Assessment of Blood Biomarker Profile After Acute Concussion During Combative Training Among US Military Cadets: A Prospective Study From the NCAA and US Department of Defense CARE Consortium.

Importance: Validation of protein biomarkers for concussion diagnosis and management in military combative training is important, as these injuries occur outside of traditional health care settings and are generally difficult to diagnose. Objective: To investigate acute blood protein levels in military cadets after combative training-associated concussions. Design, Setting, and Participants: This multicenter prospective case-control study was part of a larger cohort study conducted by the National Collegiate Athletic Association and the US Department of Defense Concussion Assessment Research and Education (CARE) Consortium from February 20, 2015, to May 31, 2018. The study was performed among cadets from 2 CARE Consortium Advanced Research Core sites: the US Military Academy at West Point and the US Air Force Academy. Cadets who incurred concussions during combative training (concussion group) were compared with cadets who participated in the same combative training exercises but did not incur concussions (contact-control group). Clinical measures and blood sample collection occurred at baseline, the acute postinjury point (<6 hours), the 24- to 48-hour postinjury point, the asymptomatic postinjury point (defined as the point at which the cadet reported being asymptomatic and began the return-to-activity protocol), and 7 days after return to activity. Biomarker levels and estimated mean differences in biomarker levels were natural log (ln) transformed to decrease the skewness of their distributions. Data were collected from August 1, 2016, to May 31, 2018, and analyses were conducted from March 1, 2019, to January 14, 2020. Exposure: Concussion incurred during combative training. Main Outcomes and Measures: Proteins examined included glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1, neurofilament light chain, and tau. Quantification was conducted using a multiplex assay (Simoa; Quanterix Corp). Clinical measures included the Sport Concussion Assessment Tool-Third Edition symptom severity evaluation, the Standardized Assessment of Concussion, the Balance Error Scoring System, and the 18-item Brief Symptom Inventory. Results: Among 103 military service academy cadets, 67 cadets incurred concussions during combative training, and 36 matched cadets who engaged in the same training exercises did not incur concussions. The mean (SD) age of cadets in the concussion group was 18.6 (1.3) years, and 40 cadets (59.7%) were male. The mean (SD) age of matched cadets in the contact-control group was 19.5 (1.3) years, and 25 cadets (69.4%) were male. Compared with cadets in the contact-control group, those in the concussion group had significant increases in glial fibrillary acidic protein (mean difference in ln values, 0.34; 95% CI, 0.18-0.50; P < .001) and ubiquitin C-terminal hydrolase-L1 (mean difference in ln values, 0.97; 95% CI, 0.44-1.50; P < .001) levels at the acute postinjury point. The glial fibrillary acidic protein level remained high in the concussion group compared with the contact-control group at the 24- to 48-hour postinjury point (mean difference in ln values, 0.22; 95% CI, 0.06-0.38; P = .007) and the asymptomatic postinjury point (mean difference in ln values, 0.21; 95% CI, 0.05-0.36; P = .01). The area under the curve for all biomarkers combined, which was used to differentiate cadets in the concussion and contact-control groups, was 0.80 (95% CI, 0.68-0.93; P < .001) at the acute postinjury point. Conclusions and Relevance: This study's findings indicate that blood biomarkers have potential for use as research tools to better understand the pathobiological changes associated with concussion and to assist with injury identification and recovery from combative training-associated concussions among military service academy cadets. These results extend the previous findings of studies of collegiate athletes with sport-associated concussions.

An Evaluation of the Structural Validity of the Work Limitation Questionnaire Using the Rasch Model.

