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Case study 37 - minor injury

Overview

This case study explores a dispute about whether several injuries (cervical, thoracic and lumbar spine) are minor injuries under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act).

Introduction

The claimant was the driver of a motor vehicle that was hit from the side. The claimant felt pain across the lower back, centre of the spine, neck and their legs felt weak. The claimant was able to drive home. No police or ambulance attended.

The claimant attended their treating doctor the following day who noted lower back, thoracic spine and neck pain with radiculopathy.

The claimant reported no history of cervical or thoracic spine problems prior to the motor vehicle accident (MVA).

Seven years prior to the MVA the claimant injured their lower back and 3 years later underwent lumbar spine surgery.

The Medical Assessment

The claimant was assessed approximately 8 months post MVA reporting constant pain in their neck, less in the mid back and not so much in the lower back. The reported spinal pain radiated sideways.

Clinical Examination

Cervical Spine

  • No paravertebral muscle guarding and no tilting with spinal motion
  • Neck movements were uniformly reduced in extension/flexion, rotation and lateral flexion to one third, with no dysmetria
  • No non-verifiable radicular complaints
  • No signs of radiculopathy in upper limbs

Thoracic Spine

  • No paravertebral muscle guarding and no tilting with spinal motion
  • Thoracic spine movements were uniformly reduced to one third of the expected range for a person their age in flexion/extension and rotation, with no dysmetria

Lumbar Spine

  • No guarding and no tilting with spinal motion
  • Lumbar spine movements were uniformly reduced in flexion/extension to one third of the expected range for their age, with no dysmetria
  • Global subjective altered sensation did not follow the anatomical pathway of a specific spinal nerve root
  • No non-verifiable radicular symptoms and no signs of radiculopathy in lower limbs

Upper Extremity

  • Contour normal
  • Unable to obtain three consistent measurements of shoulder movements due to pain
  • No synovial hypertrophy, no crepitus and no sign of instability
  • No structural damage on examination

Summary of Documentation

Treating doctor records noted lower back pain, thoracic spine pain and neck pain with radiculopathy.

Treating specialist report indicated lower back pain, neck pain and interscapular pain with numbness and tingling in both hands. There was no neurological deficit in upper or lower limbs.

MRI of the cervical spine showed a disc herniation at the C5/6 area affecting the right side more than the left. No ligamentous injury or fracture of the cervical spine or thoracic spine was noted.

MRI of the thoracic spine was normal.

MRI of the lumbar spine 8 days post-MVA noted L4/5 moderate bilateral facet arthropathy narrowing the inferior aspect of the neural foramen resulting in mild bilateral formal stenosis without impingement. No disc protrusion and no definite neural impingement was noted at the L5/S1 area.

Diagnosis

  • Neck – mild strain

There is no objective medical evidence of a significant acute injury to the cervical spine, there is no neurological deficit and no signs of radiculopathy or dysmetria.

  • Thoracic Spine – mild strain

There was no significant physical signs or neurological deficit or radiculopathy. No injury to nerves, radiculopathy, complete or partial rupture of tendons, ligaments, menisci or cartilage was found.

  • Lumbar Spine – mild strain

The claimant had some symptoms related to the lumbar spine, but no significant physical signs, no radiculopathy or neurological deficit.

The lumbar spine showed some pre-existing operative and degenerative changes only. No injury to nerves, radiculopathy, complete or partial rupture of tendons, ligaments, menisci or cartilage was found.

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 – mild strain
  • Thoracic Spine – mild strain
  • Lumbar Spine – mild strain