Damages awarded following misdiagnosis of ruptured biceps tendon

We have settled a claim on behalf of our client, whose ruptured right distal biceps tendon was misdiagnosed when he attended Russells Hall Hospital A&E.

As a result of this misdiagnosis, he suffered persistent pain, discomfort and loss of function in his right arm. There was a delay of only six weeks before the injury was correctly diagnosed, but by this time the opportunity to repair the ligament properly had been missed.

The distal biceps tendon is a cord of tissue which attaches the biceps muscle to the elbow. Timely surgical repair can result in excellent recovery of function and strength, but even a seemingly short delay in treatment can lead to a poor outcome.

Our client suffered the injury to his distal biceps tendon whilst on duty as a police officer. He attended Russells Hall Hospital A&E where he was seen by a locum doctor. He told the doctor that he had felt a ‘pop’ at the time of the injury, followed by immediate pain and discomfort in his arm. He showed the doctor that the muscle to the top right of his arm had retracted to just below the armpit. These are both classic signs of distal biceps tendon rupture. He was advised that he had suffered a sprain to his right arm, and was discharged with a sling and advice to rest and to take painkillers.

His symptoms failed to improve: his right arm remained weak and painful, and the shape of his biceps muscle continued to appear deformed.

Our client consulted his GP a few weeks later, who suspected a tendon injury and referred him for an ultrasound scan. The scan was performed that month and showed a complete rupture of the right distal biceps tendon. The following month, our client was reviewed by an orthopaedic surgeon at the hospital who discussed the results of the ultrasound scan with him. He noted wasting of the right biceps muscle compared to the left. Our client later underwent surgery to repair the right distal biceps tendon, but the time elapsed since the original injury meant the tendon was found to have retracted and the repair that was achieved was not as comprehensive as it would have been with timely diagnosis and management. Our client did regain a reasonable range of movement following the surgery and some alleviation in pain, though there was still some residual weakness.

Once instructed, we obtained supportive expert evidence from an A&E consultant who confirmed that it was a breach of duty to fail to refer our client for an ultrasound scan and arrange a review by the orthopaedic surgeons at the time he first attended the hospital. We proceeded to obtain evidence from an expert consultant orthopaedic surgeon who confirmed that had this occurred, a correct diagnosis would have been made and our client would have been admitted for surgery. As a result he would have avoided the six-week period of unnecessary pain and discomfort and a better standard of repair would have been likely.

We wrote to the defendant trust setting out our allegations and they responded admitting the negligent failure to diagnose, and that absent the delay, our client would have had a better outcome. We proceeded to consider the value of our client’s claim. In the meantime, our client unfortunately suffered a re-rupture to his right biceps tendon under similar circumstances. An ultrasound scan once again confirmed complete rupture to the tendon, and he underwent further repair surgery in February 2018. This time a graft had to be taken from his hamstring to re-attach the tendon. Though the surgery was successful, our client continued to suffer from residual weakness in his right arm. Our orthopaedic expert confirmed that but for the negligent delay, our client was likely to have avoided the re-rupture.

Court proceedings were commenced to protect our client’s position and because the defendant had not admitted any causal link between its negligent failure to diagnose and the fact of the later re-rupture. This further element of causation was eventually admitted and we were then able to achieve a good settlement for our client to reflect the unnecessary pain and discomfort he had endured, in addition to the residual weakness in his right arm.

This case serves to demonstrate the consequences for a patient which can follow from a failure to correctly diagnose a tendon injury in a timely manner.

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