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Associations Between Insurance Type and the Presentation of Cubital Tunnel Syndrome

Published:October 12, 2019DOI:https://doi.org/10.1016/j.jhsa.2019.07.011

      Purpose

      In the setting of cubital tunnel syndrome (CuTS), delays in diagnosis can have permanent effects including sensory loss, muscle weakness, and atrophy of intrinsic hand muscles. This study sought to evaluate the association of insurance type on the severity of CuTS. We hypothesized that publicly insured patients will have delayed presentation to the orthopedics office and more significant condition severity.

      Methods

      A retrospective chart review was conducted for all patients evaluated for CuTS between December 2013 and January 2018 by a fellowship-trained orthopedic hand and upper extremity surgeon at our tertiary referral center. Insurance type, demographics, and measures of CuTS severity were compared.

      Results

      Patients presenting with CuTS of severity greater than or equal to McGowan stage 2A had 4.4-fold greater odds of being publicly insured than privately. Motor and sensory velocities across the elbow were diminished at 42.2 ± 13.9m/s and 33.0 ± 20.8m/s in publicly insured patients compared with 47.5 ± 11.3 m/s and 47.0 ± 16.4m/s for privately insured patients. The same trend was present for motor and sensory amplitudes at 6.6 ± 3.8 μV and 16.9 ± 17.8 μV in publicly insured patients compared with 8.5 ± 3.2 μV and 26.0 ± 18.9 μV in privately insured patients. Patients with public insurance were symptomatic for longer prior to their initial visit, on average 82.8 ± 86.5 weeks, compared with 42.4 ± 58.9 weeks for patients with private insurance.

      Conclusions

      Publicly insured patients were significantly delayed in seeing an orthopedic surgeon for evaluation and treatment of CuTS and presented with more severe clinical and electrodiagnostic findings compared with privately insured patients. These findings suggest that insurance type, among other socioeconomic factors, may be a barrier to CuTS care.

      Type of study/level of evidence

      Prevalence IV.

