Delay in Diagnosis and Treatment of Ulnar Collateral Ligament

Lanyon Bowdler acted for a claimant who brought a claim for damages for personal injuries and consequential loss arising from alleged clinical negligence. This was with respect to the delay in diagnosis and treatment of ulnar collateral ligament of the right thumb.

The claimant, aged 44, sustained injuries during a fall on 30 May 2011. She attended the Accident & Emergency Department of the Worcester Royal Hospital where it was noted that she had fallen onto her outstretched hand; there was pain to the right thumb with swelling; decreased range of movement and tenderness. An x-ray was said to show a fracture to the base of the first metacarpal. The plan was for the claimant to have a thumb spica, high arm sling and to be reviewed in the Fracture Clinic the following morning.

On 31 May 2011, the claimant was seen as planned by a locum registrar in Trauma and Orthopaedics. It was noted on examination that she was extremely tender around the ulnar aspect of the metacarpophalangeal joint of the right thumb. X-rays were said not to show any fractures but there appeared to be some translation at the metacarpophalangeal joint. The locum registrar considered that the claimant might have a significant ligamentous injury, but could not confirm this clinically on account of pain. She was to be kept in a soft case thumb spica for one week to allow it to settle and then to be seen again.

The claimant was seen again in the Trauma Clinic on 3 June 2011 by a Consultant Orthopaedic Surgeon. He requested an urgent ultrasound to look for evidence of a Stenner lesion. He noted that if that was present, open repair would be required, otherwise the injury could be managed with a spica for four to eight weeks.

In the event, the ultrasound request card was not received by the Radiology Department and the claimant underwent the ultrasound on 6 July 2011. When reviewed by another locum registrar, on 22 July 2011, he noted that the ultrasound scan showed that the ulnar collateral ligament had not been visualised and referred the claimant for an opinion regarding reconstruction of the ulnar collateral ligament. The referral letter was typed on 3 August 2011.

There was some delay in arranging surgery and the claimant finally underwent reconstruction of the ulnar collateral ligament at the Spire South Bank Hospital, Worcester. Initially, it was considered that it was settling down but by 9 December 2011, it was identified that there was a lack of stability in the thumb. By this time the claimant’s options were limited and it was decided an MCPJ fusion would be performed which was subsequently undertaken on 2 February 2012 at the Worcester Royal Hospital. Sadly, the MCPJ fusion subsequently fractured, requiring further surgery on 5 October 2012 at the Spire South Bank Hospital. In the meantime, the claimant’s employers terminated her contract of employment as she had been unable to work for so long. In November 2013, she started work again but had concerns that the initial delay in diagnosis and treatment had adversely impacted on the long term outcome.

An early, quasi Letter of Claim was sent following which full admissions were made.
Damages were awarded in the sum of £40,000.00 inclusive of CRU (recoverable benefits) totaling £8,971.25.