Disability following combat-sustained nerve injury of the upper limb

Abstract

Injuries to the limb are the most frequent cause of permanent disability following combat wounds. We reviewed the medical records of 450 soldiers to determine the type of upper limb nerve injuries sustained, the rate of remaining motor and sensory deficits at final follow-up, and the type of Army disability ratings granted. Of 189 soldiers with an injury of the upper limb, 70 had nerve-related trauma. There were 62 men and eight women with a mean age of 25 years (18 to 49). Disabilities due to nerve injuries were associated with loss of function, neuropathic pain or both. The mean nerve-related disability was 26% (0% to 70%), accounting for over one-half of this cohort's cumulative disability. Patients injured in an explosion had higher disability ratings than those injured by gunshot. The ulnar nerve was most commonly injured, but most disability was associated with radial nerve trauma. In terms of the final outcome, at military discharge 59 subjects (84%) experienced persistent weakness, 48 (69%) had a persistent sensory deficit and 17 (24%) experienced chronic pain from scar-related or neuropathic pain. Nerve injury was the cause of frequent and substantial disability in our cohort of wounded soldiers.

Defining the minimum anatomical coverage required to protect the axilla and arm against penetrating ballistic projectiles

“…Nerve repair is difficult, with outcomes notably worse the closer to the torso that the nerve is injured 33. The most common complications from upper extremity nerve damage include motor weakness, neuropathic pain, sensory deficit, limb contracture and muscle atrophy 31. Chronic pain is common25 41 and can be difficult to manage even with modern pain-modulating medications 42–46.…”

Pain‐related psychological distress, self‐rated health and significance of neuropathic pain in Danish soldiers injured in Afghanistan

“…The age of the sample was 26 (24)(25)(26)(27)(28)(29)(30)(31) years. The majority of the participants were married or living with a partner, had completed at least an upper secondary education programme and were employed.…”

“…Furthermore, 21% had neuropathic pain (PainDETECT scores ≥ 19), whereas 51% had mainly nociceptive pain (PainDETECT scores ≤ 12). The Post-traumatic Stress Disorder Checklist-Civilian score was 26 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31), the anxiety score was 4 (2-6.5) and the score for depression was 2 (1-5).…”

Raman spectroscopy of non-penetrating peripheral nerve damage in swine: a tool for spectral pathology of nerves

“…A survey of US combat injuries sustained in a nine month period of Operation Desert Shield and Desert Storm indicated nerve injury accompanied 30% of limb traumas [1]. In a cohort of 450 medically retired, wounded soldiers (injured between October 2001 and January 2005) loss of nerve function was the second leading cause of disability both in frequency and impact severity [3]; and 37% of upper limb injuries within this cohort exhibited nerve dysfunction [4]. Within open tibial fractures resulting from conflicts occurring between 2003 and 2007, 22% involved nerve injury [5].…”

“…In fact, nerve dysfunction is the second leading cause of long-term disability in injured service members [3] and is present in 37% of upper limb injuries with disability [4]. Identification and assessment of non-penetrating nerve injury in trauma patients could improve outcome and aid in therapeutic monitoring.…”