A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees

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.

A comparative study of thumb reconstruction through the transplant of the first toe compound free flap between emergency surgery and elective surgery

“…If not treated in time, it will inevitably cause tendon and muscle atrophy, which will bring great difficulties to thumb reconstruction and functional exercise. [5] Dogu study found that hand trauma is prone to psychological depression in the early stage, which brings great suffering to the recovery of hand function. [7] Therefore, after the thumb is severed, how to rebuild a complete thumb and maximizing its function recovery is an important purpose of hand surgery.…”

Health concerns of veterans with high-level lower extremity amputations

“…Psychological disorders have been identified in veterans that experienced numerous physical problems [ 42 , 43 ]. The epidemiology of psychological disorders reveals that more than half of the veterans with short transfemoral, hip disarticulation and hemipelvectomy had been in outpatient care and more than one-tenth had a history of hospitalization, which was greater than that found in a study that evaluated 103 veterans with bilateral upper limb amputation [ 44 ]. A total of 3% of those patients had a history of hospitalization in psychiatric wards.…”

Basic Principles of Plastic Surgical Approach to Patients with High Energy Traumas

“…Bu nedenle ekstremitenin kurtarılması yö-nündeki eşiğin çok düşük olmaması önerilmektedir. Gelişmekte olan ülkelerde ekstremite travmalarına bağlı ampütasyonlar morbiditenin önemli bir kaynağı olarak karşımıza çıkmaktadır (58,59) . Buna ek olarak, tüm nekrotik kasların debride edilmesi gerekmektedir.…”