Emergency Room Oversight: Misdiagnosis of Shoulder Injury After Accident - Orthopedics

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On the evening of Friday, March 8th, I had a car accident (a fall) on my way home from work and was taken by ambulance to a hospital in Taoyuan.
When my family arrived, the emergency doctor said everything was fine and that I could go home if I didn't feel nauseous or dizzy after lying down for a bit.
However, my left arm was very painful, and when I asked the doctor, he also said there were no fractures, and the discharge summary did not mention any fractures either.
I thought it was just a bruise from the fall.
But on Monday, March 11th, the pain persisted, so I went to see an orthopedic doctor.
The orthopedic doctor then informed me that there was a slight fracture of the acromion, confirmed by an X-ray.
I would like to know if the emergency room doctor made an error in this case.
If we had naively not gone to see the orthopedic doctor, the consequences could have been severe.
Who would be held responsible?

Mars, 30~39 year old female. Ask Date: 2013/03/12

Dr. Shi Guozheng reply Orthopedics


The emergency department is generally a place for urgent care or for handling more critical and severe patients.
Therefore, after patients are seen by the emergency physician, they are usually advised to return for follow-up in outpatient care to ensure that nothing has been overlooked.
Some subtle fractures may not be easily detected by those who are not orthopedic specialists.
Scapular fractures typically heal on their own.
If every physician were required to be 100% perfect, then no one would be willing to work in the emergency department.

Reply Date: 2013/03/12

More Info


In your situation, it appears that there may have been a misdiagnosis in the emergency room regarding your shoulder injury after your accident. Misdiagnosis can occur for various reasons, including the complexity of the injury, the limitations of initial assessments, or even the subjective nature of pain reporting.
When you arrived at the emergency room, the attending physician likely conducted a preliminary evaluation based on the information available at that moment. If you did not exhibit symptoms such as severe swelling, deformity, or significant loss of function, the doctor may have concluded that there was no serious injury. However, the absence of these symptoms does not always correlate with the absence of an injury, especially in cases involving fractures or soft tissue damage.

Shoulder injuries, particularly those involving the rotator cuff or the shoulder blade (scapula), can sometimes be subtle and may not present with obvious signs on initial examination. X-rays are typically the first imaging modality used to assess such injuries, but they may not always reveal all types of fractures, especially if they are hairline or involve the joint surfaces. In some cases, further imaging such as an MRI or CT scan may be necessary to fully understand the extent of the injury.

The fact that you experienced persistent pain and sought further evaluation from an orthopedic specialist was a prudent decision. The orthopedic doctor’s diagnosis of a mild fracture of the shoulder blade indicates that there was indeed an injury that required attention. If you had not pursued additional medical advice, the injury could have worsened, potentially leading to complications such as chronic pain, reduced range of motion, or even the need for surgical intervention.

In terms of accountability, while it can be frustrating to feel that a medical professional has overlooked a significant injury, it is essential to understand that medicine is not an exact science. Emergency room physicians often have to make quick decisions based on limited information and the most pressing concerns at the time. However, if there is a pattern of negligence or if the standard of care was not met, there may be grounds for a complaint or further investigation.

To prevent similar situations in the future, it is crucial for patients to advocate for themselves. If you feel that something is wrong or if your symptoms persist, seeking a second opinion is always a valid option. Additionally, keeping a detailed record of your symptoms and any changes can help healthcare providers make more informed decisions.

In summary, while there may have been an oversight in your initial evaluation, the important takeaway is that you took the right steps by seeking further medical attention. It is always better to err on the side of caution when it comes to injuries, especially those involving bones and joints. If you have ongoing concerns about your shoulder or any other aspect of your recovery, do not hesitate to follow up with your healthcare provider for further evaluation and management.

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