OBJECTIVE: To investigate the targeting, scaling, and structural validity of the Work Limitation Questionnaire (WLQ) using Rasch analysis. DESIGN: Secondary data analysis. SETTING: Tertiary care hospital. PARTICIPANTS: The data were sourced from an upper limb specialty clinic of injured workers using the convenience sampling method and from a national randomized controlled trial investigating 2 surgical options for rotator cuff repair by formal, randomized selection (N=315). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Work Limitation Questionnaire 25-item version (WLQ-25). The WLQ contains 25 items measuring a client's ability to perform specific job demands on a 5-point ordinal response scale ranging from 0 (difficulty none of the time) to 4 (difficulty all the time). The average of all 25 items is used as the total score, ranging from 0 to 4, where higher index scores indicate greater difficulty performing daily work. Subscales were used to assess time management, physical demands (PD), mental-interpersonal demands, and output demands. RESULTS: The Rasch analyses performed on the dataset included the test of fit of residuals, ordering of item thresholds, Person separation index, differential item functioning (DIF), dependency, and unidimensionality. The partial credit model was selected for the current Rasch analysis because the likelihood ratio test was significant at both the overall questionnaire and the subscale level (P<.001). The WLQ-25 did not fit with the Rasch model (χ2=1715.58; df=125; P<.001) and most of the thresholds were disordered. A series of steps were undertaken to improve the fit statistic, including item reduction (6 items) and response merging (9 items). DIF was absent in the revised scale based on sex, age, full- or part-time employment, and type of employment. Only 3 revised subscales, namely the PD, mental demands, and interpersonal demands subscales, demonstrated acceptable fit to the Rasch model. CONCLUSIONS: The WLQ-25 demonstrated substantial misfit from the Rasch model, which could not be fully mediated. The revised PD, mental demands, and interpersonal demands subscales could be used to assess these constructs.

Joint moment trade-offs across the upper extremity and trunk during repetitive work.

Individuals can coordinate small kinematic changes at several degrees of freedom simultaneously in the presence of fatigue, leaving it unclear how overall biomechanical demands at each joint are altered. The purpose of this study was to evaluate trade-offs in joint moments between the trunk, shoulder, and elbow during repetitive upper extremity work. Participants performed four simulated workplace tasks cyclically until meeting fatigue termination criteria. Emergent fatigue-induced adaptations to repetitive work resulted in task-dependent trade-offs in joint moments. In general, reduced shoulder moments were compensated for by increased elbow and trunk joint moment contributions. Although mean joint moment changes were modest (range: 1-3 Nm) across participants, a wide distribution of responses was observed, with standard deviations exceeding 10 Nm. Re-distributing biomechanical demands across joints may alleviate constant tissue loads and facilitate continued task performance with fatigue but may be at the expense of increasing demands at adjacent joints.

Acute and long-term costs of 268 peripheral nerve injuries in the upper extremity.

BACKGROUND: Peripheral nerve injury in the upper extremity is linked to high socioeconomic burden, yet cost-analyses are rare and from small cohorts. The objective of this study was to determine the costs and long-term socioeconomic effects of peripheral nerve injuries in the upper extremity in Germany. METHODS: We analyzed data of 250 patients with 268 work-related upper extremity nerve injuries from acute treatment to long-term follow-up on rehabilitation, sick-leave and disability-pension. RESULTS: Patients were on average 39.9±14.2 years old, male (85%) and mean inpatient treatment was 7±6 days. Location of nerve was 8% (N = 19) proximal to the wrist, 26% (N = 65) at the wrist and metacarpus, and 66% (N = 166) at phalangeal level. Acute in-patient treatment for (single) median nerve injury accounted for 66% with hospital reimbursement of 3.570€, ulnar nerve injury for 24% and 2.650€ and radial nerve injury for 10% and 3.166€, all including finger nerve injuries. The remaining were combined nerve injuries, with significantly higher costs, especially if combined with tendon 5.086€ or vascular injury 4.886€. Based on location, nerve injuries proximal to the wrist averaged 5.360±6.429€, at the wrist and metacarpus 3.534±2.710€ and at the phalangeal level 3.418±3.330€. 16% required rehabilitation with average costs of 5.842€ and stay of 41±21 days. Sick leave was between 11-1109 days with an average of 147 days with socioeconomic costs of 197€/day, equaling on average 17.640€. 30% received a mean yearly disability pension of 3.187€, that would account to 102.167€ per lifetime. CONCLUSION: This large German patient sample indicates that nerve injury has a major impact on function and employment, resulting in significant health care costs. Both proximal and distal nerve injuries led to long-term disability, subsequent sick-leave and in 30% to permanent disability pension. These data are determined to support future studies and health economical work on prevention, treatment and rehabilitation of these often small injuries with great consequences.

The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study.

