Injuries In Soldiers Research Articles

Systematic Review and Meta-analysis of Exercise for the Prevention of Musculoskeletal Injuries in Soldiers

Systematic Review and Meta-analysis of Exercise for the Prevention of Musculoskeletal Injuries in Soldiers

The effectiveness of telehealth gait retraining in addition to standard physical therapy treatment for overuse knee injuries in soldiers: a protocol for a randomized clinical trial

IntroductionRunning is the most common cardiovascular exercise in the military. However, there is a high incidence of running-related overuse injuries that reduces military readiness. Gait retraining is a common intervention to treat running-related injuries, but the high cost of equipment and lack of clinician expertise and availability reduces utilization. Gait retraining intervention in a telehealth format might improve feasibility. The purpose of this randomized clinical trial is to determine the effectiveness of a telehealth gait retraining intervention on pain, self-reported function, and biomechanical risk factors for injury in service members who present to a Military Health System physical therapy clinic with an overuse knee injury.MethodsThis is a parallel, two-arm, single-blind randomized clinical trial. The two independent variables are intervention (2 levels: telehealth gait retraining intervention with standard of care or only standard of care) and time (3 levels: baseline, 10 weeks or post-intervention, 14 weeks). Participants between the ages of 18 to 60 years will be included if they report knee pain during and/or after running to be anywhere from a 3 to a 7 on the numerical pain rating scale and demonstrate a rearfoot strike pattern. The primary dependent variables are as follows: (1) pain (worst pain during and/or after running) and (2) foot strike pattern (conversion rate from rearfoot to non-rearfoot foot strike pattern during running). Secondary outcomes include patient self-reported function and running biomechanics.DiscussionThe effectiveness of a telehealth gait retraining intervention to reduce pain and modify foot strike pattern is not known. The results of this study may help determine the effectiveness and feasibility of a telehealth gait retraining intervention to reduce pain, change foot strike, improve function, and improve running gait biomechanics.Trial registrationClinicalTrials.gov, NCT04269473. Registered 05 February 2020.

Ocular Trauma in Operation Iraqi Freedom and Operation Enduring Freedom from 2001 to 2011: A Bayesian Network Analysis

ABSTRACT Purpose To update the epidemiology of ocular injuries in soldiers admitted to Walter Reed Army Medical Center (WRAMC) from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Methods Data were collected in the Walter Reed Ocular Trauma Database. A Bayesian Network Analysis was completed to better understand the relationships between different ocular demographic variables, injuries, surgeries, ocular trauma scores (OTS) and visual outcomes. Results There were 890 consecutive globe or adnexal combat injuries, or both, sustained by 652 United States soldiers treated at WRAMC between 2001 and 2011.The primary mechanism of injury was improvised explosive device (62.47%). Many patients (62.0%) had final visual acuity (VA) grades of 1–2 (20/15 – 20/200), while 29.9% of patients had final VA grades of 3–5 (less than 20/200), and 8.1% had unknown final VA grades. Bayesian Network Analysis revealed that the injury variables of Retina (47.9%), Lens (44.6%), Posterior Segment (43.7%) and Anterior Segment (40.3%), and the surgical variables of Enucleation (97.6%) and cataract extraction and posterior capsule intraocular lens placement (CEPCIOL; 43.3%) all had probabilities greater than 40% for a poor final VA, while all other variables were less than 40%. Conclusion Modern-day combat trauma results in complicated ocular injuries causing 30% of patients to be left legally blind in their injured eye. It is critical to maintain a wide variety of deployable, specialty trained ophthalmologists to ensure the best visual outcomes for wounded warriors and to maintain mission readiness.

A novel mouse model of mild traumatic brain injury using laser-induced shock waves

Blast-induced mild traumatic brain injury (mild bTBI) has been a frequent battlefield injury in soldiers during the conflicts in Iraq and Afghanistan. Understanding the pathophysiology and determining effective treatments for mild bTBI has become an international problem in the field of neurotrauma research. Contributing to this problem is a lack of an experimental model that accurately mimics the characteristics of mild bTBI. To date, the “mild’’ versions of common experimental models of TBI have simply been less severe degrees of traumatic injury; these animals do not necessarily exhibit the clinical characteristics of mild bTBI seen in humans. Therefore, our first objective was to develop a highly controlled mouse model of bTBI using laser-induced shockwaves (LISWs). We established the parameters necessary to cause a reproducible injury of very mild severity, the most important feature seen in clinical practice. We defined very mild bTBI as having no traumatic change on the head visible to the naked eye after the insult was applied using very mild shockwaves to the heads of mice. Our very mild bTBI mouse model exhibited neurobehavioral changes in the chronic phase, such as cognitive impairment and depression-like behavior. We also observed an increase in 5-bromo-2′-deoxyuridine-positive, proliferating cells in the dentate gyrus during the acute phase and a subsequent decrease during the chronic phase. This model appears to be an accurate representation of the damage occurring in actual mild bTBI patients. We also found that an increase in cell proliferation in the dentate gyrus during the acute phase is the most prominent feature after a TBI.

