Orthopedic Surgery Expert Witness Comments on Shoulder Surgery

This case involves a female patient who was involved in a workplace injury to her shoulder and the contiguous upper extremity. She had extensive pain immediately following the insult, which continued for a week before she decided to seek care from her family physician. The primary care physician referred her to an orthopedist, who then referred her to a shoulder specialist. Radiological studies showed a labrum tear and surgery for repair was scheduled thereafter. Upon exploration of the joint, the surgeon was unable to identify a tear grossly. The pain continued, and she was referred to a pain management specialist. The pain persisted for some time and she ultimately decided to seek a second opinion from another orthopedist. The imaging was reevaluated, and the decision for repeat surgery was made based on the findings. However, on that procedure, the orthopedic surgeon was able to identify a tear operatively, and proper surgical management was carried out. Evidence in the case showed there was a tear in the original operation but the first surgeon did not identify it.

Question(s) For Expert Witness

1. If a labrum tear is present, should there be difficulty locating/determining the area needed for reconstruction?

Expert Witness Response E-006958

MRI allows for detailed visualization of the biceps tendon. MRI is usually reserved for evaluation of more severe pathology, such as potential labral injuries or SLAP (suspected superior labral tears) lesions, or symptoms unremediated by conservative treatment including physical therapy. There is little chance of not visually inspecting the tear intraoperatively that has been diagnosed via MRI.