From the Guidelines
There is a potential malpractice case against the workers' compensation doctor for the delayed diagnosis of the flexor tendon laceration, as timely diagnosis and treatment are critical for optimal outcomes in such injuries. The initial failure to note the tendon laceration and the subsequent two-week delay before recognizing the flexion difficulty and referring to a specialist are key issues. According to the study by Rubin et al 1, MRI is ideal for evaluating tendon injuries and helping with surgical planning, with a sensitivity of 92% and specificity of 100% for diagnosing flexor tendon injuries.
In flexor tendon injuries, delays beyond 7-10 days can significantly impact prognosis due to tendon retraction, scarring, and muscle contracture. The fact that the patient continues to have difficulty with full flexion two months after repair could be related to this delay, as primary tendon repairs performed within the first week typically have better functional outcomes, as suggested by the principles outlined in the acr appropriateness criteria for acute hand and wrist trauma 1.
Establishing malpractice would require proving that the doctor's care fell below the standard expected of a reasonable physician, that this breach directly caused harm, and that the patient suffered damages as a result. Key points to consider include:
- The initial missed diagnosis and delay in referral
- The impact of delayed treatment on the patient's outcome, considering the importance of timely intervention in flexor tendon injuries
- Whether the standard of care was met in the initial assessment and subsequent management of the patient's condition. It's worth noting that not all poor outcomes constitute malpractice, and flexor tendon repairs can have complications even with timely intervention, as highlighted by the study on the diagnosis of tendon re-tears and peritendinous adhesions 1. The patient would need a medical expert to review the case and determine if the initial missed diagnosis represented negligence rather than an understandable limitation of clinical examination.
From the Research
Assessment of Malpractice
- The workers comp doctor initially failed to note the tendon laceration, which could be considered a breach of standard care 2.
- The delay in diagnosis and subsequent referral to a hand specialist may have impacted the patient's outcome, as early intervention is crucial in flexor tendon injuries 3, 4.
- The hand specialist's decision to perform surgery 4 days after the referral, and the patient's difficulty with full flexion 2 months post-repair, may be related to the initial delay in diagnosis and treatment 5, 6.
Potential Liability
- The workers comp doctor may be liable for the initial misdiagnosis and delay in referral, which could have contributed to the patient's poor outcome 2.
- The hand specialist's management of the case, including the decision to perform surgery and the post-operative rehabilitation, may also be subject to scrutiny 3, 4.
- However, it is essential to note that the complexity of flexor tendon injuries and the variability in patient outcomes make it challenging to determine liability without a thorough review of the case 5, 6.
Rehabilitation and Outcome
- The patient's difficulty with full flexion 2 months post-repair may be related to the rehabilitation protocol, which is a critical component of flexor tendon injury management 5, 4.
- The limited evidence on rehabilitation interventions for flexor tendon injuries highlights the need for further research in this area 5.
- The patient's outcome may have been influenced by various factors, including the timing and technique of the repair, the post-operative rehabilitation, and individual patient characteristics 3, 2, 6.