Division of Occupational and Environmental Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA.
Am J Ind Med. 2010 Dec;53(12):1242-51. doi: 10.1002/ajim.20866.
There are no population-based studies of return to work after ulnar neuropathy at the elbow (UNE). We examine the predictors of return to work following a diagnosis of work-related UNE.
Workers diagnosed with work-related UNE between 1995 and 2000 were identified from the administrative records of the Washington State workers' compensation system (n = 2,863). The medical records of 250 randomly selected surgical cases were reviewed. The end of wage replacement, our primary outcome, is a surrogate marker of the potential ability to return to work. Cox proportional hazards regression analyses were used to model duration of wage replacement as a function of select sociodemographic, clinical, electrodiagnostic, and disability predictors.
The mean wage replacement and medical benefits paid per case were $19,100 and $15,200, respectively. Older age, concomitant carpal tunnel syndrome, receipt of wage replacement benefits prior to diagnosis, and longer diagnostic delays were associated with lower return to work potential after injury. Type of treatment (surgical or conservative care) was not associated with return to work. Among surgically treated workers, receipt of wage replacement before establishing a diagnosis was inversely associated with return to work in multivariate models that included clinical severity and electrodiagnostic criteria.
Work-related UNE is a common and costly occupational health challenge. Efforts to accurately diagnose UNE and maximize functional recovery should start in the first medical encounter. Older workers, those who have concomitant carpal tunnel syndrome, or who are already receiving wage replacement benefits at the time of diagnosis deserve special attention.
目前尚无针对肘部尺神经病变（UNE）患者重返工作岗位的基于人群的研究。我们研究了与工作相关的 UNE 诊断后重返工作岗位的预测因素。
我们从华盛顿州工人赔偿系统的管理记录中确定了 1995 年至 2000 年间被诊断为与工作相关的 UNE 的工人（n=2863）。对 250 例随机选择的手术病例的医疗记录进行了审查。工资替代的结束是我们的主要结果，是潜在工作能力的替代指标。使用 Cox 比例风险回归分析来建立工资替代的持续时间与选择的社会人口统计学，临床，电诊断和残疾预测因素的函数关系。
平均工资替代和每个病例支付的医疗福利分别为$19100 和$15200。年龄较大，同时患有腕管综合征，在诊断前获得工资替代福利以及诊断延迟时间较长与受伤后工作能力恢复较差有关。治疗类型（手术或保守治疗）与工作恢复无关。在接受手术治疗的工人中，在确诊前获得工资替代与在包括临床严重程度和电诊断标准的多变量模型中恢复工作呈负相关。
与工作相关的 UNE 是一种常见且代价高昂的职业健康挑战。应在首次医疗就诊时就开始努力准确诊断 UNE 并最大程度地恢复功能。应特别关注老年工人，那些同时患有腕管综合征或在诊断时已经获得工资替代福利的工人。
