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Case study 40 - minor injury

Overview

This case study explores a dispute about whether injuries to the cervical 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 in a motor vehicle when they were hit from behind by a sedan. They did not hit their head and emergency personnel did not attend the scene. The claimant exchanged details with the other driver then drove home. The claimant reported bilateral symptoms in the cervical spine, a deep ache in the lower back to the right side and a frontal headache.

The claimant reported that pain in the spine and shoulders increased in severity and imaging was taken following a visit to their general practitioner.

The claimant was involved in 2 prior motor vehicle accidents and sustained suspected spine and upper extremity injuries.

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

  • Loss of ½ normal range of cervical extension and flexion range of movements and ½ loss of cervical range of right and left rotation
  • ½ loss of right and left cervical lateral flexion
  • No muscle wasting or sensory disturbance
  • No muscle guarding and reflexes normal
  • Carpal tunnel testing was negative, and muscle power was normal

Lumbar Spine

  • Lost 1/3 of normal range of lumbar extension and flexion movements and approximately ½ of lateral flexion
  • No muscle spasm, nor guarding observed
  • Straight leg raise to 65° bilaterally with some reproduction of backache. It does not reproduce leg pain
  • Normal power in lower limbs noted and no lower limb sensory disturbance present
  • Knee and ankle reflexes were preserved, no tenderness over the hamstring insertions
  • No signs of lower limb radiculopathy or sciatic nerve lesions

Upper Extremities

  • Symmetrical range of motion for both shoulders
  • May have mild digit nerve problem but certainly no sensory disturbance consistent with carpal tunnel or cervical radiculopathy

Review of Documentation

MRI report of the lumbar spine from 6 months post-accident showed disc protrusions at L4/5 and L5/S1. An MRI from 7 years prior to the accident indicated no changes from the MRI 6 months post-accident.

Ultrasound and x-ray from of the left shoulder taken 6 months post-accident indicated no rotator cuff tear, however showed mild bursitis.

MRI report of the lumbar spine from 6 years prior to the motor vehicle accident showed spondylotic changes at L4/5 and L5/S1 with no evidence of nerve root compression reported by the imaging specialist.

Diagnosis

The claimant sustained soft tissue injuries to the cervical spine in the most recent accident. Based on the imaging related to the prior accident from 7 years earlier, there is clear disc disease at the C4/5 and L4/5 level. The claimant noted being “sore for a couple of months after the accident” however the GP notes show that there were ongoing problems for at least 4 years or more post-accident following the accident that occurred prior to the subject accident.

The injuries to the upper extremities are defined as soft tissue injuries.

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.

The claimant’s symptoms are defined as soft tissue injuries to the cervical spine and lumbar spine. The significant injuries noted in the imaging are related to an accident predating the subject accident.

The following injury is a minor injury:

  • Cervical Spine – soft tissue injury
  • Lumbar Spine – soft tissue injury