A New Approach to Moral Injury of Soldiers during WAR

A New Approach to Moral Injury of Soldiers during WAR

Non-surgical treatment of knee ligamentous lesions

Introduction: Knee trauma is very common and sometimes compromises its stability. The treatment of these lesions is more and more surgical, but nonsurgical treatment remain having an importance in the management. The purpose of this study was to determine the results of nonsurgical treatment of ligamentous knee injuries in soldiers deployed in northern Mali during a stabilization mission. Materials and methods: It was a prospective study concerning ligamentous lesions of the knee, treated by orthopedic means in Togo’s level 2 hospital and followed for a period of at least 6 months. The International Knee Score (IKS) was used to determine our results. Patient satisfaction was determined by taking into account pain, knee stability and resumption of previous activities.Results: Twenty-one (21) patients were treated. They were 18 men (85.7%) and 3 women (14.3%). The average age of the patients was 32.43 years old. We found 7 cases (33.4%) of benign sprain, 9 cases (42.8%) of medium severity sprain and 5 cases (23.8%) of severe sprain. After administration of the analgesic, immobilization was made by a knee brace and sometimes a plaster splint. Rehabilitation was started at the end of immobilization. The control after 6 months of follow-up allowed to find 57,1% of excellent result and 9,5% of bad resultConclusion: Nonsurgical treatment of ligamentous lesions gives good results when properly conducted. When a surgical treatment is decided for these lesions, it is recommended to make the rehabilitation of the knee before the operation to improve the results.

Primarily hip-borne load carriage does not alter biomechanical risk factors for overuse injuries in soldiers

ObjectivesTo determine the effects of different body armour types, carried loads, and walking speeds on trunk and lower-limb joint biomechanics. DesignWithin-subjects repeated measures to determine the effects of different body armour types, carried loads, and walking speeds on trunk and lower-limb joint biomechanics. MethodsTwenty soldiers (29.5±7.1yrs) completed a treadmill walking protocol in an unloaded (baseline) condition and wearing a control, Tiered Body Armour System (TBAS) and five different armour types (cARM1-2, pARM1) with two load configurations (15 and 30kg) for a total of eight armour×load ensembles. In each ensemble, participants walked for 10min at 1.53ms−1 and 1.81ms−1 speeds. Whole-body marker kinematics and ground reaction forces were used, along with a scaled anatomic model, to determine peak lower-limb joint angles, net joint moments, and negative knee work. Peak parameters were compared between armour types, walking speeds, and carried loads using repeated measures ANOVAs. ResultsPeak plantarflexion and hip abduction moments were reduced when wearing cARM1 (p=0.040, p=0.045) and cARM2 (p=0.045, p=0.003) compared to TBAS, while carrying 30kg and/or walking fast. This suggests positive benefits of load distribution at higher task demands. Joint moments increased when participants carried greater load and/or walked faster, and the combined effects of carried load and walking speed were mostly additive. ConclusionsPrimarily hip-borne load carriage does not negatively alter joint kinetics, and some positive adaptations occurred during tasks with higher demands. These results can inform equipment design and physical training programs for load carriage.

Risk for Lower Extremity Injury After Concussion: A Matched Cohort Study in Soldiers.

