Full Length Article| Volume 36, ISSUE 1, P66-73, January 2023

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Development of overuse musculoskeletal conditions after combat-related upper limb amputation: a retrospective cohort study


      • 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.


      Study design

      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.


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      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 There is only one best answer for each question.
      • # 1.
        The study design is
        • a.
        • b.
        • c.
        • d.
      • # 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 _______
        • a.
        • b.
        • c.
        • d.
      • # 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
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.