Allegation:
A failure to properly perform shoulder surgery resulted in permanent injuries.
The Case:
The patient, a 46 YOF (5’5”; 210 lbs.), underwent an MRI of the right shoulder without IV contrast. A radiologist interpreted the MRI as highly suspicious for a non-displaced full thickness tear of the supraspinatus tendon with underlying moderate diffuse rotator cuff tendinosis; mild secondary fluid in the subacromial subdeltoid bursa; mild AC joint osteoarthrosis; and marrow reconversion. The patient presented to the defendant orthopaedic surgeon six days later. She complained of severe pain in the right shoulder that had developed over the last month and had progressively gotten worse. The defendant orthopaedic surgeon performed a drop arm test that was positive, but the push off test and speed test were fine.
Four days after the initial assessment, the defendant orthopaedic surgeon documented that he performed an arthroscopy of the right shoulder with subacromial decompression, arthroscopic Mumford, debridement of the labrum, and a mini open repair of the rotator cuff with RoG anchor x1. Although the Mumford portion of the procedure was documented, it was not actually performed.
The patient’s two-week follow-up visit with the defendant revealed a reported pain level of 7/10, a limited ROM, tenderness to palpation in the shoulder, and a positive drop arm test. The defendant recommended beginning PT in two weeks.
The patient attended PT seven times over a four-week period before returning to the defendant surgeon with complaints of severe stiffness. The defendant physician recommended manipulation under anesthesia and discussed the risks and potential complications; the patient agreed to proceed with surgery. The defendant orthopaedic surgeon performed a right shoulder manipulation under anesthesia one week later with the patient to start PT immediately after.
Over the next six weeks, the patient attended PT on 22 occasions. Upon returning for her follow-up, the patient complained of pain of 6/10; she was very stiff, without complete extension or flexion. Internal rotation, external rotation, and abduction were partial. The defendant orthopaedic surgeon discussed the risks, complications and benefits of shoulder arthroscopy in detail with the patient, and the patient elected to proceed.
The defendant orthopaedic surgeon performed a right shoulder arthroscopy on the patient. He noted in the operative report extensive synovial resection, subacromial and intra-articular, SLAP repair x1. The patient returned after one week of PT with decreased internal and external rotation of the right shoulder, along with partial abduction and adduction. The defendant surgeon prescribed medications and ordered PT three times a week for six weeks. The patient never returned to the defendant orthopaedic surgeon.
Two days after the right shoulder arthroscopy, the patient sought a second opinion from another orthopaedic surgeon. Following an MRI of the right shoulder that revealed adhesive capsulitis, impingement syndrome, and AC arthropathy, the second surgeon diagnosed post-surgical adhesive capsulitis.
The second orthopaedic surgeon indicated the patient had two problems including the original impingement syndrome and AC arthropathy, and now post-surgical adhesive capsulitis due to lack of motion and the labral repair. The second surgeon recommended surgery; the patient consented after some consideration.
Approximately two months later, the second orthopaedic surgeon performed the following: (1) right shoulder manipulation under anesthesia, (2) removal of retained intra-articular suture, (3) arthroscopic capsular release with biceps tenotomy, (4) arthroscopic subacromial decompression, and (5) arthroscopic distal claviculectomy. The second surgeon commented the patient had an open rotator cuff repair and did not have any type of bony procedures performed. The patient had a frozen shoulder that was managed with an arthroscopic capsular repair.
The patient continued to follow up with the second surgeon for a year. She continued a combination of PT and at-home exercise. The patient still had shoulder pain at 5/10 but stated she was 80% better. The patient had not returned to a full work schedule due to her shoulder disability.
The patient sued the defendant orthopaedic surgeon who performed the initial shoulder surgery, alleging the arthroscopy of the right shoulder was performed incorrectly. Plaintiff experts stated the defendant orthopaedic surgeon failed to meet the standard of care by including an AC joint resection in his plan of care and failing to perform it. Additionally, they claimed performing the SLAP repair breached the standard of care since the procedure can result in decreasing the range of motion in an already stiff shoulder.
While defense experts were willing to testify the defendant orthopaedic surgeon’s treatment fell within the standard of care, they were less supportive of the SLAP repair and the poor overall documentation.
Verdict:
The case was eventually settled with the defendant orthopaedic surgeon’s consent.
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