Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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A high number of veterans with lower limb amputations presented with upper limb nerve entrapment syndromes. Careful attention to these nerve entrapment syndromes in lower limb amputees is necessary because the symptoms may be confounded by other chronic pain-related disorders.

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Abstract-This clinical report describes the outpatient reha bilitation program for patients with multiple limb amputations enrolled in the Comprehensive Combat and Complex Casualty Care facility at the Naval Medical Center San Diego. Injuryspecific data for 29 of these patients wounded by blast weap onry in Afghanistan in 2010 or 2011 were captured by the Expeditionary Medical Encounter Database at the Naval Health Research Center and were reviewed for this report. Their median Injury Severity Score was 27 (N = 29; range, 11-54). Patients averaged seven moderate to serious injuries (Abbreviated Injury Scale scores 2), including multiple inju ries to lower limbs and injuries to the torso and/or upper limbs. All patients received care from numerous clinics, particularly physical therapy during the first 6 mo postinjury. Clinic use generally declined after the first 6 mo with the exception of prosthetic devices and repairs. The clinical team implemented the Mayo-Portland Adaptability Inventory, 4th Revision (MPAI-4) to assess functioning at outpatient program initiation and discharge (n = 23). At program discharge, most patients had improved scores for the MPAI-4 items assessing mobility, pain, and transportation, but not employment. Case reports described rehabilitation for two patients with triple amputa tions and illustrated multispecialty care and contrasting solu tions for limb prostheses.