INTRODUCTION: Electrical injuries exhibit significant acute and long-term sequelae. Amputation and neurological deficits are common in electrical injury survivors. There is a paucity of information on the long-term outcomes of this population. Therefore, this study examines the long-term outcomes of electrical injuries by comparing them to fire/flame injuries. METHODS: Data from the Burn Model System National Database collected between 1996 and 2015 was examined. Demographic and clinical characteristics for adult burn survivors with electrical and fire/flame injuries were compared. Satisfaction With Life Scale (SWLS), Short Form-12 Physical Composite Score (SF-12 PCS), Short Form-12 Mental Composite Score (SF-12 MCS), and employment status were examined at 24 months post-injury. Linear and logistic regression models were used to assess differences in outcome measures between groups, controlling for demographic and clinical variables. RESULTS: A total of 1147 adult burn survivors (111 with electrical injuries; 1036 with fire/flame injuries) were included in this study. Persons with electrical injuries were more likely to be male and injured at work (p<0.001). SF-12 PCS scores were significantly worse for survivors with electrical injuries at 24 months post-injury than survivors with fire/flame injuries (p<0.01). Those with electrical injuries were nearly half as likely to be employed at 24 months post-injury than those with fire/flame injuries (p=0.002). There were no significant differences in SWLS and SF-12 MCS between groups. CONCLUSIONS: Adult survivors with electrical injuries reported worse physical health and were less likely to be employed at 24 months post-injury compared to survivors with fire/flame injuries. A more detailed understanding of return to work barriers and work accommodations is merited for the electrical injury population. Furthermore, the results of this study should inform future resource allocation for the physical health and employment needs of this population.

Functional Performance of Firefighters After Exposure to Environmental Conditions and Exercise.

CONTEXT: Slips, trips, and falls are leading causes of musculoskeletal injuries in firefighters. Researchers have hypothesized that heat stress is the major contributing factor to these fireground injuries. OBJECTIVE: To examine the effect of environmental conditions, including hot and ambient temperatures, and exercise on functional and physiological outcome measures, including balance, rectal temperature, and perceived exertion. DESIGN: Randomized controlled clinical trial. SETTING: Laboratory environmental chamber. PATIENTS OR OTHER PARTICIPANTS: A total of 13 healthy, active career firefighters (age = 26 ± 6 years [range = 19-35 years], height = 178.61 ± 4.93 cm, mass = 86.56 ± 16.13 kg). INTERVENTION(S): Independent variables consisted of 3 conditions (exercise in heat [37.41°C], standing in heat [37.56°C], and exercise in ambient temperature [14.24°C]) and 3 data-collection times (preintervention, postintervention, and postrecovery). Each condition was separated from the others by at least 1 week and lasted a maximum of 40 minutes or until the participant reached volitional fatigue or a rectal temperature of 40.0°C. MAIN OUTCOME MEASURE(S): Firefighting-specific functional balance performance index, rectal temperature, and rating of perceived exertion. RESULTS: Exercise in the heat decreased functional balance, increased rectal temperature, and altered the perception of exertion compared with the other intervention conditions. CONCLUSIONS: A bout of exercise in a hot, humid environment increased rectal temperature in a similar way to that reported in the physically active population and negatively affected measures of functional balance. Rather than independently affecting balance, the factors of exercise and heat stress appeared to combine, leading to an increased likelihood of slips, trips, and falls.

Replantation of Nine Fingers in a Patient: A case report.

Amputation of multiple fingers of both hands is a rare and serious injury. We report a case of a 41-year-old male patient who presented to Khoula Hospital, Muscat, Oman, in 2015 with the amputation of nine fingers due to a workplace injury. With two teams working in tandem, all the amputated fingers were re-attached. A total of seven fingers survived and the patient regained reasonable functionality of his hands. To the best of the authors' knowledge, this is the first case of several finger amputations in Oman.

Outcomes of an interdisciplinary work rehabilitation program.

