Partial aponeurectomy causes paresthesia in the hand

Partial aponeurectomy for paresthesia in the patient (Court of Naples, Judgment no. 5858/2022 published 10/06/2022).

Partial aponeurectomy causes a worsening of the health conditions of the patient who claims compensation from the healthcare company.

He deduced that:

– on 20.05.2010, affected by Dupuytren’s disease of grade III in his right hand, he was admitted for a partial aponeurectomy surgery with removal of the fibrous cord in the fourth finger, from the metacarpus to the IFP;

– on 28.07.2010, after a check, the presence of paresthesias in the territory of the ulnar nerve was ascertained;

– on 20.10.2010, as he complained of stiffness in his right hand with diffuse and radiating pain in his forearm, in addition to affecting his finger 2,3,4,5, he was hospitalized again at the health center arranged with the diagnosis. of right hand algodystrophy;

– on 25.10.2010 he underwent a continuous selective blockage of the brachial plexus;

– on 15.06.2011, to investigate the nature of the reported symptoms, an MRI of the right hand was performed which showed the existence of tendon phenomena affecting the flexor of the 3rd and 4th finger with fluid filament affecting the pods as well as a diffuse edematous imbibition of the soft tissues of the distal phalanx of the first ray;

– on February 15, 2012, he underwent a new MRI of his right wrist, which showed an irregular fascial thickening sometimes attached to the tendons of the flexor muscles of the fingers, probably of a fibrotic-metacurgical nature;

– despite the partial aponeurectomy surgery performed at the agreed health center and subjected to the prescribed therapies, the functional deterioration of the reported limb did not recede;

– This circumstance was attributable to the negligent conduct of health personnel who would have implemented a therapeutic choice that was not appropriate for the pathology they were suffering from.

The Court does not consider the petition to be well-founded.

The plaintiff alleges that he suffered damages as a result of the negligent conduct of the health professionals, which consisted of the erroneous therapeutic choice in relation to the pathology he was suffering from, represented by the subjection to partial aponeurectomy surgical therapy.

Therefore, the patient must prove the contract or social contact and attach the professional’s non-compliance, which consists of the aggravation of the pathological situation, or the appearance of new pathologies as a consequence of the intervention, being ne the demonstration. of the creditor’s absence of guilt.

The plaintiff has argued and shown that she was undergoing surgical treatment at the requested partial aponeurectomy health center.

Therefore, it is necessary to establish: a) whether there is a causal link between any action or omission of the defendant and the harmful event; b) if the defendant’s conduct has been in accordance with the laws of Artis and due diligence.

In other words, it is necessary to establish whether the functional compromise of the joint is etiologically attributable to the behavior performed by the medical staff consisting of the inadequate evaluation, in relation to the pathology affecting the patient, of the therapeutic choice made, in this case undergoing partial aponeurectomy surgery of the right hand.

From the CTU carried out, the constitutive facts of the claim for damages are not considered established.

The patient, at the time of admission, was suffering from Dupuytren’s disease in his right hand, which is why, on 20.05.2010, he underwent a partial aponeurectomy.

In the postoperative phase, the patient presented with joint stiffness and generalized pain, so he underwent several outpatient checks in the same structure, subsequently, the blockage of the brachial plexus, which, however, did not have the desired result. did not determine any improvement in reported symptoms.

As the CTU clarifies, “Dupuytren’s disease is a degenerative disease of the hand that is characterized by the progressive and permanent flexion of one or more fingers of the affected hand. In particular, the pathological process is caused by the hardening of the aponeurosis of the palm of the hand, ie the membrane that covers the flexor tendons of the fingers and which clinically manifests itself with the progressive appearance of subcutaneous nodules as well as with the formation of solid and prominent cords in the palm of the hand whose presence involves the progressive hardening of the fingers in palmar flexion to the point of causing immobility. The treatment of this pathology is surgical and takes place, in particular, after an assessment of the degree of functional deterioration of the joint, by means of an aponeurectomy, as there are no effective containment treatments of a different nature … a of the two feasible surgical solutions in relation to Dupuytren’s disease and consist of the removal of only the fibrous cord, with the exclusion of the transverse fibers of the degenerated aponeurosis on the side of said cord which is instead the subject of the called aponeurectomy. Extended ……… .. It cannot be considered that, in the present case, the behavior practiced by the health professionals consisting of the decision to subject the patient to a surgical treatment of partial aponeurectomy was inappropriate in relation to the nature of the pathology found. “

“For these reasons, no conduct contrary to the rules of diligence, prudence and ordinary expertise required in relation to the specific activity carried out can be recognized in the medical staff … the type of incision and aponeurectomy chosen and that the It is unlikely that the technical consequences reported by the plaintiff are likely to go back causally to the controversial surgery, in terms of improper performance, in whole or in part. “

The petition is dismissed with a sentence for payment of court and expert fees.

Lawyer Emanuela Foligno

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