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Shoulder Injuries

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Musculoskeletal Injuries in the Military

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Abstract

Shoulder injuries are common in US military service members. Unique occupational demands including mandatory physical training requirements and various risks associated with combat training and overseas deployment present a challenge to health-care providers caring for these individuals. Shoulder injuries contribute to significant lost-duty days in active-duty soldiers as well as long-term disability in those who retire or otherwise leave military service. The incidence of many shoulder injuries such as glenohumeral joint instability, acromioclavicluar joint sprains and separations, superior labrum anterior posterior tears, and pectoralis major tears is significantly higher in the military population as compared to civilians. Rotator cuff disease including impingement and partial- and full-thickness tears are among the most common shoulder problems that affect US Military service members. Post-traumatic osteoarthritis is the most common cause of disability in US Military service members who are medically separated from active service, with injuries to the shoulder second highest in prevalence. This emphasizes the critical need for the primary prevention of shoulder injuries and the continuing need for effective delivery of orthopedic care to active-duty soldiers and veterans.

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References

  1. Jones BH, Canham-Chervak M, Canada S, et al. Medical surveillance of injuries in the U.S. Military descriptive epidemiology and recommendations for improvement. Am J Prev Med. 2010;38 Suppl 1:S42–S60.

    Article  PubMed  Google Scholar 

  2. Jones BH, Hansen BC. An Armed Forces Epidemiological Board evaluation of injuries in the military. Am J Prev Med. 2000;18 Suppl 3:S14–S25.

    Article  Google Scholar 

  3. Kaufman KR, Brodine S, Shaffer R. Military training-related injuries: surveillance, research, and prevention. Am J Prev Med. 2000;18 Suppl 3:54–63.

    Article  CAS  PubMed  Google Scholar 

  4. Peterson SN, Call MH, Wood DE, et al. Injuries in naval special warfare sea, air, and land personnel: epidemiology and surgical management. Oper Tech Sports Med. 2005;13:131–5.

    Article  Google Scholar 

  5. Lauder TD, Baker SP, Smith GS, et al. Sports and physical training injury hospitalizations in the Army. Am J Prev Med. 2000;18 Suppl 3:118–28.

    Article  CAS  PubMed  Google Scholar 

  6. Songer TJ, LaPorte RE. Disabilities due to injury in the military. Am J Prev Med. 2000;18 Suppl 3:33–40.

    Article  CAS  PubMed  Google Scholar 

  7. Walsworth MK, Doukas WC, Murphy KP, et al. Descriptive analysis of patients undergoing shoulder surgery at a tertiary care military medical center. Mil Med. 2009;174:642–4.

    Article  PubMed  Google Scholar 

  8. Wofford JL, Mansfield RJ, Watkins RS. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: secondary data analysis of the National Ambulatory Medical Care Survey. BMC Musculoskelet Disord. 2005;6:4.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Provencher MT, Frank RM, Macian D, et al. An analysis of shoulder outcomes scores in 275 consecutive patients: disease-specific correlation across multiple shoulder conditions. Mil Med. 2012;177:975–82.

    Article  PubMed  Google Scholar 

  10. Skeehan CD, Tribble DR, Sanders JW, et al. Nonbattle injury among deployed troops: an epidemiologic study. Mil Med. 2009;174:1256–62.

    Article  PubMed  Google Scholar 

  11. Belmont PJ Jr, Goodman GP, Waterman B, et al. Disease and nonbattle injuries sustained by a U.S. Army Brigade Combat Team during Operation Iraqi Freedom. Mil Med. 2010;175:469–76.

    Article  PubMed  Google Scholar 

  12. Nordqvst A, Petersson CJ. Incidence and causes of shoulder girdle injuries in an urban population. J Shoulder Elbow Surg. 1995;4:107–12.

    Article  Google Scholar 

  13. Owens BD, Dawson L, Burks R, et al. Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population. J Bone Joint Surg Am. 2009;91:791–6.

    Article  PubMed  Google Scholar 

  14. Roy TC. Diagnoses and mechanisms of musculoskeletal injuries in an infantry brigade combat team deployed to Afghanistan evaluated by the brigade physical therapist. Mil Med. 2011;176:903–8.

    Article  PubMed  Google Scholar 

  15. Roy TC, Knapik JJ, Ritland BM, et al. Risk factors for musculoskeletal injuries for soldiers deployed to Afghanistan. Aviat Space Environ Med. 2012;83:1060–6.

    Article  PubMed  Google Scholar 

  16. Roy TC, Ritland BM, Knapik JJ, et al. Lifting tasks are associated with injuries during the early portion of a deployment to Afghanistan. Mil Med. 2012;177:716–22.

    Article  PubMed  Google Scholar 

  17. Rhon DI. A physical therapist experience, observation, and practice with an infantry brigade combat team in support of Operation Iraqi Freedom. Mil Med. 2010;175:442–7.

    Article  PubMed  Google Scholar 

  18. Gondusky JS, Reiter MP. Protecting military convoys in Iraq: an examination of battle injuries sustained by a mechanized battalion during Operation Iraqi Freedom II. Mil Med. 2005;170:546–9.

