Duke Orthopaedic Faculty Advance Understanding of Shoulder Disorder Care in Military Health System

Healthcare Use Patterns for High-Volume Musculoskeletal Shoulder Disorders: Insights from a Landmark Study
horn george
Maggie E. Horn, PT, DPT, PhD and Steven Z. George, PT, PhD

A new publication co-authored by Duke Orthopaedic Surgery faculty members Steven Z. George, PT, PhD, and Maggie E. Horn, PT, DPT, PhD, and colleagues sheds light on how patients with common shoulder disorders use healthcare services within the U.S. Military Health System. The study, titled “Healthcare Use Patterns for High Volume Musculoskeletal Shoulder Disorders: A Longitudinal Cohort from the U.S. Military Health System,” was recently published in Clinical Epidemiology (Volume 2025:17, Pages 1049–1060). Read the full article here.

This research addresses a critical gap in understanding treatment pathways for musculoskeletal shoulder conditions—one of the most frequent causes of pain and disability among active-duty service members and veterans. By analyzing longitudinal data from the Military Health System, the team identified patterns in healthcare utilization, including diagnostic imaging, physical therapy, surgical interventions, and medication use.

"Our findings provide a clearer picture of how care is delivered for shoulder disorders in a large, integrated health system. This knowledge is essential for identifying opportunities to improve efficiency and ensure patients receive the right care at the right time," said Steven Z. George, PT, PhD, professor in the Department of Orthopaedic Surgery at Duke.

Key Findings:

  • Shoulder disorders represent a significant burden in military populations, often requiring multi-modal care.
  • Utilization patterns varied based on diagnosis type, patient demographics, and care setting.
  • The study highlights opportunities to optimize care delivery, reduce unnecessary interventions, and improve outcomes.

Why It Matters:
Musculoskeletal injuries are among the leading causes of limited duty and medical discharge in the military. Understanding how patients navigate care systems can inform evidence-based guidelines, improve resource allocation, and enhance patient-centered care for both military and civilian populations.

"By examining real-world data from the Military Health System, we can better understand treatment patterns and identify gaps in care. These insights are critical for developing strategies that improve outcomes and reduce unnecessary costs," said Maggie E. Horn, PT, DPT, PhD, assistant professor in the Department of Orthopaedic Surgery at Duke.

Collaborators on the Study:

  • Nrupen A. Bhavsar (Duke Population Health Sciences)
  • Steven Z. George, PT, PhD (Duke Orthopaedic Surgery)
  • Maggie E. Horn, PT, DPT, PhD (Duke Orthopaedic Surgery)
  • Sarah Morton-Oswald, Hui-Jie Lee (Uniformed Services University)
  • Daniel I. Rhon (Brooke Army Medical Center), Senior Author

This work underscores Duke’s commitment to advancing musculoskeletal research and improving care strategies for diverse patient populations.

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