Case Archive
Occupational Medicine, Family Practice, Anesthesiology, Orthopedics
Ref. # 053501

A laborer presented with elbow pain to an occupational health center, where certain physicians were board-certified in family practice and anesthesiology. He had been lifting a cabinet at work when he felt a pop in the elbow. The diagnosis was right elbow strain. During several follow-up visits over the next few weeks, the patient's symptoms included transient ecchymosis over the antecubital fossa, persistent pain over the biceps tendon area, as well as pain with flexion and supination and some associated weakness with these actions. Three and a half weeks after the initial visit, the physicians at the occupational health center noted questionable swelling over the biceps tendon sheath and they referred the patient to an orthopedic surgeon. The appointment occurred 39 days later. An MRI showed a rupture of the distal biceps tendon. Because of the retraction and scarring six weeks after the injury, surgical repair was not feasible. A medQuest occupational medicine expert reported that the mechanism of the injury, particularly the pop to the right elbow, should have led the physicians to immediately suspect the possibility of a distal biceps tendon tear. They negligently failed to perform an MRI. A medQuest family practice expert independently found a negligent delay in diagnosis and timely surgical referral despite the mechanism of the injury and the patient's presenting and persisting symptoms. A medQuest anesthesiologist reported the defendant anesthesiologist was outside his scope of practice in treating the patient and negligent in failing to refer him to the appropriate specialist. A medQuest orthopedic surgeon confirmed what each of the three previously mentioned experts also stated: with timely surgical intervention the patient would have preserved the function and strength of his right upper extremity and enjoyed a full recovery.

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