Characterization of Wrist Conditions in Active-Duty Service Members at a Major Medical Center: A Retrospective Review

PURPOSE: In a review of acute injuries sustained by active duty service members (ADSM) between the years of 2008-2017, musculoskeletal injuries to the hand and wrist accounted for the third-highest incidence of all acute injuries within the Armed Forces. The prevalence of musculoskeletal (MSK) injuries continues to threaten readiness both in peacetime and combat operations by impacting rates of lost duty time and personnel attrition. Distal upper extremity MSK injury, including the wrist, is a common diagnosis with a high prevalence rate accounting for 40.1% of all non-battle disease injuries. To date, studies exist characterizing MSK injuries within the ADSM population, but none have specifically identified the characteristics of wrist conditions by diagnosis. This study characterized the wrist conditions of ADSM who received outpatient occupational therapy services at a major medical center. The most prevalent wrist diagnoses in active duty service members, the average treatment period, and the average initial, discharge, and change scores on the Quick Disabilities of the Hand, Arm, and Shoulder (DASH) were investigated.

DESIGN: This retrospective study reviewed the charts of ADSMs ages 18-62, who received outpatient occupational therapy services for wrist conditions at a major military medical center from 1 JAN 2016 to 31 DEC 2017.

METHODS: The principal investigator performed a formal data query from the Military Health System Mart database and variable extraction from the Armed Forces Health Longitudinal Technology Application based on wrist diagnosis ICD-10 codes. Demographic and medical-related variables were retrieved from occupational therapy records and analyzed. Outcome variables for this study included: QuickDASH scores, Patient-Specific Functional Scale scores, pain ratings, range of motion (ROM), Semmes Weinstein monofilaments for sensation, grip strength assessment, and length of treatment.

RESULTS: The data query from this review identified 110 subjects who met this study’s inclusion criterion. The demographic variables analyzed included age, gender, and mechanism of injury. The average age of subjects was 36.8±10.06 years of age. Male service members (SM) represent 73% while, and female SM represents 27% of the subject population. The most prevalent wrist conditions were tendinous injuries (34%) followed by ligamentous injuries (24%). The mechanisms of injury identified in the records were categorized into injuries sustained from a fall (18%), injuries from a functional task (18%), sports-related injuries (18%), workout-related injuries (18%), and insidious onsets without injury (28%). There was a strong association between QuickDASH MCID status and D/C disposition (χ2(1) = 10.432, p = 0.001). There was a positive but weak correlation between length of treatment and QuickDASH initial scores that were statistically significant (r2 = 0.1943, p=0.047). Minimal progress was noted on QuickDASH scores, which is due in part to inconsistent administration of this standardized assessment. ADSMs achieved WNL for wrist ROM at discharge despite whether they met the MCID on the QuickDASH.

CONCLUSION: This retrospective review is the first study to characterize specific wrist diagnosis within the ADSM population. The results of this study are essential to OT practice because it demonstrates the need for MSK prevention efforts within the ADSM population based on the most prevalent wrist conditions identified. The type of injury and diagnosis play a major role in the prescription of the treatment plan and the forecast of the expected treatment length. Also, the study highlights the importance of consistent documentation and the completion of standard assessments for an accurate depiction of the effectiveness of OT treatment.

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