Transvaginal ultrasound: The musculoskeletal risks for practioners

Lianne Dadson, Ultrasound Maidstone and Tunbridge Wells NHS Trust


The aim of this study was to identify factors that affect the strain on practitioners when performing transvaginal ultrasound examinations. The positioning for transvaginal examinations were examined to demonstrate factors, which can impact the strain on the practitioners, and provide ergonomic recommendations.


The research was completed in two sections. An electronic questionnaire was designed to provide background information on the technique, prevalence and symptoms of Work Related Musculoskeletal Disorders (WRMSD) amongst practitioners performing transvaginal ultrasound. The second part, was an observational study involving 7 volunteer sonographers who each performed 5 transvaginal examinations with each scan in a different patient and sonographer position. Each scan was assessed using the Rapid Upper Limb Assessment form, which evaluated the muscular strain and positioning of the sonographer.


The study demonstrated that performing transvaginal examinations with the patient’s legs in stirrups with the sonographer seated scored a RULA score of 6.6 indicating this placed the sonographer at the highest risk of muscular strain and work. Performing transvaginal examinations using a wedge with the sonographer standing scored the lowest RULA score of 3 indicating this position resulted in the lowest risk for muscular strain.

A total of 742 responses were analysed for the electronic questionnaire, which demonstrated that 96.2% of respondents were suffering from pain and 87.8% stating transvaginal examinations resulted in awkward postures. The results of the questionnaire demonstrated multiple factors that contribute to work related musculoskeletal disorders.


The transvaginal ultrasound examination has been demonstrated to be associated with WRMSD and there remains a high prevalence of pain amongst practitioners who perform transvaginal ultrasound. Performing transvaginal examinations whilst standing improved the sonographers posture. These results are in concordance with previous literature; these results indicate a significant association between posture and examination positing and the prevalence and severity of musculoskeletal symptoms.

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