Report of Mr Nicholas Howard Jenkins
Expert Emergency Physician
On behalf of xxxx, Solicitors
Client’s name: Mr xxxx
Date: 27 April 2015 Date of injury: xx March 2010
______
FIRST REPORT OF MR NICHOLAS HOWARD JENKINS
Dated : 27 April 2015
Specialist Field : Emergency Medicine
Claimant : Xxxx
Address : xxxx
Date of birth : xxxx
Age at time of accident : 30 years
Marital status : Married
Occupation : Ceiling Fixing Dry Lining Worker
On the instructions of : xxxx, Solicitors
Accident date : xx March 2010
Mr Xxxx was examined on 31 December 2014 at 9.45 am in Cornerstones, 315a Cyncoed Road, Cyncoed, Cardiff. He was unaccompanied during the examination. He did not produce any photographic identification.
Name Mr Nicholas H Jenkins
Address Cornerstones, 315a Cyncoed Road, Cyncoed, Cardiff CF23 6PD
Telephone number 02920 759428
Reference NHJ/ED/Xxxx, JL
CONTENTS
Paragraph number Paragraph contents Page number
1 Introduction 3
2 The issues addressed and a
statement of instructions 4
3 Review of the evidence 5
4 My opinion 15
5 Expert’s declaration 19
6 Statement of truth 21
7 Statement of conflicts 22
APPENDICES
1 My experience and qualifications
2 The documents that I have examined
3 Chronology
4 Glossary of medical terms
5 Copy of Letter of Instruction
6 Definition of Disability
1 INTRODUCTION
1.01 I am Nicholas Howard Jenkins. My specialist field is Emergency Medicine. My qualifications are BSc MBBCh FRCS FCEM MCh. In 1989 I was awarded the Robert Jones Gold Medal and Prize by the British Orthopaedic Association. As an Emergency Medicine Consultant I dealt on a daily basis with the entire spectrum of acute injuries ranging from the treatment of minor injuries to the resuscitation of patients with serious life threatening injuries. Full details of my qualifications and experience entitling me to give expert opinion evidence are in Appendix 1.
1.02 Summary of the case
1.02(i) The case concerns Mr Xxxx who sustained a neck injury on xx March 2010. I have been asked to comment upon that injury.
1.02(ii) There is a chronology of the key events in appendix 3.
1.03 Summary of my conclusions
1.03(i) This report will show that in my professional opinion Mr Xxxx sustained a sprain of a constitutionally degenerate/arthritic neck in the index accident.
1.03(ii) Whilst Mr Xxxx continues to experience ongoing neck symptoms and in my opinion it would be reasonable to attribute a period of up to three months’ worth of symptoms to the injury sustained in the index accident and any symptoms beyond that period should be considered to be constitutional in origin.
1.03(iii) Mr Xxxx told me that he took “a couple of days” sickness leave from work as a result of the injury sustained.
1.04 The parties involved
Mr Xxxx (Claimant)
1.05 Medical terms and explanations
I have indicated any medical terms in bold type. I have defined these terms in a glossary in appendix 4.
2 THE ISSUES TO BE ADDRESSED
2.01 I have been instructed by xxxx Agency on behalf of xxxx, Solicitors, who have requested that I address the issues stated in their Letter of Instruction, xx October 2012. I enclose a copy of that Letter of Instruction in Appendix 5.
3 REVIEW OF THE EVIDENCE
3.01 Documents
3.01.1 Minor Injury Unit Notes, xxxx Hospital
The documentation below has been summarised from the Minor Injury Unit notes and does not represent my personal opinion.
3.01.1(i) The notes indicate that Mr Xxxx was registered in the Minor Injury Unit at 11.29 hours xx March 2010.
3.01.1(ii) Mr Xxxx was examined by an Emergency Nurse Practitioner (ENP) at 11.40 hours. The ENP noted that Mr Xxxx stated that he had sustained an injury at work the previous day. It was noted that Mr Xxxx had been wearing a hard hat and had walked into a scaffold bar thus jolting his neck. It was noted that Mr Xxxx had not lost consciousness, was not nauseous and had not vomited. Mr Xxxx complained of a mild frontal headache. The ENP noted that Mr Xxxx had no neurological deficit.
3.01.1(iii) The ENP noted that Mr Xxxx had no significant previous medical history and took no medication.
3.01.1(iv) Examination revealed that Mr Xxxx was alert and orientated. His pupillary reactions were normal and Mr Xxxx complained of no dizziness or blurring of vision. It was noted that Mr Xxxx complained of a mild frontal headache but had not taken analgesia. Examination of the head and neck revealed no obvious swelling or deformity. There was no bruising, no wounds and no grazes. There was no bony tenderness of the forehead or cervical spine. There was minimal tenderness of the right sternomastoid muscle.
