From the Guidelines
Shoulder injuries in Air Assault personnel most commonly include fractures, soft-tissue injuries such as rotator cuff tears, and joint instability, which can be managed with a combination of conservative treatment and surgical intervention when necessary. The management of these injuries should prioritize reducing morbidity, mortality, and improving quality of life. According to 1, traumatic shoulder pain can result from either fracture (of the clavicle, scapula, or proximal humerus) or soft-tissue injury (most commonly of the rotator cuff, acromioclavicular ligaments, or labroligamentous complex).
Common Injuries
- Fractures: These can include fractures of the clavicle, scapula, or proximal humerus, which may require acute surgical treatment if unstable or significantly displaced 1.
- Soft-tissue injuries: These include rotator cuff tears, acromioclavicular ligament injuries, and labroligamentous complex injuries, which can often be managed conservatively before considering surgery 1.
- Joint instability: This can result from severe injuries and may require acute surgical treatment to restore joint stability and prevent further morbidity 1.
Diagnosis and Management
Diagnosis of traumatic shoulder injuries can often be made based on clinical examination, radiography, and the mechanism of injury 1. Imaging assessment may include conventional radiography, MRI or MR arthrography for soft-tissue injuries, and CT for fracture delineation 1. Management should focus on reducing pain and inflammation, restoring function, and preventing further injury.
Prevention and Treatment
Preventative measures include:
- Proper technique during rappelling, fast-roping, and helicopter operations
- Adequate strength training to build shoulder strength and endurance
- Thorough warm-up before operations
- Maintaining proper body positioning during rappelling
- Using appropriate equipment that fits correctly
- Progressive training to build shoulder strength and endurance
For acute shoulder pain, a regimen of rest, ice, compression, and elevation (RICE) is recommended, along with non-steroidal anti-inflammatory drugs (NSAIDs) for 7-10 days to reduce inflammation and pain. Physical therapy exercises focusing on rotator cuff strengthening and scapular stabilization should be incorporated into regular training. Soldiers should seek medical attention if pain persists beyond two weeks, if there is significant weakness or inability to raise the arm, or if there are signs of instability like recurrent dislocations.
From the Research
Common Shoulder Injuries in Air Assault Personnel
- Traumatic anterior shoulder dislocations are common in Air Assault personnel, and the initial dislocation can cause permanent anatomic and biomechanical alterations to the glenohumeral joint, increasing the likelihood of further events 2
- Recurrent instability is a significant concern, and immediate surgical stabilization is often the best evidence-based approach for first-time traumatic dislocations, especially when combined with a remplissage in high-risk circumstances 2
Epidemiology of Musculoskeletal Injuries
- A study on the 101st Airborne (Air Assault) Division found that musculoskeletal injuries affected the lower extremity (60.2% of injuries), with common anatomic sublocations being the ankle (17.3%) and knee (15.0%) 3
- However, this study does not provide specific information on shoulder injuries in Air Assault personnel
Injuries during Military Parachuting Training and Airborne Operations
- A comparative retrospective study found that operational static-line jumps are more associated with serious injuries than training ones, and knee injuries were more common during operational jumps, but upper limb injuries were less common 4
- Although this study does not specifically address shoulder injuries, it highlights the increased injury rate during airborne operations
Prevention and Rehabilitation of Musculoskeletal Injuries
- Musculoskeletal injuries are a major concern in military operations and training, and understanding the types of injuries and mechanisms responsible is essential for developing strategies to reduce injury incidence and allocate resources for rehabilitation 5
- However, this study does not provide specific information on shoulder injuries in Air Assault personnel
Spine-Area Pain in Military Personnel
- Spine-area pain is a common disabling injury in service members, and risk factors specific to military personnel include concomitant psychological trauma, g-force exposure, and heavy combat load requirements 6
- Although this study focuses on spine-area pain, it does not address shoulder injuries in Air Assault personnel