    Article  PubMed  Google Scholar 

  19. Owens BD, Kragh JF, Macaitis J, et al. Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Orthop Trauma. 2007;21:254–7.

    Article  PubMed  Google Scholar 

  20. Jacob E, Erpelding JM, Murphy KP. A retrospective analysis of open fractures sustained by U.S. military personnel during Operation Just Cause. Mil Med. 1992;157:552–6.

    CAS  PubMed  Google Scholar 

  21. Mack AW, Groth AT, Frisch HM, et al. Treatment of open periarticular shoulder fractures sustained in combat-related injuries. Am J Orthop. 2008;37:130–5.

    PubMed  Google Scholar 

  22. Cross JD, Ficke JR, Hsu JR, et al. Battlefield orthopaedic injuries cause the majority of long-term disabilities. J Am Acad Orthop Surg. 2011;19Suppl 1:S1–S7.

    PubMed  Google Scholar 

  23. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35:316–29.

    Article  PubMed  Google Scholar 

  24. Pallis M, Cameron KL, Svoboda SJ, et al. Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med. 2012;40:2072–7.

    Article  PubMed  Google Scholar 

  25. Rockwood CJ, Williams G, Young D. Disorders of the acromioclavicular joint. In: Rockwood CJ, Matsen FA III, Editors. The shoulder. 2nd ed. Philadelphia: WB Saunders; 1998. pp. 483–553.

    Google Scholar 

  26. Huh J, Posner MA, Bear RR, et al. Performance of military tasks after clavicle plating. Mil Med. 2011;176:950–5.

    Article  PubMed  Google Scholar 

  27. Nordqvst A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;300:127–32.

    Google Scholar 

  28. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89:1–10.

    Google Scholar 

  29. McKee MD, Pederson EM, Jones C, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88:35–40.

    Article  PubMed  Google Scholar 

  30. Edwards A, Khan F, Smith AL. Five case studies of soldiers with painful clavicular fracture non-union. J R Army Med Corps. 1999;145:31–3.

    Article  CAS  PubMed  Google Scholar 

  31. Wenninger JJ Jr, Dannenbaum JH, Branstetter JG, et al. Comparison of complication rates of intramedullary pin fixation versus plating of midshaft clavicle fractures in an active duty military population. J Surg Orthop Adv. 2013;22:77–81.

    Article  PubMed  Google Scholar 

  32. Waterman BR, Cameron KL, Hsiao M, et al. Trends in the diagnosis of SLAP lesions in the US military. Knee Surg Sports Traumatol Arthrosc. 2013; Epub ahead of print, doi: 10.1007/s00167-013-2798-z.

    Google Scholar 

  33. Hsiao MS, Cameron KL, Huh J, et al. Clavicle fractures in the United States military: incidence and characteristics. Mil Med. 2012;177:970–4.

    Article  PubMed  Google Scholar 

  34. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury. 2000;31:353–8.

    Article  CAS  PubMed  Google Scholar 

  35. DeBerardino TM, Arciero RA, Taylor DC, et al. Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes. Two- to five-year follow-up. Am J Sports Med. 2001;29:586–92.

    CAS  PubMed  Google Scholar 

  36. Owens BD, Duffey ML, Nelson BJ, et al. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35:1168–73.

    Article  PubMed  Google Scholar 

  37. Simonet WT, Melton LJ, Cofield RH, et al. Incidence of anterior shoulder dislocation in Olmstead County, Minnesota. Clin Orthop Relat Res. 1984;186:186–91.

    PubMed  Google Scholar 

  38. Kroner K, Lind T, Jensen J. The epidemiology of shoulder dislocations. Arch Orthop Trauma Surg. 1989;108:288–90.

    Article  CAS  PubMed  Google Scholar 

  39. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92:542–9.

    Article  PubMed  Google Scholar 

  40. Taylor DC, Arciero RA. Pathologic anatomy associated with dislocation of the shoulder: arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med. 1997;25:306–11.

    Article  CAS  PubMed  Google Scholar 

  41. Kampa RJ, Clasper J. Incidence of SLAP lesions in a military population. J R Army Med Corps. 2005;151:171–5.

    Article  CAS  PubMed  Google Scholar 

  42. Snyder SJ, Karzel RP, Del Pizzo W, et al. SLAP lesions of the shoulder. Arthroscopy. 1990;6:274–9.

    Article  CAS  PubMed  Google Scholar 

  43. Enad JG, Kurtz CA. Isolated and combined Type II SLAP repairs in a military population. Knee Surg Sports Traumatol Arthrosc. 2007;15:1382–9.

    Article  PubMed  Google Scholar 

  44. Enad JG, Gaines RJ, White SM, et al. Arthroscopic superior labrum anterior–posterior repair in military patients. J Shoulder Elbow Surg. 2007;16:300–5.

    Article  PubMed  Google Scholar 

  45. Kim SH, Ha KI, Kim SH, et al. Results of arthroscopic treatment of superior labral lesions. J Bone Joint Surg Am. 2002;84:981–5.

