The Long-Term Impact of Severe Burn Trauma on Musculoskeletal Health

Abstract

Severe burn injury causes a profound stress response that leads to muscle and bone cachexia. Evidence suggests that these deficits persist for several months or even years after injury and are associated with growth delay, increased incidence of fractures, and increased hospital admissions for musculoskeletal disorders. Thus, there is an overwhelming need to determine the optimal acute and rehabilitative strategies to mitigate these deficits and improve quality of life for burn survivors. To date, there is limited research on the long-term impact of cachexia on functional performance and overall health, as well as on the lasting impact of pharmacological, nutritional, and exercise interventions. The aim of this review is to emphasize the long-term consequences of musculoskeletal cachexia and determine the best evidence-based strategies to attenuate it. We also underline important knowledge gaps that need to be addressed in order to improve care of burn survivors.

Understanding acute burn injury as a chronic disease

“…Holavanahalli et al that used a self-report measure to investigate musculoskeletal impacts, patients who had sustained burn injuries an average of 17 years earlier reported joint pain and stiffness, problems walking and running and weak arms and hands [38]. The long-term impact of burn on musculoskeletal health has also been recently reviewed in depth [39].…”

Metabolic Responses to Severe Burn Injury

“…Better definition of specific exercise modalities, as well as better identification of patient groups who would benefit from exercise therapy, is a developing area of research. 9,10,[49][50][51]…”

“…These deleterious effects can last well beyond the acute phase of the burn injury. 10 Hyperglycemia and insulin resistance result from actions of cortisol and catecholamines. Hyperglycemia is compounded further by unsuppressed hepatic glucose release and gluconeogenesis from breakdown products of fat and muscle.…”

Hyperbaric Oxygen Therapy Attenuates Burn-Induced Denervated Muscle Atrophy

“…Skeletal muscle wasting is a common features after burn injury and may last for months to years [1][2][3][4][5]. It is often associated with several complications and impaired rehabilitation.…”