Radiologists may not do much heavy lifting or strenuous physical work in their professional lives, but they suffer from work-related injuries as often as handlers and laborers, according to a report published in the American Journal of Roentgenology.
A multi-institutional group, led by Dr. Lynne Ruess from the Tripler Army Medical Center in Honolulu, described upper-extremity musculoskeletal disorders in radiologists. They also identified risk factors and preventative measures. Ruess’ co-authors are from the Uniformed Services University in Bethesda, MD, and Cornell University in Ithaca, NY.
"Considering the growing emphasis on digital imaging and widespread implementation of PACS, we believe that our clinical duties now pose added risk for work-related musculoskeletal disorders," they wrote (AJR, July 2003, Vol.181:1, pp. 37-42).
These disorders include carpal tunnel syndrome and the lesser-known cubital tunnel syndrome. The symptoms of chronic median nerve compression (carpal) include pain in the wrist, muscle weakness, and abnormal nerve conduction. In the case of ulnar nerve compression (cubital), symptoms include pain in the medial elbow and paresthesias in the ulnar nerve distribution, the authors explained.
Their report focused on four radiologists (one-third of the staff physicians sought medical attention for upper-extremity symptoms during the summer of 2000). They underwent standard occupational tests such as grip strength, pinch gauge, sensation testing, and a wrist-flexion test. Two radiologists underwent MR imaging of the cervical spine prior to the occupational tests. Finally, all of the subjects completed a survey to estimate computer use.
Although they had normal MR findings, two radiologists were diagnosed with bilateral cubital syndrome. One of these two also had bilateral carpal tunnel syndrome. The remaining doctors had unilateral right cubital tunnel syndrome.
"The four symptomatic staff radiologists spent a mean time of 3.4 years working in a PACS environment," the group reported. "They also spent significantly more time performing sonography." In addition, these radiologists were the most active on the academic front, routinely working on projects and teaching after-hours.
Amongst all the radiologists in the department, the incidence rate of carpal tunnel syndrome was 8.3 per 1,000 person/years. The authors found that this rate did not differ significantly from the 9.9 rate reported for handlers and laborers.
A review of work areas by an industrial hygienist resulted in 93 recommendations, including adjustable keyboard holders and furniture.
"We believe that prolonged computer time combined with the poor workspace ergonomics...contributed to our radiologists’ symptoms," the authors said. Activities that may have caused the cubital tunnel syndrome included the use of handheld dictaphones and telephones; an upwardly tilting keyboard may have led to elevated carpal pressure.
The authors concluded the study by urging radiology practices to seek expert advice on ergonomic hazards and corrective measures.
Since this report was put together, three of the remaining radiologists have made a concerted effort to turn their attention to ergonomics, Ruess wrote in an e-mail to AuntMinnie.com. However, they "have not been able to significantly decrease the typing requirements. Two have decreased symptoms, and one is considering surgical intervention for failed conservative management," she said. The fourth doctor has left the institution, so follow-up was not possible.
In addition, greater awareness of the issue has resulted in some changes in the department, such as correct furniture adjustments. But the PACS workstations remain the same. "Budgets do not allow for new furniture purchases at this time, but I suspect that future purchases will consider ergonomics," Ruess wrote.
By Shalmali PalAuntMinnie.com staff writer
August 20, 2003
The views expressed herein are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the U.S. government.
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