Perceived barriers and facilitators to implementation of injury prevention programs in the military: Feedback from inside the trenches.

Background: Musculoskeletal injuries enact a substantial burden in military settings, incurring high costs, long-term disability, and impacting military readiness. This has led to a prioritization of injury prevention programs. Understanding the challenges faced by those trying to implement these programs could help standardize and better inform future efforts.

A rare case of peritoneal coccidioidomycosis.

Coccidioidomycosis, also known as valley fever, is a fungal infection that can develop after inhalation of arthroconidia from soil. Coccidioidomycosis infections are most common in the southwestern United States and typically involve the lungs. Risk factors for extrapulmonary spread, which can be life-threatening, include older age, diabetes, HIV and AIDS, late-term pregnancy, immunosuppressant drug use and African or Filipino ancestry.

Missingness and algorithmic bias: an example from the United States National Outbreak Reporting System, 2009-2019.

Growing debates about algorithmic bias in public health surveillance lack specific examples. We tested a common assumption that exposure and illness periods coincide and demonstrated how algorithmic bias can arise due to missingness of critical information related to illness and exposure durations. We examined 9407 outbreaks recorded by the United States National Outbreak Reporting System (NORS) from January 1, 2009 through December 31, 2019 and detected algorithmic bias, a systematic over- or under-estimation of foodborne disease outbreak (FBDO) durations due to missing start and end dates.

Using Kern's Model to Redesign a Postgraduate Curriculum for Orthopaedic Physician Assistants.

Postgraduate physician assistant (PA) specialty training expands entry-level education, allowing PAs to work in concentrated fields. The United States Army - Baylor University Doctor of Science in PA Studies Orthopaedics program provides formal education to fill the capability gap caused by surgeon shortages in the military. Based on several sources of feedback, the authors recognized that the curriculum needed modernization and set forth to rewrite the curriculum.

Prospective Assessment of Clinical Tests Used to Evaluate Tibial Stress Fracture.

Background: Tibial stress fracture (SFx) is the most common SFx of the lower extremity. Presently, diagnostic accuracy of clinical examination techniques for tibial SFx remains suboptimal.

Purpose: To assess the diagnostic effectiveness of 5 clinical tests for tibial SFx individually versus a test item cluster.

Utilization of Neurophysiological Classification Systems in Determining Interventions for Patients with Carpal Tunnel Syndrome.

Background: Median mononeuropathy at or distal to the wrist, or carpal tunnel syndrome (CTS), is the most common peripheral nerve compression disorder in the upper extremity. Neurophysiological classification systems for patients with CTS have been developed and implemented to provide health care providers an enhanced system of electrophysiological evaluation with a grading scale, so that they may evaluate their patients with CTS within a system that confers relative severity. Electrophysiological data collected within these classification systems includes either nerve conduction studies (NCS), or both NCS and electromyography (EMG) test results.

DRY NEEDLING AND PHYSICAL THERAPY VERSUS PHYSICAL THERAPY ALONE FOLLOWING SHOULDER STABILIZATION REPAIR: A RANDOMIZED CLINICAL TRIAL.

Background: Post-operative range of motion (ROM) loss and pain can limit quality of life, prolong functional return to activity, and may be sport/career threatening. Dry needling (DN) is intended assist in the treatment of these complaints.

Purpose: To determine if the addition of upper quarter DN to a rehabilitation protocol is more effective in improving ROM, pain, and functional outcome scores when compared to a rehabilitation protocol alone after shoulder stabilization surgery.

STEMI in a patient with mirror-image dextrocardia.

ST-segment elevation myocardial infarction (STEMI) is a potentially life-threatening diagnosis that cannot be missed on ECG interpretation. However, ECG interpretation may not be straightforward in patients with dextrocardia. This case report discusses the presentation of a patient with situs inversus with dextrocardia who was found to have an acute inferior MI, and how this anatomical change results in an atypical ECG and clinical presentation.

The effects of cryotherapy on quadriceps electromyographic activity and isometric strength in patient in the early phases following knee surgery.

Purpose: To determine the effects of cryotherapy on quadriceps electromyographic (EMG) activity and isometric strength in early postoperative knee surgery patients.

Methods: Twenty-two volunteers with recent knee surgeries were included. EMG readings of the vastus medialis (VM), rectus femoris (RF), and vastus lateralis (VL) from the surgical leg were collected during a maximal voluntary quadriceps setting (QS) activity.

Effectiveness of Physical Therapy Combined With Epidural Steroid Injection for Individuals With Lumbar Spinal Stenosis: A Randomized Parallel-Group Trial.

Objective: To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).

Design: Randomized clinical trial.

Setting: Orthopedic spine clinics.

An uncommon cause of vision loss: Leber hereditary optic neuropathy.

Leber hereditary optic neuropathy (LHON) is a rare mitochondrial genetic disorder characterized by painless acute or subacute vision loss that develops during adolescence. Clinicians should know how to identify potential LHON and when to refer patients to a neuro-ophthalmologist for diagnosis and treatment. This case highlights the value of a thorough family history in ED patients.