      Key words

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      References

        • Barnett J.C.
        • Berchick E.R.
        Health Insurance Coverage in the United States: 2016.
        U.S. Government Printing Office, Washington, DC2017: 60-260 (Available at:)
        • Kim C.Y.
        • Wiznia D.H.
        • Wang Y.
        • et al.
        The effect of insurance type on patient access to carpal tunnel release under the Affordable Care Act.
        J Hand Surg Am. 2016; 41 (503–309)
        • Labrum J.T.
        • Paziuk T.
        • Rihn T.C.
        • et al.
        Does Medicaid insurance confer adequate access to adult orthopaedic care in the era of the patient protection and Affordable Care Act?.
        Clin Orthop Relat Res. 2017; 475: 1527-1536
        • Zhuang T.
        • Eppler S.L.
        • Kamal R.N.
        Variations in utilization of carpal tunnel release among Medicaid beneficiaries.
        J Hand Surg Am. 2019; 44: 192-200
        • Calfee R.P.
        • Shah C.M.
        • Canham C.D.
        • Wong A.H.W.
        • Gelberman R.H.
        • Goldfarb C.A.
        The influence of insurance status on access to and utilization of a tertiary hand surgery referral center.
        J Bone Joint Surg Am. 2012; 94: 2177-2184
        • Boone S.
        • Gelberman R.H.
        • Calfee R.P.
        The management of cubital tunnel syndrome.
        J Hand Surg Am. 2015; 40: 1897-1904
        • Mallette P.
        • Zhao M.
        • Zurakowski D.
        • Ring D.
        Muscle atrophy at diagnosis of carpal and cubital tunnel syndrome.
        J Hand Surg Am. 2007; 32: 855-858
        • Ibrahim I.
        • Khan W.S.
        • Goddard N.
        • Smitham P.
        Carpal tunnel syndrome: a review of the recent literature.
        Open Orthop J. 2012; 6: 69-76
        • Juratli S.M.
        • Nayan M.
        • Fulton-Kehoe D.
        • Robinson L.R.
        • Franklin G.M.
        A population-based study of ulnar neuropathy at the elbow in Washington State workers’ compensation.
        Am J Ind Med. 2010; 53: 1242-1251
        • Goldberg B.J.
        • Light T.R.
        • Blair S.J.
        Ulnar neuropathy at the elbow: results of medial epicondylectomy.
        J Hand Surg Am. 1989; 14: 182-188
        • Kutner M.
        • Greenberg E.
        • Jin Y.
        • Paulsen C.
        The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–483).
        US Department of Education, Washington, DC2006: 1-21 (Available at:)
        • Goins R.T.
        • Williams K.A.
        • Carter M.W.
        • Spencer S.M.
        • Solovieva T.
        Perceived barriers to health care access among rural older adults: a qualitative study.
        J Rural Health. 2006; 21: 206-213
        • Ponce N.A.
        • Ku L.
        • Cunningham W.E.
        • Brown E.R.
        Language barriers to health care access among Medicare beneficiaries.
        Inquiry. 2006; 43: 66-76
        • Gazmararian J.A.
        • Baker D.W.
        • Williams M.V.
        Health literacy among Medicare enrollees in a managed care organization.
        JAMA. 1999; 281: 545-551
        • Rowland D.
        • Lyons B.
        Medicare, Medicaid, and the elderly poor.
        Health Care Financ Rev. 1996; 18: 61-85
        • Shi Q.
        • MacDermid J.
        • Grewal R.
        • King G.J.
        • Faber K.
        • Miller T.A.
        Predictors of functional outcome change 18 months after anterior ulnar nerve transposition.
        Arch Phys Med Rehabil. 2012; 93: 307-312
        • Biggs M.
        • Curtis J.A.
        Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition.
        Neurosurgery. 2006; 58: 296-304
        • Graham B.
        The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome.
        J Bone Joint Surg Am. 2008; 90: 2587-2593
        • Sonoo M.
        • Menkes D.L.
        • Bland J.D.P.
        • Burke D.
        Nerve conduction studies and EMG in carpal tunnel syndrome: do they add value?.
        Clin Neurophysiol Pract. 2018; 3: 78-88
        • Shi Q.
        • MacDermaid J.C.
        • Santaguida L.
        • Kyu H.H.
        Predictors of surgical outcomes following anterior transposition of ulnar nerve for cubital tunnel syndrome: a systematic review.
        J Hand Surg Am. 2011; 36: 1996-2001
        • Birkmeyer J.D.
        • Reames B.N.
        • McCulloch P.
        • Carr A.J.
        • Campbell W.B.
        • Wennberg J.E.
        Understanding regional variation in the use of surgery.
        Lancet. 2013; 382: 1121-1129
        • Skinner J.
        Causes and consequences of regional variations in health care.
        in: Pauly M.V. McGuire T.G. Barros P.P. Handbook of Health Economics. Elsevier B.V., Waltham, MA2011: 45-93
        • Matsuzaki H.
        • Yoshizu T.
        • Maki Y.
        • Tsubokawa N.
        • Yamamoto Y.
        • Toishi S.
        Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome.
        J Hand Surg Am. 2004; 29: 373-378
        • Mowlavi A.
        • Andrews K.
        • Lille S.
        • Verhulst S.
        • Zook E.G.
        • Milner S.
        The management of cubital tunnel syndrome: a meta-analysis of clinical studies.
        Plast Reconstr Surg. 2000; 106: 327-334
        • Menendez M.E.
        • Mudgal C.S.
        • Jupiter J.B.
        • Ring D.
        Health literacy in hand surgery patients: a cross-sectional survey.
        J Hand Surg Am. 2015; 40: 798-804
        • Cook J.A.
        • Sasor S.E.
        • Tholpady S.S.
        • Momeni A.
        • Chu M.W.
        Hand surgery resources exceed American health literacy.
        Hand (N Y). 2018; 13: 547-551