1. At age 35, while working as a personal trainer, she lifted a portable CD stereo system and felt something "go" in the lower back. A diagnosis was made of L5/S1 disc bulge and for many years she self-managed the ensuing low back pain. However, with the passage of time her symptoms evolved to left sciatica, culminating in successful L5/S1 spacer/decompression four years ago by Dr Scholsem. The sciatica resolved very soon after the lumbar spine surgery.
2. Post-operatively, she recovered well and was able to resume running six weeks post-operatively. She worked on core strengthening/general strengthening and was able to continue her regular walking and running activities. There was mild mechanical low backache which she continued to self-manage with regular exercise and avoidance of heavy lifting/injudicious activities.
3. The lower back remained very manageable aside from a flare up which commenced after an overseas flight in approximately May 2023. She had been returning from Bali and lying on a row of three vacant seats for several hours and believes this somehow aggravated the lower back. She developed a lot of lower back muscle spasm. She could not clearly remember if there were any sciatica; she thought the issue then had mostly been low back pain.
4. She permitted some time for recovery whilst taking NSAIDS. However, when lower back symptoms were slow to settle, she consulted Dr Scholsem who had done the original lumbar surgery. His records indicate that she did receive a lumbar nerve root injection (which she initially could not recall) not long before the subject accident. She remembered there was some discussion about further lumbar decompression surgery although Dr Scholsem was not enthused for further surgery unless it were really necessary, advising a "wait and see" approach.
5. In any event, the lower back symptoms had gradually settled by the time of the accident. She recalled that she had even been able to resume running prior to the accident.
6. Medical Assessor Lahz asked her about the pre-existing left shoulder injury (complete supraspinatus tear on ultrasound) occurring in late 2022. She ascribes this to a push-up. There was subsequent pain in the posterior deltoid which she managed initially with rest, osteopathy and then strengthening. She said the left shoulder nearly fully recovered and she could resume all of her usual activities of daily living and exercise activities (even shoulder presses and push ups) aside from boxing, which tended to stir up posterior shoulder pain.

1. At the time of the accident, she was the restrained driver of a 2020 model Mazda 3, the second in a line of four cars. A car (Corolla) which itself had been rear-ended, then rear-ended her vehicle, in turn causing hers to hit the back of the car in front (Hilux). She had brief warning of the imminent collision, hearing the preceding bang and recalls attempting to swerve to the right in order to escape.
2. She did not recall any part of her body striking the cabin interior. She did remember being pushed forward and then backwards. Immediately afterwards, she felt shocked although she could exit the vehicle and walk around at the scene. An ambulance did not attend although the police arrived. She was able to make the necessary arrangements to summon a tow truck.
3. She was immediately aware of low back pain along with tightness at the left side of the neck/trapezius/shoulder. The tow truck driver later dropped her home.

1. The following day, there was ongoing left shoulder tightness/soreness although she was more focused on the lower back, given the history of surgery in this location. She worked from home, having flexible employment arrangements and saw her general practitioner the next day.
2. She started treatment with a chiropractor through "Back to Life" targeting the lower back and left shoulder. Given the pre-existing rotator cuff tear, she had thought the left shoulder tightness being experienced after the accident was attributable to a flare up of that pre-existing condition.
3. The lower back symptoms improved to baseline and she is not alleging any permanent deterioration in the condition of the lower back due to the accident.
4. The left shoulder symptoms failed to improve (despite application of self-management measures she had used after the earlier injury during 2022), and moreover worsened. There was persistent tightness at the left shoulder blade and trapezius and by September 2023, she had developed a constant burning sensation enveloping the left shoulder and upper arm.
5. She underwent a left shoulder ultrasound, which showed a "partial" tear. She thought it odd that the "complete" tear present before the motor accident, would somehow have improved to become "partial". (Medical Assessor Lahz notes however that ultrasound is an extremely operator dependent investigation, without the accuracy conferred by MRI).
6. At this stage, she started seeing a physiotherapist (Mr Nguyen) at Penshurst for the left shoulder pain/burning sensations. All the while left upper limb symptoms continued to evolve and by late 2023, there were very uncomfortable tingling sensations/paraesthesia affecting the radial forearm and thumb.
7. A few months later, Ms McGrath also developed numbness/tingling affecting the left little finger although the neurological symptoms at the thumb continued to predominate. She also developed weakness of the left hand with tendency for dropping items. Moreover, head movements to the left, especially if sustained, caused burning and shooting sensations in the left upper arm, down the forearm and increased neurological symptoms at the thumb.
8. Mr Nguyen informed her that he felt the problems were coming from the neck, and not the shoulder despite what she had originally thought.
9. Scans were undertaken showing a compressed left C6 nerve due to C5/6 foraminal narrowing.
10. Subsequently, she consulted again with Dr Scholsem. She said there were numerous delays due to the specialist being on leave and then further delays with treatment due to an interventional radiologist breaking his wrist.
11. Dr Scholsem explained the diagnosis of left cervical nerve root (C6) compression and arranged steroid injections to the C5/6 level. She underwent the first injection in June 2024 with significant (60%) relief although symptoms had gradually ramped up again by December 2024 at which time she received a further injection with again favourable, albeit short-term results.
12. In between the two steroid injections, the left upper limb symptoms abated sufficiently for

