Radiolucent shrapnel injuries in war veterans: a retrospective clinical observational study from a rehabilitation medicine perspective

The objective of this study was to describe clinical presentation patterns, diagnostic challenges, and rehabilitation-related implications associated with suspected radiolucent retained shrapnel injuries in war veterans undergoing post-acute rehabilitation. A retrospective clinical observational design was used. Medical records of 93 blast-exposed veterans referred for rehabilitation between 2020 and 2022 were screened. Sixty-one patients with radiographic evidence of metallic retained foreign bodies were excluded, leaving a cohort of 32 male veterans aged 19-43 years with negative plain radiographic findings for metallic fragments. Patients were evaluated 3-18 months after injury. Persistent focal pain was documented in 30 patients (94%) and was frequently reproducible on deep palpation. Reduced tolerance to therapy intensity occurred in 22 patients (69%), and delayed progression through standard rehabilitation protocols was observed in 18 patients (56%). Rehabilitation program modifications were required in 21 patients (66%), including reduction or avoidance of aggressive manual therapy, transition to symptom-guided therapy intensity, avoidance of deep tissue techniques, and extension of rehabilitation duration. By the end of the rehabilitation period, most patients demonstrated gradual functional improvement despite intermittent localized symptoms in some cases. These findings indicate that veterans undergoing rehabilitation after blast exposure may experience persistent focal symptoms and delayed functional recovery despite negative radiographic imaging. From a rehabilitation perspective, careful clinical assessment and individualized symptom-guided rehabilitation strategies are essential when diagnostic uncertainty related to suspected radiolucent retained foreign bodies affects functional recovery.