examples of best evidence-based practice: This would allow medical and nonmedical sonographers to reduce the barriers to ergonomic practice ¹⁰ and improve the workplace environment, the sonographer’s scanning posture, transducer grip with reduced force, and adaptation of DMS technique to prevent and limit WRMSD.^3,4,6,9,11

We wish to congratulate the authors on an interesting and thought-provoking article that will help generate international discussion on the topic of ergonomics in DMS practice. This discussion on reducing the risk of WRMSD is necessary in national health services and private practice, in response to the ever-increasing demands for DMS services.

Melanie Mifsud Nigel Frank Matthew Hiles Stephen Wolstenhulme University of Malta, Faculty of Health Sciences Msida, Malta [e-mail]