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Treatment by physiotherapist of farmer's shoulder injury requiring surgery (02HDC07420)

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(02HDC07420, 2 December 2003)

Physiotherapist ~ Shoulder injury ~ Misdiagnosis ~ Right 4(2)

A 59-year-old man complained that a physiotherapist did not refer him for diagnostic investigations when the treatment he was receiving for a shoulder injury was proving ineffective. After six weeks of physiotherapy treatment the physiotherapist referred the patient for an X-ray and ultrasound, and then to his GP. The patient had sustained a tear to the subscapularis (a muscle of the rotator cuff), and the long head of the bicep was displaced. Surgical repair was required.

An independent physiotherapist advised that subscapularis tears should be specifically looked for in people older than 40 years (such as the patient); and the physiotherapist's failure to consider a subscapularis tear and further assessment of the patient's progress was an unfortunate clinical oversight.

The Commissioner held that the physiotherapist did not breach Right 4(2)  because, even though she was a little tardy in referring the patient for further investigations, she complied with professional physiotherapy standards, and the matter was not clear-cut, particularly as she was unaware of the degree of trauma suffered by the patient, which would have alerted her to the greater possibility of more severe injury.