Mwamba Rimel N, Stepan Jeffrey G
The Pritzker School of Medicine, The University of Chicago Medical Center, Chicago, IL.
The Pritzker School of Medicine, The University of Chicago Medical Center, Chicago, IL; Department of Orthopaedic Surgery & Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL.
J Hand Surg Am. 2025 Mar;50(3):292-298. doi: 10.1016/j.jhsa.2024.11.007. Epub 2024 Dec 13.
Cubital tunnel syndrome (CuTS) is the second most common upper-extremity neuropathy and can cause debilitating symptoms. Patients presenting to care with severe CuTS can be left with permanent weakness and numbness despite treatment. The aim of this study was to examine the relationship between area-level deprivation and the severity of CuTS on presentation to a hand surgeon.
We retrospectively identified 369 patients who were diagnosed with CuTS at a new patient visit between January 2017 and December 2021. We queried the electronic health record to assess the severity of CuTS using the McGowan grade. We used patient addresses to determine the national percentile of area-level deprivation for each patient. Bivariate analyses were used to determine if sociodemographic factors were associated with CuTS severity on presentation or rates of surgical intervention.
In bivariate analysis, patients with higher levels of area-level deprivation had more severe CuTS. Those who were older, were men, and had public insurance were also found to have more severe CuTS. Secondary analysis revealed that patients with higher levels of deprivation were more likely to receive nerve conduction testing. No sociodemographic factors were associated with whether patients received surgical intervention or in time from presentation to surgery.
Patients from marginalized backgrounds present to hand surgeons with more severe CuTS disease.
Delayed presentation can lead to worse outcomes in CuTS. Understanding barriers to earlier presentation in more deprived locations and certain patient populations can help develop solutions to address these disparities.
肘管综合征（CuTS）是第二常见的上肢神经病变，可导致使人衰弱的症状。尽管接受了治疗，但因严重CuTS前来就医的患者可能会留下永久性的无力和麻木症状。本研究的目的是探讨地区层面的贫困状况与向手外科医生就诊时CuTS严重程度之间的关系。
我们回顾性地确定了369例在2017年1月至2021年12月期间初诊时被诊断为CuTS的患者。我们查询电子健康记录，使用麦高恩分级来评估CuTS的严重程度。我们利用患者地址确定每位患者在地区层面贫困状况的全国百分位数。采用双变量分析来确定社会人口学因素是否与就诊时CuTS的严重程度或手术干预率相关。
在双变量分析中，地区层面贫困程度较高的患者CuTS病情更严重。还发现年龄较大、男性以及拥有公共保险的患者CuTS病情更严重。二次分析显示，贫困程度较高的患者更有可能接受神经传导测试。没有社会人口学因素与患者是否接受手术干预或从就诊到手术的时间相关。
来自边缘化背景的患者向手外科医生就诊时CuTS病情更严重。
就诊延迟会导致CuTS的预后更差。了解在更贫困地区和某些患者群体中早期就诊的障碍有助于制定解决这些差异的方案。