Ms McGrath to resume upper limb strengthening which she had not been able to do beforehand. 13. Dr Scholsem was not keen for her to receive further cervical spine injections given the risk of cartilaginous weakening. He subsequently recommended spacer insertion to C5-6 to decompress the left C6 nerve root using an anterior surgical approach. Ms McGrath was booked to undergo the latter surgery in early September at St George Hospital in the public system. 14. Although the left upper limb symptoms are still generally better than before the 2024 cervical spine injection, they remain sufficiently bothersome that she still wishes to undertake the proposed cervical spine surgery. She had requested the neck surgery of the CTP insurer although it was declined. 15. She reported ongoing intermittent burning and shooting sensations down the left arm, commencing at the left side of the neck and spreading over the trapezial region to the arm/radial forearm associated with tingling sensations in the thumb>>little finger. She experienced "bad" days with the left arm on average twice weekly. She reported as well, being unable to lie on the left arm at night and must carefully prop her arm on a pillow. Average pain intensity at the left arm is 6/10 and the left neck/trapezial region feels tight as though it always needs a massage. She cannot tolerate prolonged left head turn due to worsening neurological symptoms in the left arm and will often have to change seats at the dining table to avoid looking left for too long. 16. The whole left hand feels peculiar and weak, and she has continued dropping items regularly. She reported finding it difficult to write given that she is left-handed. She is also wary of lifting with the dominant left arm, preferring to use the unaffected right upper limb. 17. She continues receiving physiotherapy (self-funded) weekly and she also regularly attends the gym, completing the exercise programme recommended by the physiotherapist which includes cervical spine isometrics. She avoids heavy lifting and any exercises which aggravate the left arm neurological symptoms. 18. She takes Celebrex regularly and Panadeine Forte during more severely symptomatic periods. 19. She reported reasonably satisfactory elevation of the left upper limb although there is less range compared with the right. 20. She does not believe the supraspinatus tear at the left shoulder is causing the current problem. She thinks the left arm symptoms are coming from the neck, as does the treating spinal surgeon. 21. Regarding the lower back, as noted, she is not particularly concerned. She does have ongoing back pain, mainly on the right side in the quadratus lumborum area. She attributes the laterality of the pain to overuse of the right upper limb to compensate for the persistent neck/left upper limb problems. She avoids bending over to retrieve items from low down. 22. She still does chores, shopping and cooking etc by taking care. However, the left arm pain and neurological symptoms at the hand are adversely affecting her quality of life causing sleep disturbance and functional restrictions.

1. On examination, Ms McGrath was pleasant, straightforward, cooperative and of slim muscular build. Weight was 60.4 kg and height 168 cm. Gait was unremarkable. She could walk, tiptoe and walk on heels without ado.
2. Neck movements were hesitantly performed with flexion ½ normal range, extension 1/3 normal range (with soreness complaint), lateral flexion to either side ½ normal range (irritability with leftward movement) and rotation 1/3 normal range to the right and ¼ normal range to the left again with greater irritability on leftward movement. There was dysmetria in the sagittal and coronal planes.
3. There was tenderness over C5-7.
4. There was muscle guarding/spasm with tenderness at the left trapezius, very distinct compared with the soft, non-tender right trapezius.
5. The left-sided Spurling manoeuvre was positive and other upper limb neural tension manoeuvres were also positive causing a shower of neurological symptoms into the left arm, with predominance at the radial forearm and thumb and to a lesser extent the index finger.
6. There was no measurable wasting of the arms 10 cm above the elbow crease- 26 cm nor of the forearms 5 cm below the crease- 23 cm.
7. The left biceps jerk was reduced compared with the right. Other upper limb deep tendon reflexes were symmetrical.
8. There was sensory loss at the left arm localised to the radial forearm, thumb and to a lesser extent the index finger (consistent with C6 pattern). As noted, there were also neurological symptoms in the left C6 distribution.
9. There was a degree of pain-related weakness throughout the left arm/forearm.
10. There was also mild generalised (painless) weakness of the left-hand affecting thumb flexion/extension, finger flexion/extension and finger abduction/adduction.
11. There were findings consistent with left C6 radiculopathy being reduction of the biceps jerk, sensory loss in the C6 distribution and positive left-sided upper limb neural tension tests.
12. Active range of motion at the shoulders is shown in the following table: Movements were found consistent with repetition and measured with a goniometer.

1. Active shoulder movements were limited L>R by pulling sensations in the left side of the neck and left trapezius.
2. There was no focal tenderness about the shoulders.
3. There was no asymmetrical wasting of the shoulder girdles.
4. Impingement tests at the shoulders were bilaterally negative.
5. On the right, she could reach the interscapular region with her hand whereas on the left, she could barely reach the buttock.
6. On examination of the lumbar spine, there was flattening of the lumbar lordosis.
7. Lumbar spine flexion was 2/3 normal, extension 2/3 normal, lateral flexion ¾ normal range to either side and rotation full to either side.
8. There was no muscle spasm or guarding and there were no lower limb non-verifiable radicular complaints.
9. She was able to sit on the side of the couch with legs extended i.e. lower limb neural tension tests (reverse SLR) were negative.
10. Knee and ankle jerks were present and symmetrical.
11. There was normal lower limb sensation and normal lower limb power in all groups.
12. There was no measurable wasting of the thighs 43 cm 10 cm above the patella nor the calves 20 cm, at maximal mid-calf girth 34 cm.
13. There were no findings of lower limb radiculopathy.

