{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T18:50:48Z","timestamp":1780599048130,"version":"3.54.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"5-6","license":[{"start":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T00:00:00Z","timestamp":1638576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Health Services Research Program","award":["#HU0001-20-20035 and #HU0001-17-2-0001"],"award-info":[{"award-number":["#HU0001-20-20035 and #HU0001-17-2-0001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Recent epidemiological evidence shows that shoulder and upper-arm complaints impose a substantial burden on the armed forces of the United States and create significant challenges for all components of the physical fitness domain of total force fitness. Clinicians, epidemiologists, and health-services researchers interested in shoulder and upper-arm injuries and their functional limitations rarely have objective, validated criteria for rigorously evaluating diagnostic practices, prescribed treatments, or the outcomes of alternative approaches. We sought to establish and quantify patient volume, types of care, and costs within the Military Health System (MHS) in assessing and managing active duty members with nonoperative shoulder and upper-arm dysfunction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We performed a retrospective cohort study using data from the MHS Data Repository and MHS MART (M2) from fiscal year 2014 to identify active duty individuals with a diagnosis of shoulder and upper-arm injury or impairment defined by one of the International Classification of Disease Ninth Edition diagnosis codes that were selected to reflect nonoperative conditions such as fractures or infections. Statistical analyses include descriptive statistics on patient demographics and clinical visits, such as the range and frequency of diagnoses, number and types of appointments, and clinical procedure information following the diagnosis. We also examined treatment costs related to shoulder dysfunction and calculated the total cost to include medications, radiological, procedural, and laboratory test costs for all shoulder dysfunction visits in 2014 and the average cost for each visit. We further examined the category of each medication prescribed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 55,643 individuals met study criteria and accrued 193,455 shoulder-dysfunction-related clinical visits in fiscal year 2014. This cohort represents approximately 4.8% of the 1,155,183 active duty service members assigned to the United States and its territories during FY 2014. Most patients were male (85.32%), younger (85.25% were under 40\u2009years old), and Caucasian\/White (71.12%). The most common diagnosis code was 719.41 (pain in joint, shoulder region; 42.48%). The majority of the patients 42,750 (76.8%) had four or fewer medical visits during the study period and 12,893 (23.2%) had more than four visits. A total of 4,733 patients (8.5%) underwent arthrocentesis aspiration or injection. The total cost for all visits was $65,066,767.89. The average and median cost for each visit were $336.34 (standard deviation was $1,493.87) and $163.11 (range was from 0 to $84,183.88), respectively. Three out of four patients (75.3%) underwent radiological examinations, and 74.2% of these individuals had more than one radiological examination. Medications were prescribed to 50,610 (91.0%) patients with the three most common being IBUPROFEN (12.21%), NAPROXEN (8.51%), and OXYCODONE-ACETAMINOPHEN (5.04%), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Nearly 1 in 20 active duty military service members presented for nonoperative care of shoulder and\/or upper-arm dysfunction during FY2014. Further examinations of the etiology and potential impact of shoulder\/upper-arm dysfunction on force readiness are clearly warranted, as are additional studies directed at identifying best practices for preventing injury-related dysfunction and determining best practices for the treatment of shoulder dysfunction to optimize service member fitness and force readiness.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab468","type":"journal-article","created":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T09:29:55Z","timestamp":1638696595000},"page":"e1003-e1009","source":"Crossref","is-referenced-by-count":5,"title":["Non-Operative Shoulder Dysfunction in the United States Military"],"prefix":"10.1093","volume":"188","author":[{"given":"Jeffrey C","family":"Leggit","sequence":"first","affiliation":[{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Wu","sequence":"additional","affiliation":[{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miranda","family":"Janvrin","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0314-5171","authenticated-orcid":false,"given":"Jessica","family":"Korona-Bailey","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey Perez","family":"Koehlmoos","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric B","family":"Schneider","sequence":"additional","affiliation":[{"name":"Yale University , New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,4]]},"reference":[{"key":"2023051613475741700_R1","article-title":"Chairman\u2019s total force fitness framework, CJCSI 3405.01","author":"Chairman of the Joint Chiefs of Staff Instruction","year":"2011"},{"issue":"3","key":"2023051613475741700_R2","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/JSA.0000000000000155","article-title":"The epidemiology of glenohumeral joint instability: incidence, burden, and long-term consequences","volume":"25","author":"Cameron","year":"2017","journal-title":"Sports Med Arthrosc"},{"issue":"5","key":"2023051613475741700_R3","doi-asserted-by":"crossref","first-page":"439","DOI":"10.2106\/JBJS.L.00252","article-title":"History of shoulder instability and subsequent injury during four years of follow-up: a survival analysis","volume":"95","author":"Cameron","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"8","key":"2023051613475741700_R4","doi-asserted-by":"crossref","first-page":"900","DOI":"10.7205\/MILMED-D-15-00262","article-title":"Descriptive epidemiology of musculoskeletal injuries in Army 101st Airborne (Air Assault) Division","volume":"181","author":"Lovalekar","year":"2016","journal-title":"Mil Med"},{"issue":"1","key":"2023051613475741700_R5","doi-asserted-by":"crossref","first-page":"64","DOI":"10.7205\/MILMED-D-14-00655","article-title":"Descriptive epidemiology of musculoskeletal injuries in Naval special warfare sea, air, and land operators","volume":"181","author":"Lovalekar","year":"2016","journal-title":"Mil Med"},{"issue":"6","key":"2023051613475741700_R6","first-page":"18","article-title":"Arm and shoulder conditions, active component, U.S. Armed Forces, 2003\u20132012","volume":"20","author":"Armed Forces Health Surveillance Center","year":"2013","journal-title":"Med Surveillance Mon Rep"},{"issue":"18","key":"2023051613475741700_R7","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1136\/bjsports-2015-095771","article-title":"Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomized controlled trials","volume":"50","author":"Haik","year":"2016","journal-title":"Br J Sports Med"},{"issue":"2","key":"2023051613475741700_R8","first-page":"66","article-title":"Nonoperative treatment of rotator cuff tears","volume":"45","author":"Kuhn","year":"2016","journal-title":"Am J Orthop"},{"issue":"7","key":"2023051613475741700_R9","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1177\/0269215515593784","article-title":"A self-managed single exercise program versus usual physiotherapy for rotator cuff tendinopathy: a randomized controlled trial (the SELF study)","volume":"30","author":"Littlewood","year":"2016","journal-title":"Clin Rehab"},{"issue":"10","key":"2023051613475741700_R10","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/00913847.2016.1108883","article-title":"Rotator cuff rehabilitation: current theories and practice","volume":"44","author":"Osborne","year":"2016","journal-title":"Phys Sportsmed"},{"issue":"18","key":"2023051613475741700_R11","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1136\/bjsports-2016-096515","article-title":"Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs","volume":"51","author":"Steiro","year":"2017","journal-title":"Br J Sports Med"},{"issue":"5","key":"2023051613475741700_R12","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.math.2015.03.013","article-title":"Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? 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