BACKGROUND: Work rehabilitation programs were developed to help workers with an injury return to work (RTW). While studies have examined intervention characteristics, prognostic factors, and disability level, there is little or no research examining interdisciplinary interventions, lifting capacity/strength and the level of a patient's RTW status (e.g., not working, new job, or ongoing restrictions) at the time of discharge. OBJECTIVE: To evaluate outcomes (RTW status and lifting capacity/strength changes) of an interdisciplinary work rehabilitation program and examine whether time off work prior to the program and type of injury were related to RTW status and strength changes. METHODS: A retrospective database analysis was conducted with a sample of 495 participants (Mage = 44.44 years, SD = 10.13) of which 375 (76%) were male. Participants were workers with injuries who participated in an interdisciplinary work rehabilitation program from 2006 to 2010. RESULTS: A significantly higher number of participants were working at the end of the program than at the beginning (83.9% vs. 31.6%, p < 0.0001). Mean strength was higher at the time of discharge compared to at admission (p < 0.0001). The participants that did not RTW had had significantly more days off work prior to the program (U = 11757, z = -3.152, p = 0.002). The type of injury was not related to strength at the time of discharge. CONCLUSIONS: Findings suggest the interdisciplinary program is associated with positive outcomes and early intervention may be an important factor when treating patients with work-related injuries.

Using the OVAKO working posture analysis system in cleaning occupations.

BACKGROUND: Cleaning workers experience severe musculoskeletal symptoms. OBJECTIVE: The objective of this paper was to examine musculoskeletal symptoms in cleaners of different heights to evaluate the effects of height on working postures in the work environment (schools). METHODS: We used a three-stage method including using the Nordic Musculoskeletal Questionnaire (NMQ) to evaluate musculoskeletal symptoms, a task analysis to confirm typical cleaning tasks, and the OVAKO Working Posture Assessment System (OWAS) for posture analysis. Multinomial logistic regression was performed to evaluate the adjusted effects of individual characteristics on painful body regions, using individuals without any pain as the reference category. RESULTS: This study found that the prevalence of musculoskeletal symptoms is very high for cleaners, especially in the shoulders, elbows, and lower back. Odds ratios for the accumulation of two or more risk factors were higher among men and were inversely associated with national economic indicators. The relatively high prevalence of musculoskeletal symptoms may stem from the multiple operations involved in cleaning tasks, such as trash collecting, floor mopping, toilet cleaning, and mirror polishing. Workers of different heights had differential work loadings for different tasks. CONCLUSIONS: This paper proposes recommendations for job adaptations and occupational safety training. Cleaners of different heights execute the typical tasks via different postures, and awkward postures often result in musculoskeletal symptoms. Cleaners should be provided with specific tools and training regarding working postures on the basis of height. These findings can be used as a reference for related operation designs and task improvements to ensure correct tool usage and safer working postures during cleaning.

A Robot with an Augmented-Reality Display for Functional Capacity Evaluation and Rehabilitation of Injured Workers.

Occupational rehabilitation is an integral part of the recovery process for workers who have sustained injuries at the workplace. It often requires the injured worker to engage in functional tasks that simulate the workplace environment to help regain their functional capabilities and allow for a return to employment. We present a system comprised of a robotic arm for recreating the physical dynamics of functional tasks and a 3D Augmented Reality (AR) display for immersive visualization of the tasks. While this system can be used to simulate a multitude of occupational tasks, we focus on one specific functional task. Participants perform a virtual version of the task using the robot-AR system, and a physical version of the same task without the system. This study shows the results for two able-bodied users to determine if the robot-AR system produces upper-limb movements similar to the real-life equivalent task. The similarity between relative joint positions, i.e., hand-to-elbow (H2E) and elbow-to-shoulder (E2S) displacements, is evaluated within clusters based on the spatial position of the user's hand. The H2E displacements for approximately 50% of hand position clusters were consistent between the robot-AR and real-world conditions and approximately 30% for E2S displacements. The similar clusters are distributed across the entire task space however, indicating the robot-AR system has the potential to properly simulate real-world equivalent tasks.

Taste Manipulation and Swallowing Mechanics in Trauma-Related Sensory-Based Dysphagia.

