Abstract
BackgroundUpper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently.The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.MethodsThe study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees (206 amputations) from the Iran-Iraq war were evaluated, and a detailed questionnaire was also administered.ResultsThe most common level of amputation was the finger or wrist level (108, 52.4 %). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis (65, 31.6 %), rotator cuff injury (24, 11.7 %), bicipital tendonitis (69, 33.5 %), shoulder drop (42, 20.4 %) and muscle atrophy (19, 9.2 %). Peripheral nerve disorders included carpal tunnel syndrome in 13 (6.3 %) and unilateral brachial plexus injury in 1 (1 %). Fifty-three (51.5 %) were diagnosed with facet joint syndrome at the level of the cervical spine (the most frequent site). Using a prosthesis was reported by 65 (63.1 %), both left and right sides. The back was the most common site of pain (71.8 %).ConclusionThe high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.
Highlights
Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently
This study aimed to describe clinically active and passive ranges of motion of upper extremity joints and muscle strength and to evaluate peripheral nerve and musculoskeletal disorders, distal upper extremity circulation, prosthesis use and pain of war-related bilateral upper limb amputees after more than 20 years since trauma
The data of the bilateral upper limb amputees was provided by the Veterans and Martyr Affair Foundation (VMAF) (VMAF offers health care services to the survivors of the 8-year Iraq-Iran war)
Summary
Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation. Wars have caused trauma to the limbs of soldiers, many of which result in amputation. The 8-year Iran-Iraq war was one of the longest military conflicts in the 20th century, which caused more than 1 million deaths and injuries including amputations [1]. Upper extremity amputation is one of these disastrous consequences, forcing many people to adapt to such injuries during their life [2]. Surgical procedures on injured vessels, bones, nerves and other soft tissues has diminished the rate of amputation due to these injuries, amputation due to extremity trauma is still a main cause of morbidity in developing countries [3]. As war-related amputations happen mostly in young healthy persons, these unfortunate events can adversely affect the functional and physical health of the injured person, in addition to the mental and psychological sequelae that are associated with limb loss [4]
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