It was noted that there was a full range of movement of the neck but Mr Xxxx’s pain was increased on lateral rotation.
3.01.1(v) Neurological examination revealed no abnormality.
3.01.1(vi) A diagnosis of a soft tissue injury/neck sprain was made. Mr Xxxx was provided with advice and reassurance. He was advised regarding RICE (rest, ice, compression, elevation) and provided with a written advice card. Mr Xxxx was provided with analgesia and was discharged from the department with the advice to return should there be further problems.
3.01.2 General Practitioner’s Notes
The documentation below has been summarised from the General Practitioner’s notes and does not represent my personal opinion.
3.01.2(i) There are no documented consultations with the General Practitioner in relation to the injuries sustained xx March 2010. The first documented consultation following the index accident is dated xx May 2010 and is for an unrelated issue.
3.01.2(ii) The relevant pre-accident documentation reads as follows:
· The notes contain a computer-generated discharge summary from the Accident & Emergency Department of the xxxx Hospital indicating that Mr Xxxx attended the department on xx March 2005 following a road traffic collision when he complained of injuries to the neck and back. A diagnosis of a bilateral neck injury was made.
· The notes contain an entry dated xx December 2007 when it was noted that Mr Xxxx would be investigated by way of an MRI scan of the cervical spine. The notes do not contain the results of such a scan.
· The notes indicate that Mr Xxxx was involved in a significant road traffic accident in xxxx when he sustained multiple injuries including fractures of the right elbow, left wrist, the pelvis, the right tibia and the left foot.
· Mr Xxxx consulted his General Practitioner in May 20xx complaining of polyarthralgia.
· Mr Xxxx has a past history of low back pain.
3.01.2(iii) The bundle of notes provided dates from 1971 until 14 September 2012.
3.02 My interview with Mr Xxxx and subsequent medical examination, 31 December 2012
3.02.1 Past medical history
3.02.1(i) Mr Xxxx told me that he is normally well and specifically stated that prior to the accident xx March 2010 he had no pre-existing neck problems.
3.02.1(ii) Mr Xxxx told me that he had been involved in a road traffic collision approximately five years ago when he sustained various injuries to his lower body.
3.02.2 Immediate events
3.02.2(i) Mr Xxxx described sustaining an injury whilst working on xx March 2010. He told me that he was walking up a ramp wearing a hard hat when the forehead region of his hat struck a scaffolding bar.
3.02.2(ii) Mr Xxxx told me that this caused his neck to jerk backwards.
3.02.2(iii) Mr Xxxx told me that he felt physically uninjured immediately after the accident but over the next 30 to 60 minutes experienced a progressive stiffness of his neck and shoulders.
3.02.2(iv) Mr Xxxx told me that he reported the accident.
3.02.2(v) Mr Xxxx told me that he attended a Minor Injury Unit the following day from where he was discharged following clinical examination.
3.02.3 Progress
3.02.3(i) Mr Xxxx told me that he has since continued to experience neck problems.
3.02.3(ii) Mr Xxxx told me that he has consulted his General Practitioner on a number of occasions primarily in respect of symptoms in relation to his ankles. He told me that he has mentioned his neck symptoms to his General Practitioner but his General Practitioner has told him that his neck cannot be x-rayed.
3.02.4 Current symptoms
3.02.4(i) Mr Xxxx continues to experience symptoms in relation to his neck and shoulders and told me that there has been no improvement in his symptoms since the injury was sustained.
3.02.4(ii) Mr Xxxx told me that he experiences discomfort in his neck and shoulders especially when working with an extended neck (i.e. looking upwards) and working with his arms above his shoulders.
3.02.4(iii) Mr Xxxx told me that he also experiences occipital headaches.
3.02.4(iv) Mr Xxxx told me that his symptoms do not disturb his sleep.
3.02.4(v) Mr Xxxx told me that he experiences a crunching sound from his neck on neck movements.
3.02.4(vi) Mr Xxxx did not describe any arm radiation of symptoms nor neurological symptoms.
3.02.5 Effect on employment
3.02.5(i) Mr Xxxx told me that he took “a couple of days” sickness leave from work following the index accident but told me that he then returned to work as a result of financial necessity.
3.02.5(ii) Mr Xxxx told me that his work involves working with ceilings and thus working with his neck in an extended position with his arms above his shoulders thus exacerbating his symptoms.
3.02.6 Loss of amenity
3.02.6(i) Domestic activities
Mr Xxxx told me that he found difficulty in helping with the housework in the early weeks following the accident.
3.02.6(ii) Driving
Mr Xxxx told me that he experiences stiffness of his neck when driving.
