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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Article info
Publication history
Published online: October 12, 2019
Accepted:
July 23,
2019
Received:
September 28,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
