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Case study 14 - whether injuries to the cervical spine, lumbar spine and left knee meet the definition of a minor injury

This case study examines whether injuries to the cervical spine, lumbar spine and left knee 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 motor vehicle that was hit from behind by another car. The claimant’s motor vehicle was pushed into the rear of the car in front of it. The claimant’s left knee hit the dashboard.  An ambulance attended the scene and transported the claimant to hospital for assessment.

The claimant attended a General Practitioner the following day, who made a referral to an Orthopaedic Surgeon.

The claimant has lower back pain that is felt centrally and is without radiation. There is left knee pain and some “cracking of the knee”.

The claimant attends physiotherapy treatment on a fortnightly basis. There have been approximately 14 treatments to date. Current medications are Voltaren cream and Voltaren tablets at night.

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

  • Mildly and symmetrically reduced range of motion (to 80% normal), without muscle spasm or guarding and no radicular symptoms

Upper Extremity

  • Full range of motion in all upper extremity joints including both shoulders
  • No neurological abnormalities

Lumbosacral Spine

  • Moderately and symmetrically reduced range of motion (to 60% normal), without muscle spasm or guarding and no radicular symptoms

Lower Extremity

  • Full range of motion in all lower extremity joints including the left knee where the range of motion was 0 to 120 degrees
  • There was no crepitus or instability of the knee

Review of Documentation

Certificate of Capacity completed by the General Practitioner noted “cervical spine strain, lumbar spine strain, left knee strain”.

Ambulance form noted no loss of consciousness and a low speed motor crash.

Emergency Department summary from hospital recorded left knee impact with the dashboard, and lumbar and neck pain. Investigations showed no definite abnormality.

Orthopaedic Surgeon report stated there was lower back pain without radiation, a small disc herniation and tear at L5/S1 based on the report of the imaging. Conservative treatment was recommended.

MRI report of the lumbar spine concluded there was “a small L5/S1 central herniation with subtle annular tear, minimal herniation at L4/5”.

MRI of the cervical spine showed no abnormalities.

Diagnosis

There is no current evidence of radiculopathy.

The imaging “abnormalities” are not readily apparent on review. Changes of these types are common in asymptomatic people of the claimant’s age, and there is not sufficient information to conclude medically that the imaging “abnormalities” could be attributable to the subject accident. It is therefore concluded that there have not been specific intervertebral disc injuries sustained in the subject accident.

The claimant sustained soft tissue injuries to the cervical spine, lumbar spine and right knee. These injuries fit the definition of 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
  • Lumbar spine – soft tissue injury
  • Left knee – soft tissue injury