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Case study 33 - minor injury

Overview

This case study explores a dispute about whether an injury (fractured right wrist, cervical and thoracic spine) is a minor injury under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act).  The Assessor found the claimant’s injury to satisfy the definition of Minor Injury.

Introduction

The claimant was a passenger in a motor vehicle that was rear ended by another car. The claimant was thrown forward and hit their head on the headrest, they did not lose consciousness.

No police or ambulance attended the scene of the accident.

Previous history of a motor vehicle accident (MVA), 20 years prior to current MVA, in which the claimant sustained injuries to their cervical and lumbar spine. The claimant reported these injuries resolved 2 years later.

The Medical Assessment

The claimant was assessed approximately 8 months post MVA. The claimant reported that 5 months after the MVA, they suffered a dizzy spell causing them to fall and sustain a fractured right wrist. They were referred to a specialist who found no damage to their hearing.

The wrist continues to be stiff, without any pain, however the claimant has noticed pins and needles in their fingers, mainly the lateral fingers.

The claimant reported ongoing tightness of the head and neck, but no aches, pain or issues in their shoulders. In relation to the upper back the claimant still feels tightness in the upper thoracic spine, with no pain between the shoulders. The neck symptoms continue to improve. The claimant denies any pain or problems with their lower back or legs and no problems in the upper extremities.

Clinical Examination

Cervical Spine (cervicothoracic)

  • No muscle guarding or spasm
  • Dysmetria/asymmetry of neck movement
  • Posture, alignment and contour were all normal

Thoracic Spine (thoracolumbar)

  • Tenderness in the upper most thoracic area
  • No muscle guarding or spasm

Upper Extremity (right wrist)

  • Scar over medical aspect of right radius (from open reduction and internal fixation surgery)
  • ROM not recorded due to recent fracture of less than six months ago
  • Circumference measurements of upper arms right and left 29 cm, both forearms 29cm
  • No neurological abnormalities
  • Normal power, excluding the musculature associated with wrist movements on right side
  • No sensory deficits
  • Deep tendon reflexes were present

Summary of Documentation

Discharge referral from treating hospital indicated distal radius fracture, requiring fixation, no reference to dizziness or head injury.

Treating specialist noted a brain scan and MRI scan of the cervical spine was normal and noted spondylitic changes in the cervical spine which were asymptomatic before the MVA. Reported that the claimant suffered a dizzy spell during the consultation, however the treating specialist advised this should settle over time.

No evidence of carpal tunnel syndrome of right wrist.

The treating doctor noted ongoing headaches and a fall 5 months post MVA in which the claimant suffered a fractured right wrist.

Diagnosis

Diagnosis:

  • Neck – soft tissue injury
  • Upper back-soft tissue injury

The following injury was not sustained in the MVA

  • Right wrist/arm fracture
  • Neck – dizziness

Dizziness is a symptom and not a sign and there was no evidence that it was related to the neck. It is also noted under the Regulation, that an injury to a spinal nerve root that manifests in neurological signs (other than radiculopathy) is included as a soft tissue injury for the purposes of the Act.

Minor injury

Section 1.6(2) of the Act

A soft tissue injury is (subject to this section) an injury to tissue that connects, supports or surrounds, other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.

Schedule 1 [2] clause 4 of the Motor Accident Injuries Regulation 2017:

  1. An injury to a spinal nerve root that manifests in neurological signs (other than radiculopathy) is included as a soft tissue injury for the purposes of the Act.

The following is a minor injury:

  • Neck-soft tissue injury
  • Upper back-soft tissue injury