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Case study 43 - minor injury

Overview

The following case study examines whether an injury to the cervical spine meets the definition of a minor injury in accordance with the Motor Accident Injuries Act 2017 (the Act).

Introduction

The claimant was the driver of a stationary vehicle that was impacted in the rear by another car. The claimant exited from their vehicle without difficultly and exchanged details with the other driver involved in the collision. Airbags did not deploy.

The claimant drove to work after the accident and was able to work for part of the day, however had to stop due to symptoms in the neck and arms.

The claimant saw a general practitioner (GP) a few days later and was subsequently referred to a physiotherapist and neurosurgeon for review.

The claimant has not since returned to work because they fear this will make the injury worse.

At the time of examination, the claimant complained of a restricted range of movement of the cervical spine. In addition, they described a burning sensation at the base of the skull, radiating to the shoulders and down the right and left arms, hands, fingers and thumbs.

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

  • Lateral bending to the left and right was decreased by ¼ but equally in each direction
  • Rotation to the left and right decreased by ¼ in each direction
  • Flexion and extension full, without restriction
  • Reflexes within normal limits and equal on both sides
  • Tinel’s test over the median and ulnar nerves at the wrists and elbows was negative
  • The thenar and hypothenar eminences were normal to examination and palpitation
  • No muscle wasting or weakness in either of the upper limbs
  • Sensation intact in each upper limb

Review of Documentation

Personal Injury Claim Form completed by the GP notes a soft tissue injury to the cervical spine, upper lumbar spine, upper back and shoulders. No mention of the arms or hands.

Treating Specialist report noted significant pain involving the neck and shoulders and down both arms, as well as sensory disturbance in both arms.

MRI of the cervical and upper thoracic spine showed an area of signal change involving the T2 and T3 segments. The treating specialist commented this appeared to be congenital rather than related to the motor accident. Treating specialist suggested getting the rest of the spine imaged.

Upon review of the further MRI, the specialist noted that the changes seen in the thoracic part of the spinal cord were an embryonical remnant and could not be considered accident-related.

Diagnosis

No clinical evidence of radiculopathy in that the claimant has no muscle weakness or atrophy.

No change in reflexes.

No demonstrable sensory change. No evidence of injury to a spinal nerve root.

Complaints of pain into the arms and hands are not consistent with any spinal cord distribution, nerve root or peripheral nerve. Therefore, they cannot be considered a non-verifiable radicular complaint.

Complaints are consistent with soft tissue injury to the cervical spine but there is no evidence of any injury to the nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.

No evidence of a specific nerve injury that is demonstrable on either history or examination. Thus, the claimant has by definition a minor 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:

  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