Background Rates of lower extremity musculoskeletal injury are reportedly higher in professional and collegiate athletes following concussions. However, there is a paucity of evidence on this relationship in individuals who are not high-level athletes. Objectives To examine the risk of acute lower extremity musculoskeletal injury in soldiers within 2 years of an incident concussion, compared to matched nonconcussed soldiers. Methods This was a matched-cohort study that used the medical encounter and personnel data of active-duty US Army soldiers from 2005 to 2011. Incident concussions were identified using International Classification of Diseases-Ninth Revision codes in medical encounter data of all soldiers from 2005 to 2009. One nonconcussed soldier in the US Army during the same month was matched by age, sex, rank, length of service, deployment status, and military career field to each concussed soldier. Hazard ratio (HR) and 95% confidence interval (CI) were calculated for the risk of lower extremity injury within 2 years of the incident concussion. Monthly HRs were compared to identify differences in injury rates between the groups, and an HR for the period of greatest difference was also calculated. Results A total of 23 044 individuals (11 522 concussed and 11 522 nonconcussed) were included in the study. Within 2 years of concussion, the hazard of lower extremity injury was 38% greater in concussed compared to nonconcussed soldiers (HR, 1.38; 95% CI: 1.30, 1.46), while the 15-month hazard was 45% greater (HR, 1.45; 95% CI: 1.36, 1.56). Conclusion The rate of lower extremity musculoskeletal injury among this population of physically active adults is higher following concussion, and the risk remains elevated for more than a year following injury. Level of Evidence Prognosis, level 2b. J Orthop Sports Phys Ther 2018;48(7):533-540. Epub 8 May 2018. doi:10.2519/jospt.2018.8053.

Physiological and Biomechanical Responses to Prolonged Heavy Load Carriage During Level Treadmill Walking in Females.

Heavy load carriage has been identified as a main contributing factor to the high incidence of overuse injuries in soldiers. Peak vertical ground reaction force (VGRFMAX) and maximal vertical loading rates (VLRMAX) may increase during heavy prolonged load carriage with the development of muscular fatigue and reduced shock attenuation capabilities. The objectives of the current study were (1)to examine physiological and biomechanical changes that occur during a prolonged heavy load carriage task, and (2)to examine if this task induces neuromuscular fatigue and changes in muscle architecture. Eight inexperienced female participants walked on an instrumented treadmill carrying operational loads for 60minutes at 5.4km·h-1. Oxygen consumption ( V ˙ O 2 ), heart rate, rating of perceived exertion (RPE), trunk lean angle, and ground reaction forces were recorded continuously during task. Maximal force and in-vivo muscle architecture were assessed pre- and posttask. Significant increases were observed for VGRFMAX, VLRMAX, trunk lean angle, [Formula: see text], heart rate, and RPE during the task. Increased vastus lateralis fascicle length and decreased maximal force production were also observed posttask. Prolonged heavy load carriage, in an inexperienced population carrying operational loads, results in progressive increases in ground reaction force parameters that have been associated with overuse injury.

Association Between Personal Protective Equipment Use and Injury Occurrence Among the Republic of Korea Armed Forces.

Soldiers are at a higher risk of injury than people of other occupations. To date, no studies have examined the association between injury and personal protective equipment (PPE) use in the Republic of Korea (ROK) military. Thus, this study aimed to investigate possible associations between injury and PPE use in military personnel. In addition, we aimed to identify the possible interactions between injury and PPE use according to military personnel characteristics. We used secondary data from the 2014-2015 Military Health Survey. To compare the average number of injuries according to the independent variables, we performed a t-test and analyses of variance. Additionally, statistical methods were used to compare injury incidence among PPE users and non-PPE users and, while controlling for variables including age, sex, education level, military service, and health-related characteristics were controlled. Additionally, subgroup analysis was performed for occupational variables. Among the 9,407 military personnel included in our study, 1,091 (11.6%) individuals had been injured in the past 12 months. For the 9,407 personnel, the average number of injuries was 0.17 ± 0.64; among the participants with injuries, the average number of injuries was 1.49 ± 1.25. Regression analysis revealed that personnel who did not routinely wear PPE were significantly associated with the number of injuries (relative risk [RR] = 1.13, p = 0.0138). A higher number of injuries occurred among individuals who were not wearing PPE, with a high possibility of an injury occurring because of their job characteristics (RR = 1.34, p ≤ 0.0001); however, participants in units with a high level of injury prevention efforts had a significantly lower number of injuries than those in units with moderate/low injury-prevention efforts (RR = 0.91, p = 0.0269). In addition, the practice of PPE use had a greater impact on officers than on personnel of other ranks (RR = 4.22, p ≤ 0.0001). The practice of PPE use is significantly and negatively associated with the number of injuries in soldiers.

Nutritional Supplements for the Treatment and Prevention of Sports-Related Concussion-Evidence Still Lacking.

