Feuerstein M, Miller V L, Burrell L M, Berger R
Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
J Occup Environ Med. 1998 Jun;40(6):546-55. doi: 10.1097/00043764-199806000-00007.
Upper extremity disorders (UEDs) account for a significant number of work-related illnesses in the US workforce. Little information exists on the distribution of UEDs, their associated health care and indemnity costs, or patterns of work disability. The study presented is an analysis of upper extremity claims within the federal workforce. In this study, the universe consisted of all claims accepted by the US Department of Labor, Office of Workers' Compensation Programs (OWCP), from October 1, 1993, through September 30, 1994. A total of 185,927 claims of notices of injury were processed during the study period, and of these, 8,147 or 4.4% had an UED diagnosis coded according to the International Classification of Diseases, Clinical Modification (ICD-9-CM). 5,844 claims involved a single UED diagnosis and were the only claims field by these employees between October 1, 1990, and September 30, 1994. These single claims with single diagnoses comprised the sample for further analysis. Mononeuritis and enthesopathies of the upper limb were the most common diagnoses, accounting for 43% and 31% of the claims, respectively. Women had a higher proportion of carpal tunnel syndrome, "unspecified" mononeuritis, and "unspecified" enthesopathies. The majority of claimants for both the mononeuritis- and enthesopathy-related diagnoses were between 31 and 50 years of age, received only health care benefits, and did not incur wage loss. Health care costs for mononeuritis and enthesopathy claims were $12,228,755 (M = $2,849). Carpal tunnel syndrome (CTS) and enthesopathy of the elbow were the most costly diagnoses, accounting for 57% and 16% of the total, respectively. Surgical services represented the highest expenditures in CTS claims. Physical therapy accounted for the majority of health care costs for enthesopathy cases. The mean number of workdays lost for CTS and enthesopathy claims were 84 and 79, and the average indemnity costs were $4,941 and $4,477, respectively. These findings indicate that while UEDs represent a relatively small percentage of all workers' compensation cases, the health care and indemnity costs are considerable. Also mean duration and pattern of work disability revealed that these disorders can result in chronic work disability similar to that observed in low back pain. The results highlight the need to determine whether interventions that account for the majority of costs significantly impact long-term outcomes. There is also a need to identify risk factors for prolonged disability in those who experience problems with delayed recovery.
上肢疾病（UEDs）在美国劳动力中占了相当数量的与工作相关的疾病。关于上肢疾病的分布、其相关的医疗保健和赔偿成本，或工作残疾模式的信息很少。所呈现的这项研究是对联邦劳动力中的上肢索赔进行的分析。在本研究中，总体包括美国劳工部工人赔偿计划办公室（OWCP）在1993年10月1日至1994年9月30日期间接受的所有索赔。在研究期间共处理了185,927份受伤通知索赔，其中8,147份（4.4%）根据国际疾病分类临床修订版（ICD - 9 - CM）编码有上肢疾病诊断。5,844份索赔涉及单一的上肢疾病诊断，并且是这些员工在1990年10月1日至1994年9月30日期间提交的唯一索赔。这些单一诊断的单一索赔构成了进一步分析的样本。单神经炎和上肢附着点病是最常见的诊断，分别占索赔的43%和31%。女性患腕管综合征、“未特指”单神经炎和“未特指”附着点病的比例更高。与单神经炎和附着点病相关诊断的大多数索赔者年龄在31至50岁之间，仅获得医疗保健福利，且未遭受工资损失。单神经炎和附着点病索赔的医疗保健成本为12,228,755美元（中位数 = 2,849美元）。腕管综合征（CTS）和肘部附着点病是成本最高的诊断，分别占总数的57%和16%。手术服务在腕管综合征索赔中支出最高。物理治疗占附着点病病例医疗保健成本的大部分。腕管综合征和附着点病索赔的平均误工天数分别为84天和79天，平均赔偿成本分别为4,941美元和4,477美元。这些发现表明，虽然上肢疾病在所有工人赔偿案件中所占比例相对较小，但医疗保健和赔偿成本相当可观。而且平均病程和工作残疾模式表明，这些疾病可导致与腰痛中观察到的类似的慢性工作残疾。结果强调需要确定占成本大部分的干预措施是否会显著影响长期结果。还需要确定那些恢复延迟有问题的人长期残疾的风险因素。
