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Case study 13 - no evidence of rupture or radiculopathy

This case study looks at possible radiculopathy in the cervical spine and if the related symptoms meet the criteria of a soft tissue injury as defined by the Motor Accidents Injury Act 2017.

Introduction

The Claimant was the driver of a stationary vehicle which was hit from the rear at speed. The claimant was thrown forward in their seat and the passengers phone “flew through the window”. The Claimant’s vehicle was severely damaged however was driveable. Since they had completed the day of work the claimant returned home with discomfort in the upper back and neck base, slightly to the right, which escalated to a numbness/burning sensation in the right arm and forearm.

The claimant attended their GP later the same day and was told to rest, and if it got worse to go to the hospital. The claimant attended a different GP 4 weeks post-MVA (motor vehicle accident), where their neurological symptoms had increased to weakness, numbness and intermittent bursts of burning/tingling. The claimant was referred for an MRI approximately 2 months post-MVA and referred to a Neurosurgeon and physiotherapist. The claimant continued physiotherapy weekly until approximately 6 weeks prior to assessment due to the insurer confirming the claimant had a “minor injury”.

The claimant is an owner operator of a physically intense organisation, of which he continues to complete the lighter work and administrative tasks in the organisation however has been unable to continue with the heavy tasks of the organisation. The claimant noted having a number of moderate intensity hobbies including jogging, swimming and table tennis which since the MVA they have ceased.

The medical assessment

There is a dispute as to whether the injury is a minor injury under scheduled 2 section 2(e) of the Act.

The claimant was assessed approximately 6 months post MVA. The claimant noted injuries to the cervical spine, with upper limb non-verifiable radicular symptoms.

On examination

Cervical Spine (Cervicothoracic)

  • Tenderness at C6-7 but no noted muscle spasm or guarding.
  • The claimant had the following neck movement: full flexion; 80% of normal extension; leftward rotation of 75%; left lateral flexion 75% of normal range; 50% normal range rightward; and right lateral flexion 50% of normal range.
  • No wasting in the upper limbs
  • All upper limb reflexes were present and symmetrical.
  • Subjective reduction of sensation over the entire right upper limb commencing from the supraclavicular region.
  • No focal weakness in the distribution of a single nerve root and specifically there was no focal C6 myotomal weakness.
  • Spurling and Hoffman’s test were bilaterally negative.
  • Symmetrical range of motion in both upper extremities.

The MRI noted above reported compression of right C6 by degenerative changes in the cervical spine.

Diagnosis and reasons

Right neurological symptoms were noted to not have any objective signs to support the radiculopathy. There was no measurable wasting, a bilaterally reflexes, no weakness nor sensory loss. The claimant does not meet the criteria for cervical radiculopathy and lacks significant symptoms to confirm radiculopathy to the cervical spine. Therefore the claimant is diagnosed with a soft tissue injury to the cervical spine.

Diagnosis

Soft tissue injury to the Cervical Spine

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.

There is no evidence of rupture/partial rupture of tendons, ligaments, menisci or cartilage in the cervical spine.

There is no evidence of right-sided C6 radiculopathy (referring to the criteria in the Motor Vehicle Guidelines 2 or more symptoms are not present.