Concussions are common neurologic events that affect many athletes. Very little has been studied on the treatment of concussions with supplements and medications. The U.S. Food and Drug Administration (FDA) reminds us that no supplement has been proven to treat concussions. Many animal studies show that supplements have potential for improving the effects of a brain injury but none have been shown to be of consistent benefit in human studies. Animal studies on severe traumatic brain injury (TBI) may not therefore be applicable transfer to sports-related concussions (SRC).Of the many supplements reviewed in this article, omega-3 fatty acids (Ω-3 FA) have potential for SRC treatment but in the one human trial those taking higher dosages preinjury had more concussions. In animal studies, postinjury administration was as effective as pretreatment. N-acetyl-cysteine has demonstrated a positive short-term effect on blast injuries in soldiers if administered within 24 h, but there are no studies in SRC. Caffeine, conversely, may be detrimental if taken after SRC. Lower serum levels of vitamins D, C, or E preinjury have worse outcomes in animal studies. Preinjury correction of deficiencies may be of benefit. Current human trials for nicotinamide ribose, melatonin, and branched chain amino acids (BCAA) may soon provide more evidence for the use of these supplements to reduce the impact of SRC in athletes.

Risk for Lower Extremity Injury Following Concussion

Concussions may increase the risk for subsequent lower extremity injuries in physically active people. PURPOSE: Examine concussion as a risk factor for lower extremity (LE) injury in soldiers with no history of LE injury. METHODS: Medical encounter data for all active duty US Army soldiers from 2005-2009 were used to identify soldiers who sustained a concussion by way of International Classification of Diseases, Ninth Revision (ICD-9) codes. Soldiers with a history of a LE injury were excluded from the study. LE injuries were defined according to the fractures, dislocations, sprains, and strains ICD-9 codes from the Barell injury diagnosis matrix. Matched controls (age, sex, and military occupational specialty [MOS]) were selected from the population of soldiers in the Army during the same month as each concussion case. Soldiers were followed from the time of incident concussion or matching until: 1) a lower extremity injury, 2) loss to follow-up, or 3) conclusion of a 24-month follow-up period. Using concussion as the primary risk factor, a Cox Proportional Hazard Ratio (HR) was calculated for LE injury, controlling for matched factors, time in military service, and race. Life table methods were used to evaluate LE injury rates for qualitative comparison between the two groups across the 24-month follow-up period. RESULTS: From 2005 to 2009, incident concussions were identified in 7,981 soldiers without a history of LE injuries. Of these cases, 1,892 (~24%) experienced a LE injury within 2 years following concussion. Concussed soldiers were at 53% greater risk of LE injury over the 24-month follow-up period (HR=1.53, 95%CI [1.42, 1.65]) compared to controls. On qualitative examination of unadjusted injury rates, the greatest difference in the rate of LE injuries appeared during the first 6 months post-concussion. CONCLUSION: These results suggest that a concussion puts soldiers at increased risk for sustaining a LE injury. This risk may be greatest during the first several months post-concussion. These findings may have implications for managing people returning to activity after concussion. The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government.

Chronic Hormonal Imbalance and Adipose Redistribution Is Associated with Hypothalamic Neuropathology following Blast Exposure.

Endocrine disorders have been shown to be a consequence of blast traumatic brain injury in soldiers returning from military conflicts. Hormone deficiency and adrenocorticotropic hormone (ACTH) dysfunction can lead to symptoms such as fatigue, anxiety, irritability, insomnia, sexual dysfunction, and decreased quality of life. Given these changes following blast exposure, the current study focused on investigating chronic pathology within the hypothalamus following blast, in addition to systemic effects. An established rodent model of blast neurotrauma was used to induce mild blast-induced neurotrauma. Adipose tissue, blood, and brain samples were collected at one and three months following a single blast exposure. Adipose tissue and blood were evaluated for changes in ACTH, adiponectin, C-reactive protein, glial fibrillary acidic protein, interleukin (IL)-1β, and leptin. The hypothalamus was evaluated for injury using immunohistochemical techniques. The results demonstrated that the weight of the blast animals was significantly less, compared with the sham group. The slower rate of increase in their weight was associated with changes in ACTH, IL-1β, and leptin levels. Further, histological analysis indicated elevated levels of cleaved caspase-3 positive cells within the hypothalamus. The data suggest that long-term outcomes of brain injury occurring from blast exposure include dysfunction of the hypothalamus, which leads to compromised hormonal function, elevated biological stress-related hormones, and subsequent adipose tissue remodeling.

Extremity injuries in soldiers during the conflict in Mali: experience of Togo Level two Hospital.