    Article  PubMed  Google Scholar 

  46. Kurtz CA, Gaines RJ, Enad JG. Arthroscopic management of superior labrum anterior and posterior (SLAP) lesions. Oper Tech Sports Med. 2005;13:157–61.

    Article  Google Scholar 

  47. Morgan CD, Burkhart SS, Palmeri M, et al. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998;14:553–65.

    Article  CAS  PubMed  Google Scholar 

  48. White DW, Wenke JC, Mosely DS, et al. Incidence of major tendon ruptures and anterior cruciate ligament tears in US Army soldiers. Am J Sports Med. 2007;35:1308–14.

    Article  PubMed  Google Scholar 

  49. Peliton J, Ellingson CI, Sekiya JK. Pectoralis major muscle ruptures. Oper Tech Sports Med. 2005;13:162–68.

    Article  Google Scholar 

  50. Peliton J, Carr DR, Sekiya JK, et al. Pectoralis major muscle injuries: evaluation and management. J Am Acad Orthop Surg. 2005;13:59–68.

    Google Scholar 

  51. Komurcu M, Yildiz Y, Ozdemir MY, et al. Rupture of the pectoralis major muscle in a paratrooper. Aviat Space Environ Med. 2004;75:81–4.

    PubMed  Google Scholar 

  52. Warme WJ, Whitaker DC. Pectoralis major tendon avulsion from rappelling. Mil Med. 2004;169:151–4.

    Article  PubMed  Google Scholar 

  53. Antosh IJ, Grassbaugh JA, Parada SA, et al. Pectoralis major tendon repairs in the active-duty population. Am J Orthop. 2009;38:26–30.

    PubMed  Google Scholar 

  54. Harrison AK, Flatow EL. Subacromial impingement syndrome. J Am Acad Orthop Surg. 2011;19:701–8.

    PubMed  Google Scholar 

  55. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012;31:589–604.

    Article  PubMed  Google Scholar 

  56. Matsen FA, Titelman RM, Lippitt SB, et al. Rotator cuff. In: Rockwood CA, Matsen FA, Wirth MA, et al., Editors. The shoulder. Philadelphia: WB Saunders; 2004. pp. 795–878.

    Google Scholar 

  57. Neer CS. Impingement lesions. Clin Orthop. 1983;173:70–7.

    PubMed  Google Scholar 

  58. Lehman C, Cuomo F, Kummer FJ, et al. The incidence of full thickness rotator cuff tears in a large cadaveric population. Bull Hosp Jt Dis. 1995;54:30–1.

    CAS  PubMed  Google Scholar 

  59. Yamanaka K, Fukada H. Pathologic studies of the supraspinatus tendon with reference to incomplete partial thickness tear. In: Takagishi N, Editor. The shoulder. Tokyo: Professional Postgraduate Services; 1987. pp. 220–4.

    Google Scholar 

  60. Sher JS, Uribe JW, Posada A, et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77:10–5.

    CAS  PubMed  Google Scholar 

  61. Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19:116–20.

    Article  PubMed  Google Scholar 

  62. Mall NA, Lee AS, Chahal J, et al. An evidence-based examination of the epidemiology and outcomes of traumatic rotator cuff tears. Arthroscopy. 2013;29:366–76.

    Article  PubMed  Google Scholar 

  63. Solomon DJ, Provencher MT, Bell SJ, et al. Arthroscopic rotator cuff repair in active duty military personnel: a young cohort of patients with rotator cuff tears. Oper Tech Sports Med. 2005;13:136–42.

    Article  Google Scholar 

  64. Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26–35.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Rivera JC, Wenke JC, Buckwalter JA, et al. Posttraumatic osteoarthritis caused by battlefield injuries: the primary source of disability in warriors. J Am Acad Orthop Surg. 2012;20 Suppl 1:S64–9.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Kuklo TR, Heekin RD, Temple HT, et al. A review of total joint replacement in active duty soldiers. Mil Med. 1997;162:201–4.

    CAS  PubMed  Google Scholar 

  67. Fehringer EV, Mikuls TR, Michaud KD, et al. Shoulder arthroplasties have fewer complications than hip or knee arthroplasties in US veterans. Clin Orthop Relat Res. 2010;468:717–22.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Fort Belvoir Community Hospital, 22060, Fort Belvoir, VA, USA

    Christopher J. Tucker MD, MAJ, USA MC

  2. John A. Feagin, Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY, 10996, USA

    Brett D. Owens MD, LTC, USA MC

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  1. Christopher J. Tucker MD, MAJ, USA MC
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  2. Brett D. Owens MD, LTC, USA MC
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Correspondence to Brett D. Owens MD, LTC, USA MC .

Editor information

Editors and Affiliations

  1. Keller Army Hospital, West Point, New York, USA

    Kenneth L. Cameron

  2. Keller Army Hospital, West Point, New York, USA

    Brett D. Owens

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Tucker, C., Owens, B. (2016). Shoulder Injuries. In: Cameron, K., Owens, B. (eds) Musculoskeletal Injuries in the Military. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2984-9_7

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  • DOI: https://doi.org/10.1007/978-1-4939-2984-9_7

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