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Case study 45 - minor injury

Overview

This case examines whether injuries to the cervical spine, lumbar spine, glutes and right thigh meet 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 vehicle that was stationary at traffic lights. The claimant’s vehicle was struck from behind by another car.

The claimant began to experience neck and shoulder pain at home later that evening. The following morning the claimant consulted with a general practitioner (GP). The GP issued a medical certificate, certifying time off work. The claimant returned to work five days after the accident occurred, however was sent home later that day due to pain.

Ultimately, the claimant could not continue with work due to ongoing symptoms and resigned six months post-accident.

The claimant has undergone physiotherapy treatment, which has now ceased, and uses analgesic medication to ease neuropathic pain.

At the time of examination, the claimant experienced “stabbing” lumbar spine pain and right leg pain which is dull and constant. The pain radiates down to the posterior right thigh after exertion with “pins and needles” in the right thigh and calf.

The lumbar pain is in the midline to the right side. It is associated with some tenderness over the lower lumbar spine.

The claimant has “good and bad days” associated with neck pain. There is no radiation of symptoms to the arms but there is some radiation to the scapular region on the right side. There is some tightness and tenderness over the right posterior neck extending down to the posterior right shoulder girdle.

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

  • Mild tenderness over the posterior and right cervical spine
  • Flexion to 30° with extension to 30°
  • Rotation 80° to the left and 70° to the right. There was tightness reported at the extreme of right rotation
  • No wasting of the upper limbs. Power, sensation and reflexes all normal

Lumbar Spine

  • Tenderness over the lower lumbar spine to the midline and to the right
  • Flexion was reduced by 60°. Extension was to 20°
  • Lateral flexion was 20°to the left with pulling over the right side. Lateral flexion to the right was to 20° with a “pinching” sensation
  • Rotation to the right while his spine was extended caused pain radiating to his right buttock and posterior thigh and calf. Rotation to the left did not cause any symptoms
  • Straight leg raising was to 80° on the left and 60° on the right. There was pain down the posterior of the right leg at the extreme of straight leg raising on the right. The pain was worsened by dorsiflexion
  • Reflexes in the lower limbs were all normal and equal
  • No sensory change in the lower limbs to light touch and pin prick
  • Definite weakness of dorsiflexion of the right foot and great toe (4/5 power) when compared to the left (5/5 power)

Review of Documentation

Certificates of Capacity issued by the General Practitioner note the main areas of symptoms were, at various times, the neck and lower back. An entry documented “neuralgia shooting down right calf, positive SLR and slump tests”.

MRI of the lumbar spine showed L4/5 posterior central, right central and right subarticular annular fissure associated with a mild broad-based posterior annular disc bulge, asymmetrical to the right. There is right subarticular stenosis resulting in possible impingement of the right L5 nerve root. There is L5/S1 focal left central and subarticular disc protrusion with abutment and potential impingement of the left S1 nerve root. Mild to moderate L5/S1 and to a lesser extent L4/5 facet joint arthrosis.

CT scan of the lumbar spine showed left posterior intervertebral disc protrusion at L5/S1 with likely irritation of the left S1 nerve root. Posterior intervertebral disc bulge at L4/5 with likely irritation of the right L5 nerve root within the central spinal canal.

Both of the above investigations are consistent with the clinical finding of a right L5 radiculopathy.

Diagnosis

  • Lumber Spine – disc protrusion with L5 radiculopathy.
  • Cervical Spine – flexion extension injury causing soft tissue injury to the cervical spine.

The symptoms are severe and consistent with a right sided lower limb neuropathic pain.

The claimant meets the criteria for radiculopathy as outlined in the Motor Accident Guidelines. There are two of the required clinical signs (positive sciatic nerve root tension signs and muscle weakness in an appropriate spinal nerve root.

The following injuries WERE caused by the motor accident:

  • Lumbar Spine – disc bulging and impingement to the right and left nerve root causing acute pain on movement.
  • Glutes – right buttock area is tingling and numb which is extended down the right thigh.
  • Rear Right Thigh – the right thigh area is suffering with tingling and numbness.
  • Cervical Spine.

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.

The following injuries are not minor injuries:

  • Lumbar Spine – disc bulging and impingement to the right and left nerve root causing acute pain on movement.
  • Glutes – right buttock area is tingling and numb which is extended down the right thigh.
  • Rear Right Thigh – the right thigh area is suffering with tingling and numbness.