SIRA Logo

Case study 46 - minor injury

Overview

The following case study examines whether a variety of 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 stationary at an intersection. The claimant’s vehicle was hit from behind by another car and pushed into the intersection. The claimant’s vehicle sustained significant damage.

The claimant developed severe pain overnight and consulted with a general practitioner (GP) the day following the accident.

The claimant described back pain that radiated to the left lower leg laterally. There was also pain in the left buttock and the right buttock laterally and superiorly. The claimant noted pain in the lower back and neck. The neck pain radiated to the trapezial region more on the right side than left. Occasionally, there is pain in the right arm with some change in feeling in the fourth and fifth fingers of the right hand. The claimant indicated difficulty with balance. Pain makes it difficult for the claimant to exercise and has resulted in significant weight gain.

There is ongoing physiotherapy treatment and use of analgesic medication.

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

  • Moderately and symmetrically reduced range of motion without muscle spasm or guarding
  • No radicular symptoms

Upper Extremity

  • Full range of movement in all upper extremity joints with the exception of the right shoulder, where pain in the trapezial region limited abduction to 150°and flexion to 160°
  • No neurological deficit detected in the upper extremities
  • No specific abnormality of the right elbow detected

Thoracic Spine

  • Moderately and symmetrically reduced range of motion (70% normal) without muscle spasm or guarding
  • No radicular symptoms

Lumbar Spine

  • Moderately and symmetrically reduced range of motion (70% normal) without muscle spasm or guarding
  • No radicular symptoms

Lower Extremity

  • There was full range of motion in all lower extremity joints
  • No specific abnormality of the right ankle detected
  • No neurological abnormalities
  • Claimant walked with a normal gait

Review of Documentation

Certificate of Fitness completed by GP stated that there were injuries to the neck, back, gluteal, left trochanter, right medial elbow and right ankle region. It noted “decreased sensation left lateral leg and foot, reduced range of motion neck and back and reduced power left ankle and reduced sensation right arm.”

MRI of the lumbosacral spine reported showing lumbar canal stenosis with suspected impingement of the L4 and L5 nerve roots on the left side.

MRI of the cervical spine reported showing a small to moderate size C5/6 disc protrusion with canal stenosis. There were also degenerative changes present.

Diagnosis

The soft tissue injuries to the cervical spine, lumbar spine and the right elbow and right ankle can be regarded as caused by the motor accident.

There is not sufficient evidence available to support causation of the other “injuries” listed.

There is no current evidence of radiculopathy. An acute injury does not cause degenerative spondylosis and annular tears are common in asymptomatic people of the claimant’s age. There is no convincing medical reason that an annular tear could have been caused by the accident. The other statements are descriptions of symptoms, not injuries. It should also be noted that, at the time of assessment, no definite neurological deficit manifested by objectively decreased sensation or reduced muscle power could be detected.

The following injuries WERE caused by the motor accident:

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

The following injuries WERE NOT caused by the motor accident:

  • Cervical radiculopathy and C5/6 degenerative spondylosis, lumbar radiculopathy and L4/5 annular tear, gluteal and left trochanter area, decreased sensation in the left lateral leg and foot, reduced power at left ankle, reduced sensation right arm.

The following injuries caused by the motor accident have resolved:

  • Right Elbow – soft tissue injury
  • Right Ankle – 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:

  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 is a minor injury:

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