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Chang TT, Yang QH, Chen PJ, Wang XQ. Epidemiology of Musculoskeletal Injuries in the Navy: A Systematic Review. Int J Public Health 2022; 67:1605435. [PMID: 36531604 PMCID: PMC9751041 DOI: 10.3389/ijph.2022.1605435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: This study aimed to critically review the results of recent studies that investigated the epidemiology of noncombat-related musculoskeletal injuries (MSIs) in the Navy. Methods: A systematic search was conducted of three major databases (Pubmed, Embase, and Cochrane) to identify epidemiological studies on MSIs in the Navy. Study selection and risk of bias assessment were conducted. Results: The overall prevalence of MSIs ranged from 12.69% to 48.81%. And the prevalence of head and face injuries, upper extremity injuries, spine injuries, chest injuries, and lower extremity injuries were 0.11%-0.66%, 0.53%-11.47%, 0.75%-12.09%, 0.43%-0.95%, and 0.4%-21.17%, respectively. For the specific MSIs, the incidence ranged from 0.03/1000 person-years to 32.3/1000 person-years in the Navy and Marines. The ankle-foot, lumbopelvic, knee and lower leg, and shoulder were identified as the most frequent location for MSIs. Conclusion: This systematic review summarized that the Navy population had a high prevalence of MSIs. And different risk factors for MSIs varied from different anatomic locations. This systematic review also provided valuable information on MSIs for sports medicine specialists.
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Affiliation(s)
- Tian-Tian Chang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Qi-Hao Yang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Pei-Jie Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China,*Correspondence: Pei-Jie Chen, ; Xue-Qiang Wang,
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China,Shanghai Key Lab of Human Performance, Shanghai University of Sport, Shanghai, China,*Correspondence: Pei-Jie Chen, ; Xue-Qiang Wang,
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Barbeau P, Michaud A, Hamel C, Rice D, Skidmore B, Hutton B, Garritty C, da Silva DF, Semeniuk K, Adamo KB. Musculoskeletal Injuries Among Females in the Military: A Scoping Review. Mil Med 2021; 186:e903-e931. [PMID: 33367692 DOI: 10.1093/milmed/usaa555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. MATERIALS AND METHODS A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews-Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. RESULTS From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. CONCLUSIONS This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.
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Affiliation(s)
- Pauline Barbeau
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Alan Michaud
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Candyce Hamel
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danielle Rice
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Chantelle Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danilo F da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Gun BK, Banaag A, Khan M, Koehlmoos TP. Prevalence and Risk Factors for Musculoskeletal Back Injury Among U.S. Army Personnel. Mil Med 2021; 187:e814-e820. [PMID: 34159385 DOI: 10.1093/milmed/usab217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/16/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Physical and medical readiness have emerged as a top priority in the army over the last decade. With this emphasis on deployment readiness, it is important to understand key risk factors attributed to common medical problems that arise in our soldiers, including low back pain. The purpose of this study is to elucidate demographic and lifestyle risk factors which would result in seeking medical care for musculoskeletal low back pain among active duty army personnel. MATERIALS AND METHODS A cross-sectional retrospective study investigating all active duty soldiers between October 1, 2016 and September 30, 2018 was performed using the existing Military Health System Data Repository to retrospectively review administrative claims data. Our study queried 39 unique International Classification of Disease codes, 10th Revision codes for low back pain to determine a positive case. We compared those with and without back pain across all variables using a chi-square analysis in SAS. Multivariate logistic analysis was performed to adjust for confounding within any single proposed risk factor and the six other proposed risk factors. RESULTS Six hundred fifty seven thousand and six thirty soldiers met inclusion criteria; 228,184 of whom had a medical encounter for low back pain (34.7%). All of the proposed risk factors included statistically significant unadjusted and adjusted odds ratios (ORs) with age conferring the greatest risk in soldiers aged 50-59 with an OR of 2.89 (2.73-3.05) compared to those aged 20-29. Obesity-adjusted OR was 1.77 (1.74-1.80) compared to those who were normal weight. Senior Enlisted status-adjusted OR was 1.34 (1.32-1.36). Females were 66% more likely to have low back pain compared to males with an OR of 1.66 (1.63-1.68). CONCLUSION Disease burden for low back pain tends to be high in the U.S. Army with 34.7% of service members experiencing low back pain. Older age, obesity, and being an enlisted, female service member are risk factors for these musculoskeletal injuries, which is in agreement with previously reported literature on the topic. To mitigate the burden of low back pain, policies and incentives to encourage healthy body mass index and lifestyle are needed. The results of this work inform future studies aimed at further delineating the risk factors found in this study.
