- •Development of overuse musculoskeletal conditions could have a significant influence on quality of life for Service members with traumatic upper limb amputation.
- •Incidence of overuse musculoskeletal injuries within one year after injury is high in-Service members who have sustained combat-related upper limb amputation.
- •Research efforts for devising rehabilitation programs geared toward prevention and mitigation of secondary overuse musculoskeletal injuries after upper limb loss is warranted.
Retrospective cohort study
Service members who have sustained traumatic amputations are typically young and otherwise healthy. Beyond standard care, these individuals desire long, highly active, and relatively pain-free lifestyle, whether that is returning to active duty or transitioning to civilian life. Development of overuse musculoskeletal conditions could have a significant influence on quality of life for Service members with traumatic upper limb amputation.
Purpose of the study
Compare one-year incidence of overuse musculoskeletal injuries in Service members with different levels of combat-related upper limb amputation to Service members with minor combat-related upper limb injuries.
Service members with deployment-related upper limb injury (N = 519), 148 major upper limb amputation (55 with amputation at or above elbow, 93 with amputation below elbow) and 371 minor upper limb injury were included in the study. Outcomes of interest clinical diagnosis codes associated with overuse conditions of the upper limb, neck and upper back, lower limb, low back pain, and all regions combined, one year before and one year after injury.
Overall, the one-year incidence of developing at least one musculoskeletal overuse condition after upper limb amputation was between 60% and 65%. Service members with upper limb amputations were 2.7 to 4.7 times more likely to develop an overuse upper limb condition, 3.6 to 3.8 times more likely to develop a neck and upper back condition, 2.8 to 4.4 times more likely to develop a lower limb condition, and 3.3 to 3.9 times more likely to develop low back pain as compared those who sustained minor combat-related injuries. No significant differences in the odds of developing a musculoskeletal condition was found between the above elbow and below elbow amputation groups.
Incidence of secondary overuse conditions is elevated in Service members with upper limb amputation and warrants focused research efforts toward preventative and rehabilitative interventions.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Therapy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Dillingham T. Rehabilitation of the upper limb amputee. In: Dillingham T, Belandres P, eds. Rehabilitation of the Injured Combatant. Vol 1. Washington, DC: Broden Institute; 1998:33-77.
- Major deployment-related amputations of lower and upper limbs, active and reserve components, U.S. Armed Forces, 2001-2017.Medical Surveillance Monthly Report. 2018; 25: 10-16
- Characterisation and outcomes of upper extremity amputations.Injury. 2014; 45: 965-969
- Functional and clinical outcomes of upper extremity amputation.J Am Acad Orthop Surg. 2015; 23: 751-760
- Upper extremity amputation and prosthetics.J Rehabil Res Dev. 2001; 38: 357
- A survey of overuse problems in patients with acquired or congenital upper limb deficiency.Prosthet Orthot Int. 2016; 40: 497-502
- Functional outcome of patients with proximal upper limb deficiency–acquired and congenital.Clin Rehabil. 2004; 18: 172-177
- Save that arm: a study of problems in the remaining arm of unilateral upper limb amputees.Prosthet Orthot Int. 1999; 23: 55-58
- Musculoskeletal pain and overuse syndromes in adult acquired major upper-limb amputees.Arch Phys Med Rehabil. 2011; 92 (e1961): 1967-1973
- Musculoskeletal complaints in transverse upper limb reduction deficiency and amputation in the netherlands: prevalence, predictors, and effect on health.Arch Phys Med Rehabil. 2016; 97: 1137-1145
- Unilateral upper-limb loss: satisfaction and prosthetic-device use in veterans and servicemembers from Vietnam and OIF/OEF conflicts.J Rehabil Res Dev. 2010; 47: 299-316
- The United States armed forces amputee patient care program.J Am Acad Orthop Surg. 2006; 14: S183-S187
- Ten years at war: comprehensive analysis of amputation trends.J Trauma Acute Care. 2012; 73: S438-S444
- The walter reed experience: current issues in the care of the traumatic amputee.J Prosthet Orthot Outcome Measures Lower Limb Prosthet. 2006; 18: P119-P122
- Incidence of overuse musculoskeletal injuries in military service members with traumatic lower limb amputation.Arch Phys Med Rehabil. 2018; 99 (e341): 348-354