The aim of this study was to analyse war-related and non-war-related extremity injuries in soldiers in the Mali conflict. This prospective study was performed from 1 May 1 to 31 December 2014. It concerned extremity injuries in soldiers treated at Togo Level 2 Hospital. Seventy-nine patients with an average age of 31.19 years were assessed. Among them, 50 were admitted after war injury and 29 from nonwar injury. Most war-related injuries were due to improvised explosive devices (IEDs) (36 %); road traffic accidents (51.72 %) were the main mechanism of non-war injury. A total of 125 injuries were analysed. Limb fractures were identified in 37 patients (29.6 %), and 22 cases (59.46 %) were open fractures. Twenty-six (20.8 %) patients had soft tissue wounds. The other injuries were sprains (18.4 %), muscle contusions (15.2 %), dislocations (8.8 %), traumatic amputations (4 %) and burns (3.2 %). Surgical debridement and external fixator application were the most frequently performed surgical procedures. Thirty-nine per cent of patients were evacuated to a level 3 hospital for better care. The severity of injuries and their rapid treatment require orthopaedic surgeons to have high levels of surgical experience and knowledge pertaining to military or disaster surgical doctrine.

Concussive brain injury from explosive blast.

ObjectiveExplosive blast mild traumatic brain injury (mTBI) is associated with a variety of symptoms including memory impairment and posttraumatic stress disorder (PTSD). Explosive shock waves can cause hippocampal injury in a large animal model. We recently reported a method for detecting brain injury in soldiers with explosive blast mTBI using magnetic resonance spectroscopic imaging (MRSI). This method is applied in the study of veterans exposed to blast.MethodsThe hippocampus of 25 veterans with explosive blast mTBI, 20 controls, and 12 subjects with PTSD but without exposure to explosive blast were studied using MRSI at 7 Tesla. Psychiatric and cognitive assessments were administered to characterize the neuropsychiatric deficits and compare with findings from MRSI.ResultsSignificant reductions in the ratio of N-acetyl aspartate to choline (NAA/Ch) and N-acetyl aspartate to creatine (NAA/Cr) (P < 0.05) were found in the anterior portions of the hippocampus with explosive blast mTBI in comparison to control subjects and were more pronounced in the right hippocampus, which was 15% smaller in volume (P < 0.05). Decreased NAA/Ch and NAA/Cr were not influenced by comorbidities – PTSD, depression, or anxiety. Subjects with PTSD without blast had lesser injury, which tended to be in the posterior hippocampus. Explosive blast mTBI subjects had a reduction in visual memory compared to PTSD without blast.InterpretationThe region of the hippocampus injured differentiates explosive blast mTBI from PTSD. MRSI is quite sensitive in detecting and localizing regions of neuronal injury from explosive blast associated with memory impairment.

Linking Traumatic Brain Injury to Chronic Traumatic Encephalopathy: Identification of Potential Mechanisms Leading to Neurofibrillary Tangle Development

Significant attention has recently been drawn to the potential link between head trauma and the development of neurodegenerative disease, namely chronic traumatic encephalopathy (CTE). The acute neurotrauma associated with sports-related concussions in athletes and blast-induced traumatic brain injury in soldiers elevates the risk for future development of chronic neurodegenerative diseases such as CTE. CTE is a progressive disease distinguished by characteristic tau neurofibrillary tangles (NFTs) and, occasionally, transactive response DNA binding protein 43 (TDP43) oligomers, both of which have a predilection for perivascular and subcortical areas near reactive astrocytes and microglia. The disease is currently only diagnosed postmortem by neuropathological identification of NFTs. A recent workshop sponsored by National Institute of Neurological Disorders and Stroke emphasized the need for premortem diagnosis, to better understand disease pathophysiology and to develop targeted treatments. In order to accomplish this objective, it is necessary to discover the mechanistic link between acute neurotrauma and the development of chronic neurodegenerative and neuropsychiatric disorders such as CTE. In this review, we briefly summarize what is currently known about CTE development and pathophysiology, and subsequently discuss injury-induced pathways that warrant further investigation. Understanding the mechanistic link between acute brain injury and chronic neurodegeneration will facilitate the development of appropriate diagnostic and therapeutic options for CTE and other related disorders.