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Affiliation(s)
- Baris K Gun
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Amanda Banaag
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD 20817, USA
| | - Munziba Khan
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD 20817, USA
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Tucker CJ, Cotter EJ, Waterman BR, Kilcoyne KG, Cameron KL, Owens BD. Functional Outcomes After Isolated and Combined Posterior Cruciate Ligament Reconstruction in a Military Population. Orthop J Sports Med 2019; 7:2325967119875139. [PMID: 31656823 PMCID: PMC6791041 DOI: 10.1177/2325967119875139] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The rates of return to full activity, persistent disability, complications, and surgical revisions after operative management of posterior cruciate ligament (PCL) tears in a physically active population have not been reported. Purpose: To evaluate the clinical outcomes of active military patients with symptomatic PCL tears who underwent surgical reconstruction and compare outcomes between isolated PCL and multiligament injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Individuals undergoing surgical reconstruction of the PCL (Current Procedural Terminology code 29889) were isolated from the Military Health System Management Analysis and Reporting Tool between fiscal years 2005 and 2010. Demographic variables and rates of postoperative complications, activity limitations, rates of revision surgery, physical disability ratings, and ultimate medical discharge were recorded from the electronic medical record and US Army Physical Disability Agency database. Results: A total of 182 patients underwent 193 surgeries, including 118 isolated PCL reconstructions and 75 multiligament knee reconstructions, with an average follow-up of 19.5 months. There were 174 primary procedures and 19 revision reconstructions. The mean ± SD patient age was 28.4 ± 7.2 years, with males comprising 96.2% of patients. The overall surgical complication rate was 12.4%, with a significantly higher rate in multiligament knee reconstructions compared with isolated PCL reconstructions (18.7% vs 8.5%; P = .045). Overall, 35.1% of patients were discharged from military service due to disability. Rates of discharge were significantly higher in those undergoing surgery at lower volume institutions (those that performed <2 PCL reconstructions per year during the study period) than those at higher volume institutions (41.1% vs 26%; P = .040). The overall revision rate was 10.9%, with no significant difference between the isolated PCL and multiligament knee reconstructions. Of the 103 patients with primary isolated PCL reconstructions, 35% underwent medical discharge for persistent knee complaints, and 12.6% required revision PCL reconstruction. The overall failure rate for primary isolated PCL reconstructions, which includes both revision surgery and knee-related medical discharge from military service, was 42.7%. Conclusion: In a physically active, military population, nearly one-third of patients were unable to return to previous level of military function, and 12.6% required revision at short-term follow-up due to persistent instability. Perioperative complication rates were significantly higher among patients with multiligament knee reconstructions.
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Affiliation(s)
- Christopher J Tucker
- Department of Orthopedic Surgery and Rehabilitation, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Eric J Cotter
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Kelly G Kilcoyne
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Kenneth L Cameron
- Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, New York, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University Alpert School of Medicine, Providence, Rhode Island, USA
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Beckmann NM, Sanhaji L, Chinapuvvula NR, West OC. Imaging of Traumatic Shoulder Girdle Injuries. Radiol Clin North Am 2019; 57:809-822. [PMID: 31076034 DOI: 10.1016/j.rcl.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Shoulder girdle trauma is one of the most common injuries encountered in emergency centers. These injuries can be easily overlooked due to the complex osteology of the shoulder. Although radiographs are usually sufficient for assessing traumatic shoulder injuries, cross-sectional imaging is sometimes indicated to assess portions of the shoulder not well visualized by radiographs. In this article, the authors review the spectrum of shoulder girdle injuries: sternoclavicular dislocations, clavicle fractures, acromioclavicular separations, shoulder dislocations, scapula fractures, and scapulothoracic dissociation. They also discuss the presentation, imaging evaluation, and classification of these injuries with emphasis on pitfalls in imaging diagnosis and indications for computed tomography/magnetic resonance.
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Affiliation(s)
- Nicholas M Beckmann
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX 77030, USA.
| | - Latifa Sanhaji
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX 77030, USA
| | - Naga R Chinapuvvula
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX 77030, USA
| | - O Clark West
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX 77030, USA
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