Purpose This study explored the effects of high-concentration taste manipulation trials on swallow function in persons with sensory-based dysphagia. Method Dysphagia researchers partnered with clinical providers to prospectively identify traumatically injured U.S. military service members (N = 18) with sensory-based dysphagia as evidenced by delayed initiation and/or decreased awareness of residue/penetration/aspiration. Under videofluoroscopy, participants swallowed trials of 3 custom-mixed taste stimuli: unflavored (40% weight/volume [wt/vol] barium sulfate in distilled water), sour (2.7% wt/vol citric acid in 40% wt/vol barium suspension), and sweet-sour (1.11% wt/vol citric acid plus 8% wt/vol sucrose in 40% wt/vol barium suspension). Trials were analyzed and compared via clinical rating tools (the Modified Barium Swallow Impairment Profile [Martin-Harris et al., 2008] and the Penetration-Aspiration Scale [Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996]). Additionally, a computational analysis of swallowing mechanics (CASM) was applied to a subset of 9 swallows representing all 3 tastants from 3 participants. Results Friedman's tests for the 3 stimuli revealed significantly (p < .05) improved functional ratings for Penetration-Aspiration Scale and pharyngoesophageal opening. CASM indicated differences in pharyngeal swallowing mechanics across all tastant comparisons (p ≤ .0001). Eigenvectors revealed increased tongue base retraction, hyoid elevation, and pharyngeal shortening for sweet-sour and, to a lesser extent, sour than for unflavored boluses. Conclusion Advantageous changes in certain parameters of oropharyngeal swallowing physiology were noted with high-intensity tastants per both clinical ratings and subsequent CASM, suggesting potential therapeutic application for taste manipulation.

Maculopathy from an accidental exposure to welding arc.

Welding light can cause photic retinal injury. We report binocular maculopathy induced by a brief exposure to electric arc welding light in a patient who could not equipped with protective device because of narrow space. A 47-year-old man performed electric arc welding for approximately 10-15 min without wearing protective device because of narrow space and subsequently experienced eye discomfort and decreased visual acuity. At the initial visit, his best corrected visual acuity was 0.5. Fundus examination, optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were performed. OCT showed disruption in the ellipsoid zone, and mfERG amplitudes in the central 10° were markedly reduced in both eyes. The decrease in visual acuity had been noted for at least 18 months. Using the proper protective device is essential in welding, despite short time periods of work. For patients with welding-induced photokeratitis, doctors should also consider the possibility of photic retinal injury.

Injuries in Australian Army full-time and part-time personnel undertaking basic training.

BACKGROUND: Musculoskeletal injuries are a problem in military personnel as they detract from force readiness and may prevent deployment. Injuries occur during basic training at three times the rate observed in post-training military service and more commonly in part time (PT) when compared to full time (FT) army personnel. The purpose of this study was to examine differences in rates and patterns of reported injuries between full time (FT) and part time (PT) personnel undertaking army basic training. METHODS: A retrospective cohort study was conducted to determine and compare rates and patterns of injuries which occurred during basic training in PT and FT personnel. Injury data from the period 01 July 2012 to 30 June 2014 was obtained in a non-identifiable format from the Workplace Health, Safety, Compensation and Reporting (WHSCAR) database of the Australian Department of Defence. Analysis included descriptive statistics and the calculation of injury rates and injury rate ratios. RESULTS: A total of 1385 injuries were reported across FT and PT cohorts, with an injury rate ratio for FT:PT of 1.06 [0.80-1.40], when accounting for exposure. In FT personnel, 1192 (90%) were Minor Personal Injuries (MPIs) and 43 (3.2%) Serious Personal Injuries (SPIs). In PT personnel, 147 (94.8%) were MPIs and three (1.9%) SPIs. In both FT and PT personnel, injuries most commonly: occurred during Physical Training (41.7% FT, 515 MPIs, 10 SPIs, 32% PT. 48 MPIs, 1 SPI); affected the knee (FT 41.7% 159 MPIs, 7 SPIs, PT 36.0%, 22 MPIs, 0 SPIs); involved soft tissue damage (FT 60.9%, 744 MPIs, 8 SPIs, PT 69.3%, 103 MPIs, 1 SPI); and were due to muscular stress (FT 41.7%, 509 MPIs, 6 SPIs, PT 36%, 54 MPIs, 0 SPIs). CONCLUSIONS: FT and PT recruits exhibited similar injury profiles, with mechanisms, sites and types of injuries in agreement with other research. Given these similarities, effective interventions that reduce injury risks in either population will likely benefit both.

