title: A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees.
abstract: 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.
  
  
  
  The 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.
  
  
  
  The 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 %).
  
  
  
  The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.
authors.affiliation: Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Allami
authors.affiliation: Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran.
authors.forename: Batool
authors.initials: B
authors.lastname: Mousavi
authors.affiliation: Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Masoumi
authors.affiliation: Emergency Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Modirian
authors.affiliation: Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran.
authors.forename: Hadi
authors.initials: H
authors.lastname: Shojaei
authors.affiliation: Candidate of Health Education and Promotion, Department of Health Education and Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Mirsalimi
authors.affiliation: Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Hosseini
authors.affiliation: Department of Radiology, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Pirouz
authors.initials: P
authors.lastname: Pirouzi
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology / Q000534:rehabilitation; D000674:Amputees / Q000706:statistics & numerical data; D000068337:Armed Conflicts; D001186:Artificial Limbs; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D059348:Peripheral Nerve Injuries / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D034941:Upper Extremity / Q000293:injuries / Q000503:physiopathology
keywords: Bilateral upper extremity amputation; Iraq-Iran war; Musculoskeletal disorder; Pain; Peripheral nerve injury