Injury Surveillance and Reporting for Trainees with Bone Stress Injury: Current Practices and Recommendations.

Background: Musculoskeletal injuries, including lower extremity bone stress injuries (BSI) significantly impact initial entry training (IET) in the U.S. Army due to limited duty days, trainee attrition, early medical discharge, and related financial costs.

Effects of technique-focused training in conjunction with physical readiness training on Army physical fitness test performance.

The Army Physical Fitness Test (APFT) is a semiannual requirement. While conducting physical readiness training (PRT) is a requirement for all Soldiers, there is no requirement to train Soldiers on techniques that may help to optimize their performance on the APFT. A cohort of 34 officers that attended the Army Medical Department Basic Officer Leadership Course completed a technique-focused training program in conjunction with their required PRT program subsequent to failing one or more events on their initial APFT.

Real time interrater reliability of a novel musculoskeletal readiness screening tool.

Unlabelled: Military service members receive regular screenings for a variety of health conditions, but a field-expedient and military-specific screening tool that identifies an individual's risk for injury has not yet been identified. The purpose of this study is to describe the conduct of a novel musculoskeletal readiness screening tool (MRST) and evaluate the real-time interrater reliability of the MRST when scored by raters with differing levels of medical experience.

Materials/methods: This study included a convenience sample of 40 active duty military participants (30 male, 10 female, mean age 29.

Characterization of Head-Trunk Coordination Deficits After Unilateral Vestibular Hypofunction Using Wearable Sensors.

Importance: Individuals with vestibular hypofunction acutely restrict head motion to reduce symptoms of dizziness and nausea. This restriction results in abnormal decoupling of head motion from trunk motion, but the character, magnitude, and persistence of these deficits are unclear.

Objective: To use wearable inertial sensors to quantify the extent of head and trunk kinematic abnormalities in the subacute stage after resection of vestibular schwannoma (VS) and the particular areas of deficit in head-trunk motion.

Cadaveric and Ultrasonographic Validation of Needling Placement in the Cervical Multifidus Muscle.

Objective: The aim of this study was to determine if a needle is able to reach the cervical multifidus during the application of dry needling or acupuncture.

Methods: Dry needling and ultrasound imaging of cervical multifidi was conducted on 5 patients (age: 32 ± 5 years) with mechanical neck pain and on 2 fresh cadavers (age: 64 ± 1 years). Dry needling was done using a needle of 40 mm in length inserted perpendicular to the skin about 1 cm lateral to the spinous process at C3-C4.

PERTINENT DRY NEEDLING CONSIDERATIONS FOR MINIMIZING ADVERSE EFFECTS - PART TWO.

Background: Dry needling (DN) is an evidence based treatment technique that is accepted and used by physical therapists in the United States. This clinical commentary is the second in a two-part series outlining some of the pertinent anatomy and other issues that are needed for optimal utilization of this treatment modality. Part one was an overview of the thorax with a summary of reported adverse effects (AEs) and the underlying anatomy that could be used to minimize patient risk.

THE EFFECTIVENESS OF DRY NEEDLING AND STRETCHING VS. STRETCHING ALONE ON HAMSTRING FLEXIBILITY IN PATIENTS WITH KNEE PAIN: A RANDOMIZED CONTROLLED TRIAL.

Background: Recently, dry needling has emerged as a popular treatment for muscular pain and impairments. While there are numerous studies detailing the benefits of dry needling for pain, few studies exist examining the effects on soft tissue mobility.

Purpose: The purpose of this study was to determine if the addition of hamstring dry needling to a standard stretching program results in greater improvements in hamstring flexibility compared to sham dry needling and stretching in subjects with atraumatic knee pain.

Application of Athletic Movement Tests that Predict Injury Risk in a Military Population: Development of Normative Data.

Unlabelled: Performance on movement tests helps to predict injury risk in a variety of physically active populations. Understanding baseline measures for normal is an important first step.

Objectives: Determine differences in physical performance assessments and describe normative values for these tests based on military unit type.

Exercises and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial.

Unlabelled: This randomized clinical trial investigated the effectiveness of exercise versus exercise plus trigger point (TrP) dry needling (TrP-DN) in subacromial pain syndrome. A randomized parallel-group trial, with 1-year follow-up was conducted. Fifty subjects with subacromial pain syndrome were randomly allocated to receive exercise alone or exercise plus TrP-DN.

Association of Physical Inactivity, Weight, Smoking, and Prior Injury on Physical Performance in a Military Setting.

Context:  Although inactivity, being overweight, smoking, and a history of injury are identified as risk factors for poor health and injury, few authors have examined their association on physical performance. Young adults may be more likely to adopt healthier lifestyles if they understand the effect of health behaviors on performance.

Objective:  To determine the association of being overweight, smoking, inactivity, and a history of injury with physical performance.