Effects of whole body vibration on spinal proprioception in healthy individuals.

BACKGROUND: Low back pain (LBP) is a common health problem with high reoccurrence rate. As patients with LBP are often found to be proprioception impaired, new proprioception exercises should be explored. Whole body vibration (WBV) has been proven to improve muscle function and proprioception. OBJECTIVE: The aim of this study was to determine the effects of WBV on spinal proprioception when WBV was administered in standing and seated postures. METHODS: Twenty healthy male individuals (mean age: 23.2±1.2 years) were recruited and randomly assigned to two WBV groups: WBV in standing or WBV in seated posture. Their body posture, lumbar repositioning ability, maximum reaching distance and lumbopelvic coordination during dynamic motion in flexion and extension were assessed before, immediately after, 30 minutes after and 1 hour after 5 minutes of WBV (18 Hz, 6 mm amplitude) exposure. A Mixed ANOVA was used to analyze the effects of group and time factors on these four outcome measures. RESULTS: There were no significant interaction (group and time) and group effects on all outcome measures. Participants were found to have significant different time effect on body posture, lumbar repositioning ability, maximum reaching distance and lumbopelvic coordination. CONCLUSIONS: WBV could significantly improve spinal proprioception including body posture, lumbar repositioning ability, maximum reaching distance and lumbopelvic coordination in healthy individuals. WBV protocol is recommended to confirm its clinical application for improving spinal proprioception and its effects on patients with LBP is warranted.

Incident Angle Correction Algorithm For Impulse Noise Injury Assessment.

Objectives: We developed an empirical algorithm to account for the effect of the change in the A-weighted sound exposure level (SELA) as a result of the change in angle of incidence (AoI) of the impulse noise on the prediction of hearing loss. The product is the upgraded software tool, Auditory 4.5 that incorporates the incident angle correction algorithm. Methods: The SELA calculated from free-field pressure data is used as the dose metric that was corrected for AoI. The angle-dependent eardrum pressure was measured by performing shock tube tests with the Acoustical Testing Fixture varied over a wide range of orientation angles. The yaw angle was varied from 0 to 360° and the pitch angle from -60° to +90° in 15° steps. The algorithm was constructed by calculating a correction factor, ΔSELA for any given AoI at the ear relative to the SELA at normal incidence. The ΔSELA values were applied to correct the dose values to predict injury for all AoI. Results: A three-dimensional contour of ΔSELA as a function of the AoI was produced. The largest ΔSELA was 9.81 dB at pitch = -15° and yaw = 255°. ΔSELA values compared well against available benchmark data. Conclusions: A new capability has been incorporated in Auditory 4.5 to predict the effects of AoI on impulse noise injury.

Brooding as moderator of depressive symptoms after a work accident: A longitudinal study.

This study analyzes the relationship between having experienced a work accident and developing depressive symptoms six months later, considering the subjective severity of accidents, the use of both positive and negative religious coping strategies, and brooding as predictors variables. Fifty seven women and 187 men were evaluated during the month following their accident (T1) and six months later (T2). The results show that after controlling for initial depressive symptoms, all predictors showed a statistically significant relationship with depression at six months, including the interaction between brooding and subjective severity of accident. Forty nine percent of resilient participants exhibited low symptoms at T1 and T2, 22% of recovered individuals showed high symptoms at T1 and low symptoms afterwards, 20% of depressive individuals had high symptoms at T1 and T2, and 8% exhibited high symptoms only at T2. High severity, brooding and religious coping at T1 differentiated those who exhibited stable symptoms from those who were resilient. Resilience was specifically predicted with a negative coefficient by the interaction of brooding with subjective severity of accident. We conclude that brooding is a variable that moderates the relationship between subjective severity of accident and the development and maintenance of depressive symptoms. Subjective severity of accident, brooding and negative religious coping are risk factors, while positive religious coping is not a sufficient protection factor.

Developing predictive models for return to work using the Military Power, Performance and Prevention (MP3) musculoskeletal injury risk algorithm: a study protocol for an injury risk assessment programme.