- The navy-marine corps combat trauma registry.Mil Med. 2006; 171: 691-697
- The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.J Trauma. 1974; 14: 187-196
- AIS 2005: A contemporary injury scale.Injury. 2006; 37: 1083-1091
- The injury severity score revisited.J Trauma Acute Care. 1988; 28: 69-77
- Musculoskeletal injuries description of an under-recognized injury problem among military personnel.Am J Prev Med. 2010; 38: S61-S70
- Back pain as a secondary disability in persons with lower limb amputations.Arch Phys Med Rehabil. 2001; 82: 731-734
- Compensatory movements of transradial prosthesis users during common tasks.Clin Biomech. 2008; 23: 1128-1135
- Characterization of compensatory trunk movements during prosthetic upper limb reaching tasks.Arch Phys Med Rehabil. 2012; 93: 2029-2034
- Upper-limb prosthetics: critical factors in device abandonment.Am J Phys Med Rehabil. 2007; 86: 977-987
- Prosthetic usage in major upper extremity amputations.J Hand Surg. 1995; 20: 619-622
- Epidemiologic overview of individuals with upper-limb loss and their reported research priorities.J Prosthet Orthot. 1996; 8: 2-11
- Prosthetic rehabilitation in traumatic upper limb amputees (an Indian perspective).Arch Orthop Trauma Surg. 2003; 123: 363-366
- Prosthetic management and training of adult upper limb amputees.Curr Orthopaed. 1997; 11: 193-202
- A method of early prosthetics training for upper-extremity amputees.Artif Limbs. 1971; 15: 1-5
- Chronic pain associated with upper-limb loss.Am J Phys Med Rehabil. 2009; 88: 742-751
- Amputations about the shoulder: surgical management.in: Smith D Michael J Bowker J Atlas of amputations and limb deficiencies: Surgical, prosthetic, and rehabilitation principles. American Academy of Orthpaedic Surgeons, Rosemont, IL2004: 251-566
- Occupational Therapy for the Polytrauma Casualty with Limb Loss.in: Pasquina P Cooper R Care of the combat amputee. Dept. of the Army. Office of the Surgeon General., Borden Institute (U.S.), Falls Church, Va. and Washington, DC: United States2009: 493-533
- A narrative review of the prevalence and risk factors associated with development of knee osteoarthritis after traumatic unilateral lower limb amputation.Mil Med. 2016; 181: 38-44
- Early physical therapy utilization patterns and incidence of secondary musculoskeletal conditions after lower-limb amputation: OPL36.J Orthop Sports Phys Ther. 2017; 47: A17
- A Retrospective comparison of five-year health outcomes following upper limb amputation and serious upper limb injury in the Iraq and Afghanistan conflicts.J Injury Function Rehab. 2019; 11: 577-589
- Hip muscle weakness and overuse injuries in recreational runners.Clin J Sport Med. 2005; 15: 14-21
- Is quadriceps muscle weakness a risk factor for incident or progressive knee osteoarthritis?.Phys Sportsmed. 2011; 39: 44-50
- Perceptions of low back pain in people with lower limb amputation: a focus group study.Disabil Rehabil. 2015; 37: 873-883
- Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use.J Rehabil Res Dev. 2008; 45: 15-29
- Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation.Arch Phys Med Rehabil. 2012; 93: 710-717
- Overuse syndrome and the unilateral upper limb amputee: consequences and prevention.J Prosthet Orthot. 2008; 20: 126-132
- Managing the upper extremity amputee: a protocol for success.J Hand Ther. 2008; 21: 160-175
JHT Read for Credit
Quiz: # 929
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.The study design is
- # 2.The two groups were service members with
- a.lower extremity amputation vs those with upper extremity amputation
- b.bilateral amputation vs. unilateral amputation
- c.musculoskeletal complaints but without amputation vs. those with amputation
- d.amputation vs. those with no musculoskeletal complaints
- # 3.The one-year incidence of developing a musculoskeletal overuse condition was approximately _______
- # 4.Regarding onset of an overuse condition it was found that
- a.there was a shorter time for the non-amputee group
- b.there was a shorter time for the amputee group
- c.there was no significant time difference between groups
- d.no possible explanation was suggested
- # 5.Amputees were more than twice as likely to develop overuse conditions than the non-amputees
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Published online: May 16, 2021
Accepted: May 6, 2021
Received in revised form: February 1, 2021
Received: February 17, 2020
Funding: Supported by the Extremity Trauma and Amputation Center of Excellence
Published by Elsevier Inc.