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Median Nerve Damage after Carpal Tunnel Release Surgery


A woman underwent carpal tunnel release surgery. The carpal tunnel is a canal on the palm side of the wrist. The retinaculum is the ligament that covers the carpal tunnel. The median nerve passes underneath the retinaculum and through the carpal tunnel. Small bundles of nerve fibers, called fascicles, are located within the median nerve. Pain and numbness, often described as “pins and needles,” occurs when pressure builds within the carpal tunnel and irritates the median nerve. To relieve these symptoms, an orthopedic surgeon may release, or “sever,” the retinaculum to create more space within the carpal tunnel, thereby relieving the pressure.

 

Following the surgery, the woman complained to the doctor who performed the carpal tunnel release surgery of continuing pain and numbness in her left hand. The woman made these complaints up to and through her last office visit with the doctor. The doctor repeatedly assured the woman that the surgery had been successful and that her symptoms were not related to carpal tunnel syndrome.

 

About two years after the woman’s last office visit with the doctor, the woman was examined by another physician, who recommended that the woman undergo an exploratory surgery of the left wrist to determine the causes of the woman’s continuing symptoms. This physician performed a second surgery and concluded that the woman had sustained an injury to her median nerve during the first surgery, which the second physician treated by grafting the nerve from the woman’s left ankle into the left wrist.

 

The woman sued the doctor who performed the carpal tunnel release surgery for medical malpractice. The complaint alleged that the woman sustained injuries to the median nerve in the left wrist during the surgery.

 

Based on the size of the woman’s incision and her recollection from the first surgery, the second surgeon concluded that the doctor had performed the first surgery endoscopically, rather than using an open technique in which the incision is large enough to visualize the structures of the hand. Based on observations during the second surgery, the woman’s second surgeon concluded that the first doctor had deviated from the standard of care by not completely releasing the woman’s retinaculum and injuring the median nerve by damaging the fascicles.

 

On cross-examination, the woman’s second surgeon admitted that he had not read the first doctor’s operative report or any postoperative records. Aside from the second surgeon’s observations during the second surgery, his opinions were based solely on the information relayed by the woman.

 

The operative report reflected that, as was his customary practice, the first doctor had performed an open procedure using an 18–millimeter incision made between the woman’s ring and middle fingers. The doctor testified that he completely released the woman’s retinaculum without causing any damage the fascicles, thus complying with the applicable standard of care. The postoperative records indicated that the woman could perform oppositional finger to thumb touching approximately one month after surgery. The first doctor and his expert both testified that the woman would not have been able to move her thumb in such a way if the doctor had damaged her median nerve.

 

Following a trial, the jury returned a verdict in favor of the doctor and against the woman. The Circuit Court of Lake County entered judgment on the jury’s verdict. The woman filed a motion seeking a judgment notwithstanding the verdict or a new trial. The trial court denied the motion.

 

The Appellate Court of Illinois, Second District, affirmed. The court held that the evidence was sufficient to support the jury’s verdict.

 

The evidence was sufficient to support the jury’s verdict. The opposite conclusion to the jury’s verdict was not clearly evident in light of the competing evidence presented at trial by the first doctor. The court noted that the first doctor established that the woman’s expert had not read the original operative report or any postoperative records, the operative report countered the woman’s expert’s conclusion, the postoperative records established that the woman could perform oppositional finger to thumb touching approximately one month after surgery, and the doctor and his expert both testified that the woman would not have been able to move her thumb in such a way if the doctor had damaged her median nerve, as the woman’s expert had testified. The court reasoned that the evidence, when viewed in the light most favorable to the woman, did not so overwhelmingly favor the woman such that no contrary verdict could ever stand. The court concluded that the trial court did not err in denying the woman’s motion for judgment notwithstanding the verdict regardless of the weight that the jury placed on alternative causes of the woman’s injury.

 

The Appellate Court of Illinois, Second District, affirmed the trial court’s denial of the woman’s post-trial motion seeking a judgment notwithstanding the verdict or a new trial.

 

See: Sondergaard v. Herbstman, 2017 WL 87106 (Ill.App. 2 Dist., January 9, 2017) (not designated for publication).

 

See also Medical Law Perspectives, October 2015 Report: Unclean, Unsterile, Unsafe: Risks of Injury from Unsterilized Medical Equipment

 

See also Medical Law Perspectives, July 2013 Report: New Hips, New Knees, New Problems: Hip and Knee Replacements 

 

 

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