Personal Financial Burden after Distal Upper Extremity Nerve Injury

BACKGROUND: Distal upper extremity nerve injuries are a substantial cause of disability with socioeconomic consequences, yet their personal financial impact remains poorly understood. This study assesses the financial hardship and associated risk factors in digital versus more proximal upper extremity nerve injuries. METHODS: A cross-sectional survey of 133 patients treated surgically for upper extremity nerve injuries between 2016 and 2023 assessed financial burden (composite score, 0 to 6) and worry severity (on a 5-point Likert scale). Multivariable Poisson and ordinal logistic regressions identified factors associated with financial burden and worry scores, stratified by nerve injury location and surgical complexity. RESULTS: Despite 97.7% of patients having insurance, 45.1% experienced some degree of financial burden, and 20.3% reported high financial worry. Higher composite financial burden scores were associated with increased financial worry (odds ratio [OR], 1.89; P < 0.001). Previous debt showed the strongest effect on financial burden (incidence rate ratio [IRR], 2.68; P < 0.001) and worry (OR, 3.76; P < 0.001). Proximal nerve injuries (OR, 2.31; P = 0.035) and male sex (OR, 3.84; P = 0.004) were also associated with financial worry. Younger age (IRR, 0.98; P = 0.013) and multiple nerve repairs (IRR, 1.20; P = 0.038) were associated with higher financial burden. CONCLUSIONS: Patients undergoing distal upper extremity nerve surgery face substantial financial hardship despite the high rate of insurance coverage. Increased financial hardship is associated with preexisting debt, surgical complexity, and injury location, particularly in younger male patients. These findings support risk-targeted screening protocols for proactive multidisciplinary coordination and financial counseling to mitigate financial burden and worry after distal upper extremity nerve injury.