SIRA Logo

Case study 38 - minor injury

Overview

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

Introduction

The claimant was involved in a rear end collision, where they were a passenger in the front vehicle. The claimant reported they were fixing their shoe at the time of the accident and hit their head on the dashboard. Police and ambulance attended the scene of the accident, the claimant refused to attend the hospital and was driven away from the scene by their partner.

The claimant reported no neck or back pain and noted a headache which they believed would disappear spontaneously. The claimant went to hospital the following day and reported a headache, blurred vision and some dizziness. A brain scan was completed and no acute traumatic abnormalities were noted. The claimant was discharged with analgesia. The discharge records note pain in the upper back.

The claimant also attended hospital on the third day following the collision and was again provided with analgesia then discharged.

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

Cervical Spine

  • No muscle spasm or guarding
  • No non-verifiable radicular symptoms
  • Flexion was full, extension reduced to ¼ of normal range
  • Rotation was full and lateral flexion was assessed as full range of motion
  • No muscle wasting noted, normal light touch sensation on upper limbs and normal power in upper limbs
  • The claimant noted no signs or symptoms to indicate the presence of cervical radiculopathy

Thoracic Spine

  • Tenderness C7-T5 without muscle guarding or spasm
  • Flexion was 2/3 normal range and extension was ½ normal range being self-limited by pain complaint in the upper thoracic spine
  • Rotation was ¾ of normal range on both sides
  • There were no non-verifiable radicular complaints and no objective neurological abnormalities present to indicate thoracic radiculopathy

Lumbar Spine

  • Poor localised tenderness at the lumbar spine without spasm or guarding
  • Flexion was 2/3 normal range and extension ½ normal range, limited by pain reported in the thoracic area
  • Lateral flexion was full bilaterally
  • The claimant reported numbness in the upper part of the gluteal cleft, which was not within the distribution of a single dermatome and thus neither a non-verifiable or verifiable radicular complaint
  • No lower limb neurological abnormalities reported or present

Review of Documentation

The ambulance report (day of accident) indicated a low speed nose to tail collision with minimal car damage. The claimant reported a slight headache although noted that they had not eaten lunch. They refused transfer to the Emergency Department (ED) and were able to walk. Further GCS score of 15/15 and appeared able to make their own decisions.

ED discharge summary (day following accident) reported complaint of headache and mid thoracic pain. The report noted mild occipital discomfort and of feeling “out of sorts”. Reported blurred vision, no vomiting.

ED discharge summary (two days post-accident) noted headache had returned which had previously been controlled by analgesia, GCS 15/15, no bruising or tenderness noted on the scalp or face. Whole upper body (navel to head) examined and found not have any bruising or abnormalities.

Police report from the day of the accident stated that there was a minor traffic crash. Front to rear impact with a stationary vehicle in which the claimant was travelling.

Certificate of Capacity issued by GP, indicating no capacity for employment, reported injuries of cervical spine sprain, thoracic spine strain, abdominal trauma and acute stress disorder.

A number of psychological assessments were completed and pain behaviours noted.

The MRI report indicated C3-4 and C5-6 disc herniation with cord contact. There is a noted herniation with annular tear just contacting the cord. There was a minor compression of the cord (5%), cervical spine otherwise unremarkable.

Diagnosis

No clinical signs of cervical or thoracic radiculopathy. All reflexes, muscle bulk and power assessed as normal.

  • Cervical Spine – soft tissue injury
  • Thoracic Spine – soft tissue injury (not referred)

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.

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

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 cervical radiculopathy affecting any spinal region. The presence of an annular tear at C5/6 on cervical spine imaging is likely secondary to constitutional and age-related degenerative factors and not causally related to the subject accident.

The following injury is a minor injury

  • Cervical Spine – soft tissue injury
  • Thoracic Spine – soft tissue injury (not referred)