3.02.7 Clinical examination, 31 December 2012
3.02.7(i) General
3.02.7(i)a Mr Xxxx was noted to be 6 foot 1 inch tall and weighed 16 stone 1 pound (102.6 kg) (BMI = 29.7 kg/m²) (WHO definition = “overweight”).
3.02.7(i)b Neck movements during the anamnesis were spontaneous and apparently pain free.
3.02.7(i)c Mr Xxxx’s gait and posture were normal.
3.02.7(ii) Mental State
3.02.7(ii)a There was no evidence of anxiety or depression.
3.02.7(iii) Neck and Shoulders
3.02.7(iii)a Examination of the neck and shoulders revealed no deformity.
3.02.7(iii)b Mr Xxxx indicated the paraspinal musculature and the trapezius musculature bilaterally as his site of neck discomfort. He also indicated that he experiences discomfort deep to his scapulae.
3.02.7(iii)c There was no localised tenderness.
3.02.7(iii)d Movements of the cervical spine and shoulders were full.
3.02.7(iv) Neurological
3.02.7(iv)a There was no evidence of neurological abnormality.
3.02.8 Analysis of Evidence
3.02.8(i) Mr Xxxx describes having sustained an extension injury to his neck in the index accident xx March 2010 when he hit the forehead region of his hard hat against a scaffolding bar.
3.02.8(ii) Mr Xxxx’s injury was documented at the Minor Injury Unit when Mr Xxxx attended the Unit on the day following the accident.
3.02.8(iii) Mr Xxxx told me that he has consulted his General Practitioner on a number of occasions in relation to ongoing neck symptoms, although those symptoms are not documented within the bundle of notes provided.
3.02.8(iv) The quality of Mr Xxxx’s symptoms is typical of the symptoms experienced from a degenerate/arthritic cervical spine and whilst Mr Xxxx stated that he had experienced no neck problems prior to the index accident, I would note that the documentation indicates that he attended an Accident & Emergency Department on xx March 20xx, having sustained a neck injury in a road traffic collision. He was involved in a high speed road traffic collision in August 20xx when he sustained multiple fractures and there is a note in the General Practitioner’s notes dated xx December 2007 indicating that Mr Xxxx’s cervical spine would be investigated by way of an MRI scan.
3.02.8(v) Whilst the mechanism of injury described by Mr Xxxx could be expected to result in a soft tissue injury of the neck, such an injury would not be expected to result in protracted symptoms and in my opinion Mr Xxxx’s ongoing neck symptoms are a reflection of a constitutionally degenerative cervical spine.
4 MY OPINION
4.01 Diagnosis
4.01(i) Sprain, cervical spine
4.02 Prognosis
4.02(i) In my opinion Mr Xxxx sustained a sprain of a constitutionally degenerate cervical spine in the index accident xx March 2010 and the clinical course of that injury has been described above.
4.02(ii) Under normal circumstances one would expect the symptoms resulting from such an injury to be short lived however the presence of pre-existing degenerative disease would probably be responsible for the symptoms experienced being of greater magnitude and of greater duration than would have been the case in a patient with a previously normal neck.
4.02(iii) In my opinion it would be reasonable to attribute a period of up to three months’ worth of symptoms to the index accident but any symptoms beyond that period should be considered to be constitutional in origin.
4.02(iv) In my opinion the injuries sustained would not be expected to alter the natural history of the pre-existing degenerative process.
4.03 Treatment requirements
4.03(i) Whilst Mr Xxxx’s symptoms may be improved by treatments such as Physiotherapy or manipulative therapy in the form of Osteopathy, in my opinion any such treatment would be a reflexion of the constitutional process affecting Mr Xxxx’s neck and in my opinion Mr Xxxx will not require any future treatment as a direct consequence of the injury sustained in the index accident.
4.04 Future complications
4.04(i) In my opinion Mr Xxxx’s neck injury will not be responsible for any future complications.
4.05 Note regarding conflict of interest
4.05(i) Mr Xxxx was treated at the Minor Injury Unit of xxxx Hospital which is part of the Cwm Taf Heath Board group of hospitals. I was employed by the Cwm Taf Health Board August 2012 until November 2013.
4.06 Consistency of account
4.06(i) Mr Xxxx answered the questions during the interview in a straightforward manner and I was unaware of any deliberate attempt to exaggerate symptoms or their effects.
4.07 My opinion regarding loss of amenity/disability
4.07(i) Mr Xxxx told me that he took “a couple of days” sickness leave from work following the index accident and described how the nature of his work has affected his neck symptoms. In my opinion the period of sickness leave described was consistent with the injury sustained and directly attributable to the index accident. In my opinion it would be reasonable to have expected Mr Xxxx’s working activities to have exacerbated his symptoms during the first three months following the index accident.