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Case study 42 - minor injury

Overview

The following case study examines whether various injuries sustained in a motor accident are considered minor or non-minor injuries in accordance with the Motor Accident Injuries Act 2017 (the Act).

Introduction

The claimant was the driver of a vehicle that was passing through an intersection. Another car failed to give way and collided with the front of the claimant’s motor vehicle. The claimant was transported to hospital by ambulance, however did not get examined as the wait time was excessive.

The claimant subsequently attended a general practitioner (GP). The GP referred the claimant for physiotherapy and x-rays. The claimant reported a painful neck, severe headaches, pain in the right shoulder and pain in the lower back and legs.

The claimant has been unable to return to work since the accident.

The claimant was involved in a subsequent motor accident in which another driver reversed into their car with considerable force in a parking lot. The claimant noted that thereafter they suffered “much more” back pain.

Current treatment is Endep, Panadeine Forte and Mobic. Physiotherapy had ceased by the date of examination.

The Assessment

There is a dispute about whether the injury is a minor injury under Schedule 2 section 2(e) of the Act.

Clinical Examination

Cervical Spine

The claimant demonstrated normal left rotation and normal flexion and extension. Right rotation was reduced to half. There was muscle guarding in the right paraspinal muscles. There was no alteration of spinal contour and no other abnormality detected.

Thoracic Spine

There was no tenderness on palpitation. There was no paraspinal muscle spasm and no muscle guarding. There was full range of movement and no abnormality of the normal posture.

Lumbar Spine

The claimant was acutely tender at all levels in the lumbar spine. The claimant refused to demonstrate flexion, extension or rotation. The claimant was able to sit on the side of the bed demonstrating 90° of flexion of the lumbar spine. There was no observable muscle spasm, muscle guarding and no flattening of the lumbar lordosis.

Upper Extremity

Left upper extremity was normal in all respects.

Examining the left shoulder compared to the right shoulder, the right was significantly bigger. There was no wasting, swelling or dropping of the shoulder. Abduction and flexion were to 90° and all other movements were normal.

Elbow, wrist and hand movements were normal. There was no unilateral muscle wasting in the arm and no other abnormality was detected.

Lower Extremity

The claimant was able to lie supine. Reflexes were brisk and equal. There were no sensory changes and no nerve tension sign and no unilateral wasting.

Review of Documentation

GP clinical notes mention a consultation a few months prior to the subject accident in relation to a fridge falling on the claimant’s back, resulting in pain and tenderness as well as affecting sleep, sitting and walking. When questioned about this, the claimant denied the fridge had fallen on them.

Further GP clinical notes mention another consultation prior to the subject accident for “neck pain and shooting since few days, tender on extension and rotation.”

MRI of the lumbar spine reports disc disease with an annular fissure at L3/4 and a transitional L5 vertebrae and possible compression of the transiting left L4 nerve root.

MRI right shoulder reports biceps tendon intact, intact supraspinatus with no significant tendinopathy or tear. There is mild subacromial bursitis.

CT of the lumbar spine shows no significant focal disc prolapse or rupture and no evidence of spinal canal or neural foraminal stenosis.

X-ray of the right shoulder is reported as normal.

Ultrasound of the right shoulder reports mild bursitis.

Diagnosis

  • Neck pain with headache and radiculopathy – no evidence of a disc lesion and no evidence of radiculopathy. The claimant was therefore assessed with a musculo-ligamentous strain of the cervical spine.
  • Right shoulder – no evidence clinically or radiologically of a tear of the rotator cuff or other tendons in the shoulder mechanism. The claimant is considered to have a soft tissue strain of the right shoulder.
  • Lumbar spine – there is an annular fissure which is not a rupture. There is no evidence of radiculopathy in the lower limbs. The claimant is assessed with a musculo-ligamentous injury.
  • Right side of chest – resolved.
  • Right knee – resolved.

The following injuries WERE caused by the motor accident:

  • Neck – musculo-ligamentous injury
  • Right Shoulder – soft tissue injury
  • Lumbar Spine – musculo-ligamentous injury

The following injuries caused by the motor accident have resolved:

  • Right Side of Chest – soft tissue injury
  • Right Knee – soft tissue injury

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:

  • 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 – musculo-ligamentous injury
  • Right Shoulder – soft tissue injury
  • Lumbar Spine – musculo-ligamentous injury
  • Right Side of Chest – resolved
  • Right Knee – resolved