Arthroscopic Repair of the Shoulder Malpractice Case
Privacy Disclaimer Mr. DP presented to Dr. HH with a diagnosed large tear of the supraspinatus and infraspinatus rotator cuff tendons by MRI. The condition was producing considerable pain and functional difficulty for the patient. He was scheduled for an arthroscopic repair of the shoulder with a decompression. The initial consultation by Dr. HH specifically notes that the axillary, long thoracic, dorsal scapular, musculotaneous, radial, ulnar and median nerves were all intact.

QUALIFICATIONS

I am a board certified orthopedic surgeon, have reviewed the medical records provided to me and listed below regarding the treatment of Mr. DP for a rotator cuff tear. I have been in the practice of orthopedic surgery for over 30 years and have done shoulder surgery involving rotator cuff repairs, sub acromial decompressions, stabilization surgery for dislocations, and total shoulder replacements. I am very familiar with the standard of care necessary in the procedure performed on Mr. DP. I have formed opinions from my review which are discussed below and reserve the right to revise or amend these opinions should additional information come to light. I have no financial interest in the outcome of this action and I do not know either party in this suit.  

RECORDS REVIEWED

        Records of Dr. HH including letters to the referring doctor.

        Records of Dr. EEZ—neurosurgeon

        Operative record of the shoulder arthroscopy

        Records of **** **** Medical

 

FACTS

Mr. DP presented to Dr. HH with a diagnosed large tear of the supraspinatus and infraspinatus rotator cuff tendons by MRI. The condition was producing considerable pain and functional difficulty for the patient. He was scheduled for an arthroscopic repair of the shoulder with a decompression. The initial consultation by DR. HH specifically notes that the axillary, long thoracic, dorsal scapular, musculotaneous, radial, ulnar and median nerves were all intact.

The arthroscopic surgery was performed at **** ****** Medical Center in May 2008.  The operative report describes lots of release of the retracted tendons all the way over to the coracoid process. Instruments used in doing this were shavers, baskets, and arthrocare wand. There is no mention of any sort of complications during surgery and apparently a complete repair was done. The surgery also consisted of tenodesis of the long head of the biceps tendon and AC joint decompression. The post- operative course was unremarkable as well as the first few months of physical therapy. The patient first noticed some weakness which was persistent in the arm as noted by physical therapy notes on 9/3/2008.

The patient was discharged from physical therapy on 9/17/2008 seemingly doing well. The first office visit recheck noting some concerns of the surgeon was on 12/30/2008, whereby it was recorded that the patient was worried about the wasting in the biceps and triceps. At the recheck visit of 1/2/ 2009, it is recorded that the patient is not happy with the weakness and atrophy of the biceps muscle. The flexion power of the elbow was recorded as 4/5. At this visit the patient was referred to Dr. EEZ for possible nerve grafting. The EMG results had shown injury to the musculotaneous nerve with no function and a right carpal tunnel syndrome. This was performed by Dr. BD. The actual report is not available in these records. The consult with Dr. EEZ was 5/2/2009 almost a full year from the day of surgery and the impression from Dr. YR was that with the profound atrophy, the nerve repair was not feasible and his suggestion was to get the carpal tunnel release done. In other words the injury to the musculotaneous nerve was permanent.

DEVIATION FROM THE STANDARD OF CARE

Mr. DP had normal nerve function going into arthroscopic shoulder surgery for repair of large tears of two rotator cuff tendons. From the MRI it was known that these were large tears and at the time of surgery lots of releases of tissue around the shoulder joint was necessary to achieve a repair. This dissection involved working around the coracoid process which is where the musculotaneous nerve passes headed to the biceps muscle.  Mr. DP came out of surgery with a non- functioning musculcutaneous nerve. By the time he was seen by a neurosurgeon a year had passed and there was too much atrophy of the biceps muscle to make any repair successful. The deviation from the standard of care at the time of surgery was the injury to nerve by one of the instruments. Had it not been for the negligence of Dr. HH this injury could not have occurred.

The standard of care would be to use care and due diligence in doing releases and not to injure the nerve knowing that it runs at the base of the coracoid process. The standard of care would be to accept a partial repair of the cuff tendons or just to debride the tendons rather than injure the musculotaneous nerve.

Secondly, there was considerable delay in diagnosing the injury and directing the patient to a neurosurgeon. This was a missed opportunity to explore and probably repair the damaged nerve.  This is also below the standard of care. The standard of care would have been to determine the problem at the first sign of any unusual weakness that was not responding to good physical therapy and then to consult a neurosurgeon.  Also, at this time frequent use of electrical stimulation of the biceps muscle, had it been ordered by DR. HH, would have prevented rapid wasting.

DAMAGES

The non-repairable nerve damage to the musculotaneous nerve will leave Mr. DP with a permanently weak dominant arm. There will be a point in time where the brachioradialis muscle will not function as well in flexing the elbow. The patient will have major difficulties in performing his prior work functions and possibly will not work again in his usual type of employment.