Muscle Injury Tutorial

No matter the age or skill level of an individual, participation in stressful physical activity puts demands on the body that can lead to pain and injury. Muscles can be injured by several different mechanisms with separate pathologic processes. These muscle injury tutorials provide information on common injuries that occur to the muscle and related structures, particularly in highly physical situations. A discussion of sprains, strains and contusions as well as conditions that affect the rotator cuff are discussed in regards to information that is relevant to rating personnel.

Gulf War Syndrome/Illness

According to the Under Secretary for Health (Garthwaite, 2001) "care of Gulf War veterans has remained challenging." Those that served in the Gulf War were exposed to various environmental agents and have significant health problems. These health problems have now been labeled, Gulf War syndrome/illness. The Centers for Disease Control (CDC) defines a case of Gulf War syndrome/illness as having one or more chronic syndromes (for more than 6 months) from at least two of three categories—fatigue, mood-cognition and/or musculoskeletal. This tutorial further expands on the definition of Gulf War syndrome/illness and provides information on how the condition is diagnosed, its signs and symptoms, treatment and prognosis.

Agent Orange & Related Illnesses (including Diabetes)

Agent Orange, an herbicide blend, was used in Vietnam to kill unwanted plants and to remove leaves from trees which provided cover for the enemy. The name Agent Orange came from the orange stripe on the gallon drums. One of the chemicals in Agent Orange contained minute traces of the chemical TCDD or dioxin. Studies have suggested that this chemical may be related to a number of conditions and disorders. A registry for Vietnam veterans who were concerned about the possible health effects of exposure to Agent Orange was established. The components of the registry are described in the Agent Orange tutorial as well as body systems that are given particular attention during a health examination. Moreover, conditions or diseases that have been presumptively associated with exposure to the herbicide are presented.

Health Effects from Chemical, Biological, and Radiological Weapons

The tutorials on "Health Effects of Chemical, Biological and Radiological Weapons" address the most prevalent materials likely to be used within each category, with a focus on the health implications and manifestations that a rater may address during a veterans medical chart and case history review. The subject matter was developed by reviewing topics from the Veterans Health Initiative (VHI) web site, and other related sources, in order to provide the rater with a consolidated version of health effects on each topic as they may relate to military service, and assist the rater to better serve the veteran more expeditiously.

Susceptibility of exposure to chemical agents is relatively easy through the environment, personal use, or occupational settings. The chemical weapons tutorial discusses classification of chemical agents and the three primary types of agents most likely to be used in military operations, and non-military terrorist attacks. The physiological process that occurs once exposure has taken place, and acute and chronic manifestations that may result from exposure to these agents is addressed in this tutorial.

The primary groups of biological agents that are the greatest concern to humans are the germs that cause anthrax, smallpox, plague, botulism, tularemia, and viral hemorrhagic fever. In the hands of terrorists, anthrax and smallpox pose the greatest threat of widespread illness due to their ease of dissemination, transmission, ability to produce a high mortality rate, and potential for extreme social disruption.

Radiological Weapons

Historically, many veterans have been exposed or contaminated with various forms of radiation over the course of military service. Today the use of nuclear weapons by terrorists is less likely than in the past, though still possible, due to the difficulty of obtaining the necessary components and the underlying critical technology required to make a nuclear weapon. More favorable and simpler weapons created from radioactive materials are much more accessible to terrorists, maintaining the potential for widespread radiological contamination.

Other Specific Environmental Hazards

Sulfur Fire

On June 24, 2003 roughly 42 million pounds of sulfur dioxide (SO2) per day as well as release of hydrogen sulfide (H2S) in Northern Iraq, and from late 2004 through February 2007 exposure to the Mishraq State Sulfur Mine Fire was reported.

• polycyclic aromatic hydrocarbons formed during the incomplete burning of coal, oil and gas, garbage, or other organic substances
• volatile organic compounds (VOCs) emitted as gases from certain solids or liquids, and
• toxic organic halogenated dioxins and furans to include those associated with tactical herbicide use in Vietnam.

