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Case study 47 - minor injury

Overview

This case 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 motor vehicle that was hit in the rear by another car. The claimant was wearing a seatbelt. An ambulance did not attend the scene.

Three weeks post-accident, the claimant attended a general practitioner (GP). The claimant complained of pain in the neck, shoulders and lower back. The claimant was referred for physiotherapy and treated with analgesic medication.

MRI of the cervical spine was performed which uncovered “no particular issues”.

At the date of examination, the claimant described neck and shoulder pain. There were no symptoms to either arm.

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

  • No paravertebral muscle guarding or spasm
  • No scoliosis or loss of cervical lordosis
  • Lateral bending to the right and left was decreased by one quarter in each direction
  • Rotation to the left and right was decreased by one quarter in each direction
  • Flexion and extension were each full and complete, without restriction
  • Thenar and hypothenar eminences were normal to examination and palpation
  • Tinel’s test was slightly positive over the left median nerve at the wrist but not on the right side
  • Tinel’s test was slightly positive over the right ulnar nerve at the elbow but not on the left side
  • Reflexes in the upper limbs were each ½ normal range, i.e within normal limits and equal on both sides
  • Testing of sensation in both arms was within normal limits
  • No apparent muscle wasting or atrophy

Review of Documentation

GP assessment noted “headaches, neck pain and stiffness, bilateral shoulder pain, intermittent pins and needles in the forearm, upper back pain, power back pain, stiffness, trouble sleeping, flashbacks, anxious and cautious to drive.” Cervical spine was said to show limited range of movement in all directions. Decreased range of movements of the shoulders. No mention of any neurological conditions. No evidence supplied of radiculopathy or of a non-verifiable radicular complaint.

Diagnosis

There is evidence that the claimant has a soft tissue injury to the cervical spine attributable to the motor accident.

The following injury WAS caused by the motor accident:

  • Cervical Spine – 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.

  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 following injury is a minor injury:

  • Cervical Spine – soft tissue injury