Case Study: Claim for Damages

Case Study of a Successful Claim for Damages After Surgery for Carpal Tunnel Syndrome

After surgery for carpal tunnel syndrome — one of the most common compression syndromes — Mr. M. came to see me in my practice. Following the operation, the patient suffered from particularly severe day and night pain in the affected hand, as well as an almost complete loss of sensation on the thumb-side surface of the ring finger.

The complex corrective surgery (freeing the nerve from scar tissue, wrapping the nerve with a gliding tissue flap, and widening the wrist canal with a skin graft) ultimately led to the elimination of pain symptoms, but only to partial restoration of the ring finger’s sensitivity.

The orthopedic expert appointed in the first instance confirmed that the surgeon had performed the operation lege artis and declared that, although the symptoms in this intensity were very rare, they still fell within the possible spectrum of complications.

However, the questioning of the operating surgeon carried out by me in the second-instance proceedings revealed a completely different situation — without accusing the doctor of culpable behavior — while still enabling the patient to receive the compensation he was entitled to.

The surgeon had performed the operation under local anesthesia. Using an injection needle, he first deposited a small amount of anesthetic under the skin and then carefully advanced the needle deeper until the patient felt a sharp pain. This indicates that the needle had reached or touched the surface of the nerve. At this point, additional local anesthetic was injected, and the surgical area became completely numb (as confirmed by both the doctor and patient).

It was almost certain that in Mr. M.’s case, this approach (the needle penetrating the nerve) led to injury of a nerve fascicle, which subsequently caused the loss of sensation in the ring finger and the internal scarring around the nerve.

I was able to attest that the colleague had chosen a method for local anesthesia that was lege artis (this technique is described in textbooks and, unfortunately, is often used by many colleagues for its simplicity). Nevertheless, it was causally related to the injury and therefore responsible both for Mr. M.’s symptoms and the need for the revision surgery.

The judge therefore ruled in favor of the surgeon in that no malpractice had occurred. However, the hospital’s liability insurance had to comply with Mr. M.’s claim for damages, since another procedure for local anesthesia — one I had described in my report — could have been used that would have excluded nerve injury. In this alternative method, after creating the subcutaneous depot, the needle is not advanced toward the nerve. Instead, the skin incision is made first, and the nerve is exposed. Then, under direct vision and using magnifying glasses, the sheath of the nerve is gently lifted with blunt forceps, creating a small distance from the nerve surface. A very fine needle is then inserted parallel to the nerve surface to inject the local anesthetic between the nerve and its sheath. Thus, the needle cannot injure the nerve. With this hyperselective method of administering the anesthetic, complete pain elimination is achieved.

The orthopedist was unaware of this method, as was the surgeon. The physician’s liability insurer argued that the technique I described might be known only in university clinics and that knowledge of it was not mandatory for the average specialist in surgery or orthopedics.

The judge ultimately agreed with my expert opinion and upheld Mr. M.’s claim.