Case Studies

Claim settled against Northwick Park Hospital for failings in the management of a shoulder dislocation


We have recently settled a claim against Northwick Park Hospital for the alleged failure to appropriately diagnose and treat our client’s shoulder dislocation during his A&E attendance, causing a delay in treatment and avoidable nerve damage.

Our client injured his shoulder after falling off of his bicycle. He was in a great deal of pain and unable to move the affected shoulder and arm. He also considered that there was a very obvious deformity of his shoulder, which he described as appearing “lop-sided”.

He attended his local A&E department very soon after his accident where he was initially assessed by a triage nurse and then an A&E clinician. Following a physical examination of the injury, the A&E clinician ordered an X-ray so that the extent of the injury could be assessed further. Upon receipt of the X-ray results, the A&E clinician reviewed our client again and considered that the X-ray had specifically ruled out any dislocation. He was sent home with a diagnosis of a soft tissue injury. Unfortunately, overnight, our client continued to suffer with severe pain and, for the first time since sustaining his injury, he experienced an onset of numbness in the fingers of his right hand, coupled with an inability to move and flex his fingers.

As is standard in most A&E departments, our client’s X-rays taken at A&E were reviewed by a different radiologist the day after his discharge. This procedure is adopted as part of “safety netting”, which involves screening certain forms of tests performed within an A&E department with the aim of detecting any missed fractures, dislocations or misdiagnoses made by medical practitioners during a patient’s initial attendance. Thankfully, this procedure was adopted in our client’s case and it was recognised that the X-rays performed the previous day revealed a shoulder dislocation.

It was acknowledged that our client’s injury was wrongly diagnosed and he was recalled to A&E urgently, so that the dislocation could be appropriately treated. Unfortunately, by the time he returned to A&E, some 24 hours after his original attendance, our client was noted to have suffered injury to his nerves (neuropraxia), which had not been present during his original attendance.

During the course of our investigations, we obtained expert evidence to assess the standard of care given to our client during his original A&E attendance and, if any failings were identified in the management of his injury, whether any such failings were detrimental to his outcome. A supportive independent expert opinion was obtained whereby it was ascertained that the original X-rays performed at A&E demonstrated an “obvious dislocation of the glenohumeral joint” and that any reasonably competent A&E clinician should have detected the dislocation and treated it without delay. The expert was of the opinion that, as a result of the 24 hour delay in treating the shoulder dislocation, our client developed neuropraxia which was caused by the prolonged stretching of the part of the brachial plexus that supplies the C7 and C8 (ulnar side of the hand), affecting sensation and movement. 

A letter of claim in accordance with the Pre-Action Protocol for the Resolution of Clinical Disputes was therefore submitted to the London North West Healthcare NHS Trust. A full admission of liability was received and a good settlement was reached at an early stage, without the need for litigation.


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