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Case study 26 - injury to cervical spine

Introduction

The claimant was driving a vehicle which suffered a rear-end impact from another car. The claimant’s head hit the steering wheel which resulted in a small cut just above the inner aspect of the right eyebrow. The claimant complained of neck discomfort. The claimant’s vehicle was “written off” due to extensive damage.

The claimant was transported to hospital via ambulance. X-rays of the neck were taken. The claimant was cleared of cervical spine fracture. The claimant returned home that same day.

Later in the day, the claimant saw a General Practitioner to complain of a burning sensation, mostly on the left-side at the neck root. The claimant was subsequently referred to a physiotherapist and prescribed analgesic medication. Physiotherapy treatment provided no sustained symptomatic benefit.

Due to neck pain, the claimant reduced their daily work hours from 15 to 8.

The Assessment

There is a dispute about whether the injury is a minor injury under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act)

Clinical Examination

There was mild swelling just above the medial aspect of the right eyebrow although there was no visible or palpable abnormality at the forehead and no visible scar.

Cervical Spine

  • Flexion was 2/3 normal range whereas extension due to protracted posture was ½ normal range
  • Dysmetria with disproportionate restriction of rightward neck movement ¼ compared with leftward 1/3
  • No muscle guarding or spasm
  • No non-verifiable radicular complaints

Upper Extremity

  • Full range of motion at the shoulders, elbows, wrists and hands

Review of Documentation

Physiotherapist’s report noted that the neck and shoulder were being treated for pain and stiffness

Ambulance report noted a laceration about the right eye with dizziness and forehead pain. There was no loss of consciousness. There was C4-5 tenderness with decreased flexion and extension. There was good range of motion and strength in the extremities without sensory loss.

Hospital records state that there was a laceration/haematoma about the right eye and dizziness. Tenderness of the lower cervical spine with complaint of neck pain. Slightly reduced right shoulder abduction. Reduced range of neck motion, although resolved on repeat examinations.

General Practitioner records show a diagnosis of whiplash injury of the neck

Report of the CT scan of cervical spine refers to severe pan-cervical spondylosis with multilevel hyperostosis associated with interbody bony bridging. There was mild disc space narrowing at C3-4. There was neurocentral degenerative change at right-sided C6-7 causing narrowing of the lateral recess. There was advance joint degenerative change at C7-T1 causing some narrowing of the lateral recesses, especially on the left.

CT of the brain showed no sequelae of injury

Right shoulder x-ray showed osteoarthritis of the acromioclavicular joint without fracture.

Diagnosis

Soft tissue injury of the cervical spine with attendant chronic symptomatic aggravation of underlying degenerative change. Radiological investigations confirm long-standing advanced cervical spine generative changes. Clinical examination findings do not satisfy those necessary for diagnosis of cervical radiculopathy.

Soft tissue injury to the right forehead which has healed, albeit with mild residual tenderness but no apparent residual deformity or scarring

No evidence on clinical examination of rupture or partial rupture of tendons, ligaments, menisci or cartilage at either the head or cervical spine. There were no neurological abnormalities to indicate cervical radiculopathy or cervical myelopathy.

The claimant complains of disabling neck pain, yet the injury is nonetheless within the bounds of “minor injury” as defined by the Act.

Based on the history provided by the claimant and the medical information available to the medical assessor, the following injuries were determined to be caused by the motor accident

  • Cervical spine soft tissue injury with aggravation of underlying degenerative changes
  • Head (forehead) soft tissue injury with residual mild tenderness

The following injuries were not caused by the motor accident

  • Cervical radiculopathy

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 injury is a minor injury

  • Cervical spine soft tissue injury with aggravation of underlying degenerative changes
  • Head (forehead) soft tissue injury with residual mild tenderness