Marilyn Nayan

Project title: Predictors of Outcome in Surgically and Non-surgically Treated Work Related Ulnar Neuropathy at the Elbow

Degree: MPH | Program: Occupational Medicine (Occ Med) | Project type: Thesis/Dissertation
Completed in: 2003 | Faculty advisor: Gary M. Franklin


Approximately 800 claimed for work related ulnar neuropathy at the elbow (UNE) were reported in the Washington State worker's compensation system between 1995 and 2000. Approximately 26% went on to surgical treatment for this disorder, and 74% received a medical diagnosis of ulnar neuropathy at the elbow only without having surgery. The medical disability and human costs of this disorder may be very significant, but have not been previously reported.

Based on characteristic features of the history, physical examination and nerve conduction tests, work related ulnar neuropathy at the elbow is relatively simple to diagnose (AAEM, 1999). However, the criteria utilised for this disorder in practice may be quite varied, and the accuracy of the diagnosis may be questioned. The variability of both outcomes and treatment may reflect inaccuracy in diagnosis.

Of particular interest is whether there is any consistent application of a case definition of ulnar neuropathy at the elbow in practice, or whether there are diagnostic criteria which are more accurate predictors of a good surgical outcome than others.

Few studies have evaluated variables that may influence the outcome of UNE surgery and the workers future potential for return to work. Seragde and OWens (1998) concluded that higher recurrence rates could be anticipated in female patients, in patience with concomitant ipsilateral thoracic outlet syndrome and/or carpal tunnel syndrome, in patients in their third or fourth decade of life, or in patients not returning to work within months after surgery. Other investigators (Nathan, et al., 1995) have reported that application of a phyical therapy rehabilitation program which began on the day after surgery resulted in an average time to return to work after simple decompression of 20 workdays.

Factors which relate to disability following surgical intervention for work related injuries are receiving increased attention. Franklin, et al. (1991) evaluated variables potentially related to long term disabilioty following lumbar fusion for occupationally related back injuries. None of the classical indicators for this procedure predicted outcome, suggesting that, at least in workers compensation, predictors of disability may not relate to biologic severity. When one realizes both the monetary and human suffering impact of such a disability, it is apparent that further investigation of cause and effect in post surgical disability for occupationally related injuries is critical.

Taken from the beginning of thesis.