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Case study 12 - neck and lumbar spine minor injury

Introduction

The claimant had a MVA 3 years prior causing a back injury, however they had returned to work and reported no symptoms at the time of the subject motor vehicle accident (MVA).

The claimant was driving when a car turned in front causing them to t-bone the vehicle.  Neck pain was immediate after the MVA.

The claimant was reviewed by their general practitioner (GP) and reported back pain.  Treatment included pain relief, physiotherapy and hydrotherapy for approximately 5 months.

A review by an orthopaedic surgeon resulted in radiological scans and injection into the sacroiliac joint, the latter did not improve symptoms.

Since the MVA they have been unable to work and driving is limited to 20 minutes.  They are restricted with bending, lifting and some household tasks.

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

  • Normal lordosis
  • No spasm or guarding
  • Reduced rotation to the right by ¼, left rotation normal
  • Normal range of movement for flexion, extension and lateral flexion

Lumbar spine

  • No tenderness over sacroiliac joint
  • Tenderness over left L5 facet joint
  • No spasm or guarding
  • Reduced flexion – loss of ¾ of normal
  • Reduced extension by ½ of normal
  • Lateral flexion and rotation to both sides reduced by 1/3 of normal

Upper extremity

  • Full range of movement of both shoulders
  • No neurological deficits in the upper limbs (normal muscle power tone, reflexes and sensation)
  • Upper arm measurements were 33cm on both sides and for the forearm 29.5cm on the right and 28cm on left

Lower extremity

  • Unable to walk on heels or toes
  • Able to squat holding on
  • Straight leg raise right side reduced to 30° with negative Lasegue’s sign, left side 50
  • No neurological deficits in the lower limbs (normal muscle power tone, reflexes and sensation.
  • Thigh measurement right 59cm, left 58.5cm
  • Calf measurement right 41.5cm, left 42cm
  • Full range of movement of hips, knee and ankles

Review of Documentation

MRI Report 3 years prior to the MVA showed disc desiccation and prolapse with similar changes in latest MRI following subject MVA.  No complete or partial rupture of tendon, ligament, menisci or cartilage due to MVA.

Bone scan shows no evidence of any significant uptake, any uptake is likely due to inflammation rather than a tear of the structure.

Medical reports from an orthopaedic surgeon outline neck and lumbar spine symptoms.

Documents relating to previous MVA outline injury to lumbar spine with central posterior disc protrusion into the body of L5 and S1.

Diagnosis

Aggravation of pre-existing back condition.  There is no structural tear.  The right leg pain is not of a radicular patter and not consistent with radiculopathy.

The neck is a soft tissue injury with no evidence of radicular complaints or radiculopathy. There is no injury to either shoulder joint as a result of the MVA.  There is no rupture of any tendon, ligament or cartilage in either shoulder.

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

  • Neck – soft tissue injury
  • Lumbar spine – aggravation of degenerative changes