Ruptured Tendon “Missed Trauma”

Miss G attended her local hospital complaining of pain in her right upper arm following any sort of lifting. A deformity was noted in her bicep muscle and she was referred to her local A&E department.

Miss G was examined in A&E, her arm put into a sling and was referred to a local fracture clinic. She attended the appointment at the fracture clinic and was diagnosed with a rupture to the distal end of her bicep tendon. The registrar informed Miss G that it was not routine to repair the injury. He did however, make a referral to an upper limb surgeon but this was made on a non-urgent basis.

Miss G attended the appointment with the upper limb surgeon and an urgent referral for a distal bicep reconstruction was made. The surgeon commented that this was “missed trauma”. Miss G underwent a right distal bicep repair and was discharged the following day with a sling and instructions to commence slow stretching exercises after 3 weeks.

Post-operatively Miss G informed her treating doctors that she had numbness in her forearm but she was reassured that this was normal. However, a follow up MRI scan showed that the bicep had re-ruptured and revision surgery had to be carried out.

Miss G continued to have difficulties with her hand, in particular in relation to grip strength.

She subsequently moved home and therefore the care for her ruptured tendon transferred to a neighbouring authority. Following a number of exploratory assessments by her new surgeon, she was informed that a misplaced screw would likely require further surgery. An independent orthopaedic surgeon also agreed that further surgery was required.

It was Miss G’s case that an urgent referral to a surgeon should have been made as soon as the ruptured tendon had been identified. There had also been a failure to diagnose the re-rupture and the misplaced screw had resulted in further surgery. Experts claimed that had the initial surgery been carried out within 2-6 weeks, the re-rupture would have been avoided.

The case settled by negotiation in which payment of damages was agreed.