INTRODUCTION: The space sector is growing remarkably fast. Its value is expected to increase from $447 billion in 2022 to $2.7 trillion by 2040. The demand for astronauts and astro-civilians is growing, and there will be an increased need for experts who understand the effects of spaceflight on the neuromusculoskeletal (NMSK) system. Orthopedic specialists in space medicine are sparsely reported in the literature, and standards of care for astro-civilians are not well established. This review discusses the current prevalence of peri-flight NMSK injuries in astronauts, the role of orthopedic specialists, and considerations for standards of care for astro-civilians. METHODS: A systematic review using PubMed, MEDLINE, and NASA Technical Report Server was performed to identify original research containing NMSK injuries in astronauts. RESULTS: There were 29 studies included in the review. In 2388 documented injuries, the prevalence of injuries during preflight is 46.5%, in flight is 37.0%, and postflight is 16.5%. In 2081 documented injury locations, the prevalence of injuries in the upper extremity is 32.4%, in the shoulder is 31.4%, in the back is 26.4%, in the lower extremity is 5.5%, and in the neck is 2.3%. DISCUSSION: Common peri-flight injuries involve the shoulder, back, and hand, such as shoulder tendonitis, space adaptation back pain, and herniated nucleus pulposus. It is critical to consider NMSK injuries for the growing space sector. As public interest grows, costs related to space are expected to decrease. Decreased costs increase accessibility to space and, consequently, the risk of NMSK injuries, increasing the demand for medical standards and experts in orthopedics and space medicine. Ward GH, Anderson DN, Scheuring RA. Peri-flight neuromusculoskeletal injuries in astronauts. Aerosp Med Hum Perform. 2025; 96(2):155–167.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram delineating neuromusculoskeletal or orthopedic astronaut injuries in preflight, in-flight, and postflight conditions article selection. Export controlled, courtesy of NASA.
Onycholysis of the second and third hand digits due to spacesuit glove moisture.29 Export controlled, courtesy of NASA.
Cervical spine MRI of symptomatic C7 radiculopathy on the left A) immediately postflight with disc herniation (arrowhead) and damage (arrow) and B) 7-mo postflight with disc herniation (arrow) and no longer symptomatic.12 Export controlled, courtesy of NASA.
EVA 32, ISS EXP 35/56, July 2013; EVAs in space; injuries primarily in the hands and feet due to compression mechanisms; less common incident of a superior labrum anterior and posterior lesion from traction style movement.23 Export controlled, courtesy of NASA.
Depiction delineating common documented neuromusculoskeletal injuries in astronauts and the calculated prevalence of documented data for preflight, in-flight, and postflight injuries and injury locations. Export controlled, courtesy of NASA.
Hamstring tear while performing Advanced Resistive Exercise Device presenting A) clinically as a Grade II tear (arrows) and B) as a Grade I tear under ultrasound (arrows): amt = adductor magnus tendon; ct = conjoint tendon; it = ischial tuberosity; smt = semimembranosus tendon.1 Export controlled, courtesy of NASA.
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