1. Ms McGrath presented in a straightforward manner and Medical Assessor Lahz accepted the chronology of left shoulder/upper limb symptoms provided.
2. There was immediate reference to the left shoulder in the general practitioner records which evolved to the present features of left C6 radiculopathy characterised by reduced biceps jerk, sensory loss confined to C6 and positive left-sided upper limb neural tension signs.
3. Dr Scholsem also made similar clinical findings on 14/6/24 consistent with left C6 radiculopathy.
4. Given there are two or more signs of left C6 radiculopathy, Ms McGrath has a non-threshold injury of the cervical spine as defined by MAG (Medical Assessment Guidelines).

1. The Review Panel met again at 4.00pm on 8 July 2025 when it discussed the findings as reported by Medical Assessor Sophia Lahz.
2. After discussion, the members of the Panel agreed that it was significant that Ms McGrath gave a straight-forward account of the chronology of the development of pain and symptoms of the left shoulder and left upper limb.
3. The Panel accepted the reliability of that history as provided by Ms McGrath. She also presented in a consistent manner during the physical examination with reproducible findings.
4. The members of the Panel agreed on the significance of the facts as found by Medical Assessor Lahz that there was an immediate reference to the left shoulder in the general practitioner records and those features evolved to those consistent with left C6 radiculopathy which as was found by Medical Assessor Lahz and accepted by the Panel, characterised by reduced biceps jerk, sensory loss confined to C6 and positive left-sided upper limb neural tension signs.
5. The Review Panel thought that it was significant that Dr Scholsem had made similar clinical findings on 14 June 2024:

" ...Rachelle had a tear in the left supraspinatus and initially related the pain she was experiencing to that. She organised physiotherapy using her own funds but a few weeks later she developed a burning pain in the left upper limb in the C6 dermatome. Her neck pain slowly improved but she has not noticed any improvement in the left upper limb symptoms and now has also numbness and feels that her strength is not as good as prior. She cannot exercise like she used to do and has to take regular anti inflammatories.

Ten days ago, she had a CT guided nerve root injection which unfortunately did not help her much at all.

On examination there is mild limitation of cervical spine mobility. There is no pain on palpation of the facet joint or paravertebral muscle. There is some hypoesthesia to light touch and pinprick in the left C6 dermatome but also weakness affecting elbow flexion on that side, Reflexes are weak bilaterally and I cannot detect any long tract signs.

I had a chance to review the MRI performed 3 months ago explaining very well Rachelle's symptoms. There is severe foraminal stenosis on the left at C5 - C6 but fortunately no significant foramina) narrowing anywhere else..."

1. These findings by Dr Scholsem as to the two signs of radiculopathy were specifically assessed in the report of 16 September 2024 and were consistent with left C6 radiculopathy.
2. The other members of the Panel concurred with Medical Assessor Lahz that given there were two or more signs of left C6 radiculopathy, Ms McGrath had a non-threshold injury of the cervical spine as defined by the Medical Assessment Guidelines.

1. The Panel accepted Ms McGrath's chronology, including relevant materials of her Statement.
2. The Panel in particular referred to [17], [18], and also [20].
3. The Panel noted that at [21] Ms McGrath stated that:

"The pain was very different to anything I had previously experienced ... before the accident my left shoulder was not causing me much grief or pain"

"The pain in my left shoulder is much worse and I am experiencing significant restriction."

1. Medical Assessor Lahz and the Panel also took into account the history provided by the claimant, that the following day there was ongoing left shoulder tightness/soreness and she reported the problems to a general practitioner Dr Dixon when she saw him the following day [51].
2. The Panel also considered Ms McGrath's history at [54] that the left shoulder symptoms failed to improve and that there was persistent tightness of the left shoulder blade and trapezius, and that by September 2023 she had developed a constant burning sensation enveloping the left shoulder. She also developed neurological symptoms in the left hand. Both the left shoulder pain and the neurological symptoms at the left hand were due to evolving left-sided cervical radiculopathy.
3. The Panel does not consider that the claimant has incurred a non-threshold injury of the left shoulder due to the motor accident. Documents indicate that there was a pre-existing left-sided rotator cuff tear which remained evident on imaging after the motor accident. The Panel considers that the left shoulder symptoms following the accident were due to evolving left-sided cervical radiculopathy and not arising from any shoulder injury due to the motor accident.

1. The Review Panel revokes the determination of Medical Assessor Alexander Woo of

24 February 2025 that the cervical spine was a threshold injury for the purposes of the Act and in lieu certifies that it is a non-threshold injury for the purposes of the Act.