Socioeconomic Differences between Sexes in Surgically Treated Carpal Tunnel Syndrome and Ulnar Nerve Entrapment

Zimmerman, Malin; Anker, Ilka; Nyman, Erika

doi:10.3390/epidemiologia3030027

Cited by 4 publications

(5 citation statements)

References 31 publications

(52 reference statements)

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“…Individuals with ≥ 4 weeks of sick leave in the year before surgery had risk for higher QuickDASH scores (> 40). This trend is also noted in nerve entrapment disorders, where increased sick leave predicted worse postoperative QuickDASH scores at 12 months for CTS and ulnar nerve entrapment (UNE) patients 32 . A noticeable correlation emerged between higher QuickDASH scores and being a man with a major nerve trunk injury.…”

Section: Discussionmentioning

confidence: 65%

Socioeconomic factors and outcome after repair and reconstruction of digital and major nerve trunk injuries in the upper limb

Frostadottir,

Perez,

Dahlin

2024

Sci Rep

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Peripheral nerve injuries in the upper limb can lead to substantial disability and pain. We aimed to assess how socioeconomic factors affect outcomes after repaired or reconstructed digital or major nerve trunk injuries in the upper limb. We identified 670 individuals, who underwent surgical nerve repair or reconstruction using sensory nerve autografts, in the Swedish National Quality Registry for Hand Surgery 2010–2018. Socioeconomic factors, including education, cohabitation, type of work, sick leave, immigrant status and income, were gathered from the Swedish statistical agency (www.scb.se) and National Diabetes Register (NDR). We calculated prevalence ratios (PR) to assess the relationship between socioeconomic factors and surgical outcomes for the nerve injuries. Individuals with a major nerve trunk injury had higher QuickDASH scores and lower income compared to those with digital nerve injury. Individuals with immigration background (adjusted PR = 2.0, 95% CI 1.2–3.2), history of > 4 weeks of sick leave the year before surgery (adjusted PR = 1.8, 95% CI 1.1–3.1), or education level below tertiary (adjusted PR = 2.8, 95% CI 1.7–4.7) had significantly higher QuickDASH scores. Recognizing impact of non-biological factors, including immigration, prior sick leave, and education level, on outcome after nerve surgery is crucial for improving prognosis in socioeconomically deprived individuals.

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Section: Discussionmentioning

confidence: 65%

Socioeconomic factors and outcome after repair and reconstruction of digital and major nerve trunk injuries in the upper limb

Frostadottir,

Perez,

Dahlin

2024

Sci Rep

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“…The socioeconomic factor remains predictive for mortality even when adjusting for major health risk behaviors [ 55 , 56 , 57 ]. Socioeconomic factors are also well known to affect the patient’s health and the outcome of orthopedic surgery in general [ 58 ] and ulnar nerve entrapment in particular [ 6 , 7 ]. A low educational level has specifically been shown to be a risk factor for ulnar nerve entrapment [ 59 ].…”

Section: Ulnar Nerve Entrapmentmentioning

confidence: 99%

“…Further on, women with ulnar nerve entrapment are more socioeconomically deprived than men and rate their disabilities greater than men do both before and after surgery. Interestingly, they also improve more with surgery [ 6 , 63 ]. In contrast, male sex and older age have been reported to be associated with a more severe ulnar nerve entrapment at presentation at the outpatient clinic [ 23 , 62 ].…”

Section: Ulnar Nerve Entrapmentmentioning

confidence: 99%

“…Nerve entrapment affecting the ulnar nerve—ulnar nerve entrapment—can be challenging to treat. The symptoms that affected patients present, often with a prominent pain component, may be difficult to judge, and even defining a precise diagnosis of ulnar nerve entrapment is demanding due to the heterogeneities of the patient population, sometimes extensive comorbidity, and influencing socioeconomic factors [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. There are speculations that the ulnar nerve and its large, myelinated nerve fibers are more susceptible to diseases and injuries because of the limited “reserve capacity” of nerve fibers [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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The Unpredictable Ulnar Nerve—Ulnar Nerve Entrapment from Anatomical, Pathophysiological, and Biopsychosocial Aspects

