A large percentage of the illegal work force unknowing in their options and oftentimes unable to take full advantage of a social system to which they are not truly entitled otherwise; i.e. prolonged disability, unemployment, etc., ultimately results in returning to their country of origin. They are aggressively recruited by meat packing plants whose only pre employment screening criterion is the ability to fog a mirror-here I am quoting an anonymous IBP (AKA Tyson) packing plant safety manager. Rather than ascertain proper job skills, health history and ruling out the presence of ongoing nerve entrapment such as CTS and Cubital and the associated ailments that accompany these the illegals are hired to fill a void without appropriate screening tests. Testing is available. Several studies have proven the very high incidence of median nerve entrapment in job applicants i.e. pre-employment, in the range of 20% (see Bingham et al 1996 in bibliography). These individuals then try to blame their symptoms on their jobs and enormous workers compensation premium costs. Interestingly the predominant cost remains that due to unnecessary disability, i.e. time off of work even though is totally unnecessary-especially with endoscopic carpal tunnel release.
Unfortunately the low education and skills level of may of these people lead to tragic industrial injury (not just CTS) due to inexperience and barrier to training.Yet the uneducated from third world countries and to a lessor degree the uneducated US citizens are the most difficult to coax along and help. They become fixated on the false idea that their hand problem is precipitated and caused by their mean employer and staying at work or returning promptly to work after the physical cause is relieved is greatly hampered. They often feign inability to grip etc. due to ridiculous pain-known as symptom magnification. This is also officially termed malingering. Malingering is relatively easy to prove with the use of a grip meter known as a dynamometer.
The low education level and illiteracy of these individuals as well as legal newly arrived refugees make them very difficult to treat. There are cultural barriers in getting beyond "medicine men" and non traditional, unscientific modalities in addition to the inability to educate people who can't read or write in the language of their mother countries let alone English. Fluently multilingual interpreters are costly and add to the healthcare burden since one is nedded at each clinic visit. Unfortunately, rather than a real interpreter the patient shows up with a juvenile with a limited vocabulary unable to apppropriately convey the message.