| Here's an interesting case I handled recently: It | | | | York City. Immediately upon being examined, the |
| involved a young man who put his arm through a | | | | hand surgeon advised the patient that he had |
| window. He was taken to the emergency room | | | | significant damage to his ulnar nerve; precisely the |
| where he was bleeding profusely from cutting an | | | | nerve that controls the fourth and fifth fingers. |
| artery. He had a "pumper," with blood spurting and | | | | Exploratory surgery revealed the patient's worst |
| pulsating out like a garden hose. While in the | | | | fears: |
| emergency room a doctor tried to stop the | | | | "A suture used to tie off bleeding vessels had |
| bleeding by applying pressure to the wound. This | | | | somehow been used instead to tie off your ulnar |
| worked, but the young man needed a blood | | | | nerve," was what the hand surgeon advised him. |
| transfusion since he lost a lot of blood during the | | | | "As a result, your ulnar nerve was deprived of |
| five minutes from accident site to the hospital. | | | | oxygen and blood flow, causing the nerve to die." |
| After the bleeding was initially controlled, another | | | | This young man was told that he'd need another |
| doctor came to stitch the wound. The doctor, | | | | surgery to try and transplant another nerve from |
| while throwing stitches, never realized that he put | | | | a different part of his body into his arm to see if |
| a stitch around the ulnar nerve! This is a big | | | | that would help. He was told that nerves can |
| "no-no." Stitches are meant to tie off bleeding | | | | regenerate, if lucky, at a rate of one inch per |
| vessels like veins and arteries. They are not | | | | month. In other words, a very slow process. |
| meant to tie off good, healthy nerves. | | | | The second surgery went well, and he did not |
| Importantly, while the patient was being stitched | | | | need a nerve transplant. Instead, the existing |
| up, he yelled out that his arm felt as if it had been | | | | nerve was cleaned up, and stretched as gingerly |
| 'zapped', similar to hitting your funny bone. The | | | | as possible to get close enough to attempt to |
| doctor simply said "Don't worry about it, you'll be | | | | reattach the two damaged ends of the nerve. |
| fine." Well, a day or two later, the young man, | | | | Eighteen months later, this patient still had loss of |
| thinking that it's ok to have unusual sensations in | | | | sensation and decrease in function in his hand. |
| his had following this accident did not think much | | | | The moral of this tragic story is that this injury |
| of the ongoing discomfort he was having in his | | | | was totally preventable. Had the emergency room |
| hand. By day three, he started to think something | | | | doctor been careful in placing those stitches, and |
| was really wrong. His fourth and fifth finger were | | | | had the clinic residents recognized the signs of |
| getting numb and were also painful. | | | | nerve damage two days after the accident, this |
| The patient returned to the hospital, where it | | | | event leading to permanent nerve damage never |
| took some coercion to get the clinic residents to | | | | would have happened. |
| evaluate his hand. Despite the patient's complaints, | | | | End Result: |
| he was sent home, and told it it normal to have | | | | Through extensive investigation and many |
| this pain following such an accident. Two days | | | | depositions, I was able to finally learn that one or |
| later, the numbness and inability to move the | | | | more doctors had sutured the wound closed. |
| fourth and fifth fingers brought the patient back | | | | What made this case so fascinating is that the |
| to the hospital clinic. Again, nobody recognized that | | | | doctor or doctors who stitched this patient up, |
| the young man's ulnar nerve was dying off | | | | never wrote a note in the hospital chart- It's |
| before their eyes. | | | | almost as if they knew what they did was |
| This young man made a wise decision to get an | | | | inappropriate and did not want to acknowledge it. |
| opinion from an experienced hand surgeon in New | | | | The case settled favorably during jury selection. |