Nyman,

Dahlin

2024

Diagnostics

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Peripheral nerves consist of delicate structures, including a rich microvascular system, that protect and nourish axons and associated Schwann cells. Nerves are sensitive to internal and external trauma, such as compression and stretching. Ulnar nerve entrapment, the second most prevalent nerve entrapment disorder after carpal tunnel syndrome, appears frequently at the elbow. Although often idiopathic, known risk factors, including obesity, smoking, diabetes, and vibration exposure, occur. It exists in all adult ages (mean age 40–50 years), but seldom affects individuals in their adolescence or younger. The patient population is heterogeneous with great co-morbidity, including other nerve entrapment disorders. Typical early symptoms are paresthesia and numbness in the ulnar fingers, followed by decreased sensory function and muscle weakness. Pre- and postoperative neuropathic pain is relatively common, independent of other symptom severity, with a risk for serious consequences. A multimodal treatment strategy is necessary. Mild to moderate symptoms are usually treated conservatively, while surgery is an option when conservative treatment fails or in severe cases. The decision to perform surgery might be difficult, and the outcome is unpredictable with the risk of complications. There is no consensus on the choice of surgical method, but simple decompression is relatively effective with a lower complication rate than transposition.

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“…Manual labor, depression and bilateral surgery have been identified as predictive factors for longer RTW after carpal tunnel release [54][55][56] . A history of longterm sick leave can affect the outcome of surgery after UNE 57 and an increased number of days on sick leave predicts a poorer postoperative outcome (measured using the PROM QuickDASH) in men having surgery for UNE 58 . Studies of sick-leave pattern and time before RTW after surgery for UNE in a real-life setting are scarce but nonetheless an important measure of the outcome of surgery.…”

Section: Surgical Treatment Optionsmentioning

confidence: 99%

Surgery for ulnar nerve compression at the elbow : Focusing on factors influencing outcome

Giöstad

2023

Linköping University Medical Dissertations

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Ulnar nerve compression at the elbow (UNE) is a common peripheral nerve compression disorder in the upper limb. The literature regarding surgical outcome is inconclusive.This thesis aims to highlight various aspects of real-life settings for patients with UNE and to increase the understanding of underlying factors influencing the outcome of surgery.Patients undergoing surgery for UNE at a tertiary referral hospital were retrospectively evaluated (Linköping cohort; n=202). Comorbidity was extensive.Patients treated with simple decompression (SD) had a lower rate of complications than those with transposition surgery. Emerging neurogenic pain was the most common complication, with a two-fold risk for smokers. Scores from the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire revealed no differences between the surgical groups. Satisfaction with surgery was relatively low (53%), however only 8% stated that they would not go through the same surgical procedure again.Images from magnetic resonance imaging (MRI), performed in conjunction with surgery (Linköping cohort; 62 patients), were re-evaluated by a neuroradiologist.Spinal nerve root pathology contributing to the ulnar nerve (C8-Th1) was rare (1/62 patients), however, nerve root affections at other levels were common (26/62). No relation between cervical pathology and patient-reported outcome was seen.The Linköping cohort was combined with two cohorts from Region Skåne to evaluate time before return to work (RTW) after surgery for UNE (n=635 in total). RTW within 6 weeks was more common among older, SD and non-manual workers.Those who were unemployed were on sick leave longer than the rest of the population.Transposition of the ulnar nerve was the only predictor for prolonged RTW in the regression model. Paper V Experiences of living with chronic pain in conjunction with surgery for ulnar nerve compression at the elbowa qualitative studyAim: To explore experiences and consequences of living with chronic pain in conjunction with surgery for UNE.Methods: Purposeful sampling including patients with experience of chronic pain (lasting >3 months) in conjunction with UNE surgery/surgeries. In-depth interviews were carried out and transcribed. The transcripts were read and re-read and subjected to content analysis independently by two people.Results and conclusions: Chronic pain in conjunction with surgery for UNE affects most aspects of daily life and contributes to a heavy burden for the individual. The results clarify the need for a biopsychosocial approach among healthcare personnel when treating patients with UNE.

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Socioeconomic Differences between Sexes in Surgically Treated Carpal Tunnel Syndrome and Ulnar Nerve Entrapment

Cited by 4 publications

References 31 publications

Socioeconomic factors and outcome after repair and reconstruction of digital and major nerve trunk injuries in the upper limb

Socioeconomic factors and outcome after repair and reconstruction of digital and major nerve trunk injuries in the upper limb

The Unpredictable Ulnar Nerve—Ulnar Nerve Entrapment from Anatomical, Pathophysiological, and Biopsychosocial Aspects

Surgery for ulnar nerve compression at the elbow : Focusing on factors influencing outcome

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