Reducing Disability Durations and Medical Costs for Patients With a Carpal Tunnel Release Surgery Through the Use of Opioid Prescribing Guidelines.

OBJECTIVE: The impacts of compliance with opioid prescribing guidelines on disability durations and medical costs for carpal tunnel release (CTR) were examined. METHODS: Using a dataset of insured US employees, opioid prescriptions for 7840 short-term disability cases with a CTR procedure were identified. Opioids prescriptions were compared with the American College of Occupational and Environmental Medicine (ACOEM)'s opioid prescribing guidelines for postoperative, acute pain, which recommends no more than a 5-day supply, a maximum morphine equivalent dose of 50 mg/day, and only short-acting opioids. RESULTS: Most cases (70%) were prescribed an opioid and 29% were prescribed an opioid contrary to ACOEM's guidelines. Cases prescribed an opioid contrary to guidelines had disability durations 1.9 days longer and medical costs $422 higher than cases prescribed an opioid according to guidelines. CONCLUSIONS: The use of opioid prescribing guidelines may reduce CTR disability durations and medical costs.

A randomized controlled trial evaluating an alternative mouse or forearm support on change in median and ulnar nerve motor latency at the wrist.

BACKGROUND: The purpose of this study was to determine the effects of an alternative mouse and/or a forearm support board on nerve function at the wrist among engineers. METHODS: This randomized controlled intervention trial followed 206 engineers for 1 year. Distal motor latency (DML) at baseline and follow-up was conducted for the median and ulnar nerves at the right wrist. RESULTS: One hundred fifty-four subjects agreed to a nerve conduction study at the beginning and end of the study period. Those who received the alternative mouse had a protective effect (OR = 0.47, 95% CI 0.22-0.98) on change in the right ulnar DML. There was no significant effect on the median nerve DML. The forearm support board had no significant effect on the median or ulnar nerve DML. CONCLUSIONS: In engineers who use a computer for more than 20 hr per week, an alternative mouse may have a protective effect for ulnar nerve function at the wrist. No protective effect of a forearm support board was found for the median nerve.

Upper extremity mononeuropathy among engineers.

OBJECTIVES: The objectives of this study were to estimate the prevalence of mononeuropathy at the wrist among engineers who use computers and to identify associated risk factors. METHODS: This is a cross-sectional study of 202 engineers using questionnaires and electrophysiological nerve testing. The definition for median or ulnar mononeuropathy required the combination of distal upper extremity discomfort and abnormal distal motor latency. RESULTS: The prevalence of neuropathy at the wrist among engineers was 10.3% (right median), 3.4% (left median), 1.8% (right ulnar), and 2.9% (left ulnar). Logistic regression analysis identified three variables with positive associations (body mass index, hours of computer use, and antihypertensive medication) and three variables with negative associations (typing speed, driving hours, total break time). CONCLUSIONS: Mononeuropathies at the wrist occur among computer-using engineers and are related to a number of factors, including hours of computer use.