N-Acetyl cysteine prevents synergistic, severe toxicity from two hits of oxidative stress

The two hit hypothesis of neurodegeneration states that cells that have been severely stressed once are more vulnerable to the negative impact of a second hit. In other words, the toxicity of two hits of severe stress may be synergistic in neurons. We previously developed a two hit model of proteotoxic neurodegeneration using the proteasome inhibitor MG132. In that study, we found that the potent antioxidant N-acetyl cysteine was able to protect against the toxicity associated with dual MG132 hits. N-acetyl cysteine has been shown to ameliorate cognitive deficits in Alzheimer's patients and to reduce the symptoms of blast injury in soldiers. These studies and many others in experimental models of neurodegeneration suggest that N-acetyl cysteine can protect neurons even when they are severely injured. In the present study, we tested the hypotheses that dual hits of hydrogen peroxide and paraquat would elicit synergistic neurodegeneration and that this extreme toxicity would be prevented by N-acetyl cysteine. The findings reveal for the first time that neuronal N2a cells are much more sensitive to oxidative stress from hydrogen peroxide treatment when they have been exposed previously to the same toxin. Two hits of hydrogen peroxide also caused severe loss of glutathione. N-acetyl cysteine attenuated the loss of glutathione and reduced the near-complete loss of cells after exposure to dual hydrogen peroxide hits. The present study supports the notion that N-acetyl cysteine can robustly protect against severe, unremitting oxidative stress in a glutathione-dependent manner.

N-Acetyl cysteine blunts proteotoxicity in a heat shock protein-dependent manner

N-Acetyl cysteine, a glutathione precursor, has been shown to benefit patients with Alzheimer’s disease and reduce the symptoms of traumatic brain injury in soldiers. Parkinson’s and Alzheimer’s disease are both characterized by stress from protein misfolding, or proteotoxicity. We have developed a high-throughput model of proteotoxicity by treating neuroblastoma N2a cells with the proteasome inhibitor MG132 and performing three independent assays for viability. Our previous study showed that N-acetyl cysteine protects N2a cells against two sequential treatments of MG132 and raises glutathione levels in a two-hit model of synergistic neurodegeneration. In the present study, however, N-acetyl cysteine was found to reduce the toxicity of a single hit of MG132 independent of its effect on glutathione. All three viability assays confirmed this protection. We measured heat shock protein 70 (Hsp70) levels because Hsp70 is a protective chaperone that helps refold proteins or guides ubiquitinated proteins toward degradation by the proteasome. Hsp70 levels were higher in MG132-treated cells when N-acetyl cysteine was applied. No parallel change in heat shock cognate 70 (Hsc70) was elicited. Inhibition of Hsp70/Hsc70 activity with VER 155008 attenuated the protection afforded by N-acetyl cysteine in a dose–responsive manner. MG132 induced a large rise in ubiquitinated proteins and N-acetyl cysteine reduced this effect. Consistent with the chaperone functions of Hsp70, VER 155008 also prevented the reduction in ubiquitin-conjugated proteins by N-acetyl cysteine. These data reveal a new role for N-acetyl cysteine: this compound may reduce misfolded protein levels and ameliorate proteotoxicity through heat shock proteins. These findings broaden the potential mechanisms of action for this dietary supplement in neurodegenerative proteinopathies.

Diffusion Tensor Imaging and Mild Traumatic Brain Injury in Soldiers: Abnormal Findings, Uncertain Implications

Diffusion Tensor Imaging and Mild Traumatic Brain Injury in Soldiers: Abnormal Findings, Uncertain Implications

Recurrent Posterior Shoulder Instability After Rifle Shooting

Rifle shooting produces a sudden counterforce against the body thorough the anterior shoulder, which may produce a traumatic injury in soldiers. Posterior instability of the shoulder can occur in soldiers who practice rifle shooting. To the authors' knowledge, few reports have examined shooting-related injuries in soldiers. This article describes the case of a 27-year-old male soldier who presented with left shoulder pain and instability after rifle training. He developed symptoms, and presented radiographic findings consistent with a posterior Bankart lesion. Intraoperatively, while in the lateral decubitus position, a posterior portal was created 3 cm inferior and 2 cm lateral to the posterolateral corner of acromion for making a proper angle for inserting anchors. A reverse bony Bankart lesion and adjacent cartilage breakdown at the glenoid rim were noted. An arthroscopic capsulolabral repair was performed with 3-mm bioabsorbable anchors to the glenoid rim. No gross reverse Hill-Sachs lesion or hyaline cartilage lesion was noted. Postoperatively, the arm was supported in a sling with an abduction pillow for 5 weeks. Codman's exercises, scapular protraction exercises, and elbow and wrist exercises were started. Physical therapy focused on reestablishing glenohumeral range of motion and rotator cuff and periscapular muscle strength. Six months postoperatively, the patient had normal scapular kinesis and reported no shoulder pain or symptoms of instability associated with a reverse bony Bankart lesion.