Camp Lejeune, North Carolina- drinking water contaminated with VOCs. Contaminants included:

• tricholoroethylene (TCE)
• perchloroethylene (PCE)
• benzene
• vinyl chloride, and
• other VOCs.

Chromium VI in sodium dichromate is a lung carcinogen through inhalation and an acidic compound that can cause immediate irritation to the eyes, nose, sinuses, lungs, and skin. Particulate Matter is made up of a number of components to include:

• acids (such as nitrates and sulfates)
• organic chemicals
• metals, and
• soil or dust particles.

Shrapnel (Trauma) Wounds

In the changing face of strategical combat in recent and current wars, the increased use of improvised explosive devices (IED) and roadside bombs have contributed to the threat of shrapnel injury to military personnel. This tutorial discusses the most common injuries, pathophysiological response, and those body systems most often affected by trauma from shrapnel penetration. Moreover, methods to determine possible outcomes of injury and the long-term consequences of injury are also addressed.

POW Medical Issues

Former Prisoners of War (POWs) have been mistreated and killed since the beginning of recorded history. Studies indicated that life-long effects on health, social and vocational adjustment, and increased vulnerability to psychological stress results from endless fears faced by imprisoned American service members as a result of the physical hardships, and psychological abuse endured by POWs.

In addition, the length of captivity, the promptness of implementing treatment, and the duration of treatment may all have an impact on a former POWs ability to face additional obstacles once returned to their pre-war lives.

Infectious Diseases

Infectious diseases that afflicted the geographic areas of western Asia during the Gulf War pose the same risk of infecting military personnel in Iraq today. Prior experience with these various communicable diseases during the Gulf War has assisted in the implementation of greater countermeasure defenses against mass outbreaks within the military community in Iraq, thus decreasing the incapacitation of troops.

Regardless of preventive measures taken, such as vaccinations, a small percentage of veterans will return from overseas deployments with unusual illnesses. Some veterans will return from hazardous military deployments with serious symptoms difficult to diagnose. Historically, after every major military conflict some form of chronic symptoms have arisen.

Different types of infectious diseases to include those causing acute and chronic illnesses and those putting military personnel at risk in the Iraqi environment are included in this tutorial. Route of transmission and correlating diseases including symptomatology and complications are also discussed and links to additional resources are provided.

Heat Injuries

A discussion of heat-related conditions that are the result of a heat injury, heat illness, or exertional heat illness is presented. The discussion highlights the differences in heat-related conditions that are often referred to as classic or exertional heat injury or heat illness. Heat illness and heat injury are used synonymously to discuss the most frequently occurring heat-related conditions, heat exhaustion and heatstroke. It should be noted that not every person will present with all of the signs and symptoms for the suspected condition due to possible differences in pathophysiological responses to the same physiologic heat stress. Classifications, categories and or groupings of heat-related conditions may differ between health care facilities, and/or health care providers.

Post-Viral Syndrome

A condition classified by the World Health Organization (WHO) as a disease of the nervous system, Post-viral syndrome is a complex compilation of many named illnesses and symptoms, the most prevalent of which is muscle fatigability, characterized by three main categories.

This tutorial reveals specific diagnostic criteria, and symptomatology exemplified within three main categories. Also included are the association between this condition and US veterans returning from war, the insidious long-term effects on ones life, and current treatment measures that are available to alleviate symptoms and promote quality of life while living with this condition.

Post-Polio Syndrome

The Post-polio syndrome tutorial discusses the affects of the disorder on individuals long after one has succumbed to an initial poliovirus attack. Though this disorder may be marked by long periods of stability, it has a slow, progressive and unpredictable course that is difficult to diagnose, and leads to permanent lifestyle changes.

Silicosis and other conditions secondary to harmful inhalants

Of all the dust diseases, or pnuemoconioses, silicosis produces the largest number of victims. According to the World Health Organization (WHO), silicosis, one of the oldest occupational diseases, still kills thousands of people every year everywhere in the world. This tutorial provides important information on silicosis, asbestosis (another common respiratory disease caused by an inhalant) and pleural effusion a condition that commonly occurs secondary to silicosis and asbestosis.