How to Perform a Transvaginal Exam Without Tearing Your Shoulder Apart

Transvaginal ultrasound is one of the most informative studies in pelvic imaging. It gives unparalleled detail of the uterus, endometrium, and adnexa—but let’s be honest, it’s not always ergonomic bliss. After a few exams in a row, your shoulder may feel like you just pitched nine innings in the World Series. So how do you protect your body and get the diagnostic images you need?

The Shoulder Strain Struggle is Real💪

Transvaginal exams often mean leaning, reaching, and holding awkward probe angles far longer than any musculoskeletal system was designed for. Over time, repetitive strain can lead to shoulder impingement, rotator cuff irritation, or just that dull “I’m not as young as I used to be” ache at the end of the day.

✅Tip 1: Adjust the Bed, Not Yourself

The exam table has wheels and an adjustable height for a reason. Get the patient as close to you as possible and adjust the table height so that your elbow stays comfortably at your side. If you’re reaching across the room like you’re auditioning for Cirque du Soleil, stop and reposition.

✅Tip 2: Chair Check – Your Throne Matters👑

A good ergonomic chair makes all the difference. Ideally, use one with adjustable height and back support. If your facility provides “that one squeaky stool with a cracked seat,” advocate for better equipment. Your rotator cuff will thank you. And standing is under-rated- sometimes standing for transvaginal studies helps to relieve shoulder pain too.

✅Tip 3: Use Your Hands Strategically

While one hand controls the probe, the other can help stabilize or reposition. For example, rest your non-probe hand on the side of the bed for counterbalance. This takes the weight off your shoulder instead of leaving it hanging mid-air. You can also place a towel or other prop under your elbow for support.

✅Tip 4: Think Small Movements

Sometimes we over-rotate the probe when subtle wrist and forearm movements will do the job. Let the transducer—and gravity—work for you. A few millimeters of movement often reveal what you’re looking for, no need to crank your arm around like a helicopter blade. And don't forget - start out in a transverse plane - that gives you a wider field of view, so you don't miss those ovaries!

✅Tip 5: Optimize the Patient, Too

Encourage the patient to scoot down until their hips are at the edge of the bed. This brings anatomy closer to you, reduces awkward angling, and honestly makes the exam faster and more comfortable for everyone.

Humor Break

If your shoulder feels like you just competed in an arm-wrestling tournament after every transvaginal scan, it’s not you—it’s your ergonomics. Remember: you’re a sonographer, not a professional contortionist. (Although some days, it feels like both.)

The Takeaway🎯

Protecting your shoulder during transvaginal exams isn’t just about comfort—it’s about career longevity. Small ergonomic adjustments, the right equipment, and mindful probe handling can make all the difference. Take care of your body now, and you’ll still be scanning strong years down the road.

Because at the end of the day, your goal is clear imaging of the pelvis—not a trip to the orthopedist with worker's comp.

Want FREE CME and to learn more about Sonographer Ergonomics? I've got you covered! Check out my course at All About Ultrasound - Enroll for free today and get a free SDMS CME credit.

-Lara Williams, BS, ACS, RCCS, RDCS, RVT, RDMS, FASE

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