By Bernadette Mason

(Accredited Medical Sonographer, Health and Wellbeing Committee ,Australasian Sonographers Association ASA)

To remain injury-free during a career as a sonographer it is necessary to master shoulder stability. The repetitive nature of scanning puts a large amount of stress on that small ball and socket which is the shoulder joint. The brachial plexus is the bundle of nerve fibres that trigger contraction of the complex array of muscles that make up the rotator cuff. The anatomic configuration of these muscles gives rise to a large range of movement for such a small joint. When all is in alignment the movement is free, allowing for such activities as lifting and moving weights, as well as movement in many directions.


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Images 1 – 4: Anatomical Images (Agur & Dalley, 2013)

The problems of shoulder pain experienced by sonographers have been widely documented. It arises when the motion and strain on the shoulder is repetitive and sustained for long periods of time as with abduction greater than 30 degrees from the body, forward abduction or forward rolling of the shoulders and bad posture. All these close down the anterior capsule of the shoulder, reducing blood supply, delaying drainage and compressing the brachial plexus.


Image 5-6: Anatomical Photographs (Agur & Dalley, 2013)

Sonographers are often expected to perform many of the same types of scan and this can mean a repetitive strain on the shoulder joint itself. If the posture is not neutral, and this is repeated for many months or years, shoulder problems may occur.

To check that you are scanning correctly, sit comfortably with the neck drawn slightly in and turn you head to one side. Then turn to the other side, if you can see the whole of your shoulder, you have rolled your shoulders forward. You should be able to view the anterior portion of the shoulder if your shoulders are neutral. To enable this, sit up straight, bring your scapular down and together. Hold this position and let your scapular relax. Notice the difference in the “tension” experienced in your shoulder. If you cannot see your shoulder it is too far back.

When scanning we should also be aware of the relation of the elbow to the body. Sustained forward abduction has the same effect on this joint as it does for the shoulder. It is not possible to scan with our arm by our side because we need a free range of movement to cover the area we are assessing. Relaxed muscles when conducting scans will allow the muscles to do their work whilst the joint to be remains stable.

When you are doing a study that is taking a long time, remember to have mini breaks from scanning and rest your shoulder and back. Transducer Cable bands are ideal for this as you can let the transducer drop for a second and not fall to the floor. Move your arm and stretch slightly to loosen the muscles. You can have a short conversation with the patient, who I am sure will be glad of a short break as well. Check your posture and resume scanning.

Be aware of the grip you have on the transducer. Use palmar or power grip and not a pincer or finger grip. This all radiates up to the muscles of the neck and should. Be aware of the position of your neck and head, and try to keep the jaw and mouth slightly relaxed. Scan safely and you will have a rewarding and long career. We will cover these in following articles.




Agur, A., & Dalley, A. (2013). Grant's Atlas of Anatomy. Baltimore, USA: Lippincott, Williams & Wilkins.

Balmain Sports Medicine. (2013). Common Causes of Shoulder Pain. Retrieved February 5, 2014, from Balmain Sports Medicine:

Bass, C., & Gregory, V. (2008, March). Guidelines for Reducing Injuries to Sonographers/ Sonologists. Australian Sonographers Association Journal.

Brown, J. (2009, January 21). Beginners Guide to Shoulder Pain. Retrieved February 5, 2014, from EXOS Knowledge:

Gregory, V. (1999). Occupational Health and Safety Update. Sound Effects Vol. 43.

Orenstein, B. (2009). Scanning in Pain - Sonographers Seek Relief from Job-Related Hazard. Radiology Today Vol. 10, No. 18, 24.

Teefey, S., Middleton, W., & Yamaguchi, K. (1999). Soulder Sonography; State of the Art. Radiologic Clinics of North America Vol 37 Issue 4, 767-785.



Survey results Australasian Society Of Ultrasound in Medicine, 2014

There is a high potential for workplace injuries to affect sonographers in Australia. Injuries to sonographers are commonly caused by twisting the neck and trunk during examinations, a static posture or the downward application of transducer pressure.

A targeted audience of sonographer members were surveyed through the Australian Sonographers’ Association (ASA). The aim of the survey was to ascertain aspects of sonographer health and wellbeing in the workplace and the level of compliance with the “Guidelines for Reducing Injuries” (ASUM, 2002, revised 2010), a document developed in collaboration with the Australian Society for Ultrasound in Medicine (ASUM) and available from the ASA.

 This survey was conducted online and participation was voluntary, with 102 questions aimed at gathering information on awareness of the safety guidelines and the implementation of the safe work practice in the workplace in Australia. Correlation of the results was done by an external survey company.

There are 5000 registered sonographers in Australia according to the Australian Sonographers Accreditation Registry (ASAR, 2014) and of those, 3980 are members of the ASA. Of those members, approximately 360 took part in the survey. Comparison of the returned statistics was made with a similar, smaller targeted survey conducted in 1999, and a revised survey conducted in 2006.

The previous survey of 1999 (Gregory, 1999) of a smaller sample of volunteers (197 completed surveys) revealed that 95% of respondents were carrying between one (1) and five (5) injuries each. These ranged from fatigued muscles to career-ending injuries for 25% of those who returned a survey.  Fifty percent (50%) of sonographers surveyed stated that they exercised between 1 and 5 times per week to maintain fitness and 67% stated they were at a good level of fitness at the time of the survey. 2006 survey had 93% of sonographers experiencing some degree of pain since commencing their career. ( 427 returned surveys.)

This latest survey has revealed that, of the 325 sonographer responders, 54% have read the guidelines for safe scanning techniques to reduce injuries in sonographers. Of these 325 sonographers, 290 (89%) have suffered pain or discomfort since commencing scanning. This can be interpreted as a slight decrease in the rate of injury to sonographers since the earlier survey. A pain and discomfort rate of almost 90% is still an unacceptably high level of injury for any profession, particularly given that 93% of respondents who had read the guidelines stated that they had taken measures to prevent workplace injury. With regard to the severity of injuries 24% had taken longer than 4 weeks off work duties and 5 moved to non-scanning roles or light duties.

An interesting point of note was the non-scanning arm injury rate (fig. 1). Of the 45 sonographers reporting injury to the non-scanning arm, 50% reported slight pain, 37% moderate and 14% severe pain. 50% of respondents reported hand and finger problems on the non-scanning side (cf. 44% in 2006); 216 respondents confirming an injury of the shoulder on the non-scanning side, with 26% slight, 51% moderate and 26% severe.



Figure 1: Q.76, p.77 of survey results.



Figure2: Q.79, p.82 survey results.

The degree of pain varied (fig. 2), with 58% of respondents reporting slight out of work activity, 58% limiting out of work activities and 56% experiencing sleep disruption due to pain. Of greatest concern was the 23% of respondents who experienced severe disruption or career-ending injury across all of the areas reported.

In response to questions about symptom aggravation, 78% of respondents reported an increase in pain when applying downward pressure whilst scanning - 50% had pain when turning or twisting their neck or trunk and 58% experienced continuous pain (fig. 3 & 4).