BACKGROUND: Musculoskeletal injuries are a primary source of disability in the US Military, and low back pain and lower extremity injuries account for over 44% of limited work days annually. History of prior musculoskeletal injury increases the risk for future injury. This study aims to determine the risk of injury after returning to work from a previous injury. The objective is to identify criteria that can help predict likelihood for future injury or re-injury. METHODS: There will be 480 active duty soldiers recruited from across four medical centres. These will be patients who have sustained a musculoskeletal injury in the lower extremity or lumbar/thoracic spine, and have now been cleared to return back to work without any limitations. Subjects will undergo a battery of physical performance tests and fill out sociodemographic surveys. They will be followed for a year to identify any musculoskeletal injuries that occur. Prediction algorithms will be derived using regression analysis from performance and sociodemographic variables found to be significantly different between injured and non-injured subjects. DISCUSSION: Due to the high rates of injuries, injury prevention and prediction initiatives are growing. This is the first study looking at predicting re-injury rates after an initial musculoskeletal injury. In addition, multivariate prediction models appear to have move value than models based on only one variable. This approach aims to validate a multivariate model used in healthy non-injured individuals to help improve variables that best predict the ability to return to work with lower risk of injury, after a recent musculoskeletal injury. TRIAL REGISTRATION NUMBER: NCT02776930.

Work-Related Musculoskeletal Injuries in Plastic Surgeons in the United States, Canada, and Norway.

BACKGROUND: Musculoskeletal injuries are more common among surgeons than among the general population. However, little is known about these types of injuries among plastic surgeons specifically. The authors' goals were to evaluate the prevalence, nature, causes, and potential solutions of these musculoskeletal injuries among plastic surgeons in three different countries: the United States, Canada, and Norway. METHODS: A survey was e-mailed to plastic surgeons in the United States, Canada, and Norway, soliciting their demographics, practice description, history of musculoskeletal issues, potential causes of these symptoms, and proposed suggestions to address these injuries. The prevalence of various musculoskeletal symptoms was calculated, and predictors of these symptoms were evaluated using multivariate logistic regression. RESULTS: The survey was sent to 3314 plastic surgeons, with 865 responses (response rate, 26.1 percent); 78.3 percent of plastic surgeons had musculoskeletal symptoms, most commonly in the neck, shoulders, and lower back. U.S. surgeons were significantly more likely to have musculoskeletal symptoms than Norwegian surgeons (79.5 percent versus 69.3 percent; p < 0.05); 6.7 percent of all respondents required surgical intervention for their symptoms. The most common causative factors were long surgery duration, tissue retraction, and prolonged neck flexion. The most common solutions cited were core-strengthening exercises, stretching exercises, and frequent adjustment of table height during surgery. CONCLUSIONS: Plastic surgeons are at high risk for work-related musculoskeletal injuries. Ergonomic principles can be applied in the operating room to decrease the incidence and severity of those injuries, and to avoid downstream sequelae, including the need for surgery.

Surgical treatment of acute type V acromioclavicular joint dislocations in professional athletes: an anatomic ligament reconstruction with synthetic implant augmentation.

BACKGROUND: Most acromioclavicular (AC) joint injuries occur in men in their third decade of life during high-speed or high-impact body contact sports. The management of acute complete AC joint dislocation is surgical. Current surgical techniques include anatomic reconstruction of the main restraints of the AC joint and aim to improve functional outcomes and to reduce the complication rate. METHODS: We present 10 cases of acute type V AC joint dislocation in professional athletes treated surgically with anatomic reconstruction of the coracoclavicular and AC ligaments and augmentation with the use of a synthetic polyester tape. The minimum follow-up of the patients was 2 years (mean, 48 months; range, 24-86 months). The postoperative functional outcome was assessed at 1 year and 2 years using the Constant-Murley, American Shoulder and Elbow Surgeons, and modified University of California-Los Angeles scoring systems. RESULTS: In all cases, the postoperative scores were significantly improved (P < .005 in all comparisons with the preoperative scores), and all patients returned to their preinjury high level of activity 6 months postoperatively. Radiographs at 1 month and 6 months revealed the maintenance of reduction. There were no complications. CONCLUSION: According to the results of our series of patients, demanding cases of acute AC joint dislocation Rockwood type V, in professional athletes, require anatomic fixation of both coracoclavicular and AC ligaments for return to sports as soon as possible and at the preinjury level of performance.