Patient’s with cauda equina syndrome may initially be diagnosed with generalised back pain and sent to a physiotherapist. However, a patient’s condition will gradually worsen as they begin to develop further symptoms of nerve root compression. A physiotherapist has a duty to detect this deterioration and refer a patient to hospital. If there is a failure to do so, there could be a case of medical negligence.
The duty of a physiotherapist
Cauda equina syndrome arises when the nerves controlling the bladder and bowel function are impaired. This can occur in patients who have a slipped disc, narrowing of the spine or a tumour growing on the spine.
Initially, cauda equina syndrome will cause considerable lower back pain, which may also extend to the buttocks and legs. When a GP is presented with a patient suffering such symptoms, their first reaction may be to make a referral to a physiotherapist. As long as there are no other signs of cauda equina compression (including urinary and bowel problems and sexual dysfunction) this will be considered a reasonable course of action for the GP to take.
Physiotherapists must, however, be wary of patients who have lower back pain spreading to the buttocks and thighs – especially if there is also numbness in the genital area. Indeed, physiotherapists should be fully aware of cauda equina syndrome and advise a patient about the condition, telling them to attend A&E should any deterioration in bladder or bowel control occur.
Furthermore, a physiotherapist must assess a patient’s symptoms, and reassess their condition every time they attend for an appointment. If a patient is thought to be displaying the characteristic signs of cauda equina syndrome, the treating physiotherapist must make an urgent referral to hospital. Indeed, physiotherapists should not work in isolation but alongside medical doctors, most usually orthopaedic surgeons. They have a duty to identify patients who require further investigation who may have a nerve root problem or more serious spinal pathology so that they can receive appropriate review and treatment.
Claiming against a physiotherapist for cauda equina syndrome
A physiotherapist must therefore:
- Provide detailed and relevant assessments patients, including response to physiotherapy treatment, behaviour of symptoms, medication prescribed, examination of range of movement, neurological assessment;
- Recommend appropriate management and advise a patient to attend A&E should their symptoms worsen;
- Monitor a patient’s symptoms and refer a patient with symptoms associated with cauda equina syndrome. If there is any doubt, a physiotherapist should err on the side of caution and still make a referral to the hospital.
If a physiotherapist fails to take the course of action as described above, causing a patient’s cauda equina syndrome to remain undetected for a significant amount of time, there will be a case of medical negligence. If this has happened to you, contact us at the Cauda Equina Solicitors.