MIG Update – January 27, 2025
CNR’s + Imaging Determinative of Complete Shoulder Tear
This week’s MIG case, an escape, where the Tribunal considers whether a diagnosis of a full thickness tear of the right shoulder was a preexisting condition or rather was caused by the subject accident.
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In De Vuono v. BelairDirect (22-009738), Maria De Vuono, a front seat passenger was involved in an accident on September 27, 2018 when the vehicle she was in was struck in a perpendicular fashion by a commercial truck on the right side. She sought entitlement to three Treatment Plans for physiotherapy, chronic pain assessment and orthopedic assessment totaling $6,409.92. She submitted that she should be removed from the MIG as she suffered a complete supraspinatus tear in her right shoulder, as noted in the imaging report taken on the day of the accident.
BelairDirect submitted that De Vuono’s injuries fell within the MIG as it relied on two IE reports. First, Dr. Corrin dated January 2019 who opined that the bilateral shoulder ultrasound in which a full thickness tear was suspected and that the hospital imaging was consistent with a chronic complete supraspinatus tendon tear. Second, Dr. Tu’s report dated December 2020 discounted the full thickness tear of De Vuono’s right shoulder as the imaging had poor visibility and suboptimal quality and because the hospital records characterized her high riding shoulder as consistent with a chronic complete supraspinatus tendon tear.
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The Tribunal found:
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- The CNRs of the family physician failed to demonstrate ongoing issues leading up to the accident to rationalize a full thickness tear, as there were only two right arm issues, one in July 2016, where she complained of right arm pain from gardening, and one in May 2018 but the physician considered that it was likely inflammation and ordered no investigations or further treatment.
- The lack of pre-accident complaints and imaging related to the right shoulder led to the conclusion on a balance of probabilities that the shoulder injury did not pre-date the accident, as BelairDirect suggested.
- While the report of Dr. Corrin included reference to the bilateral shoulder ultrasound in which a full thickness tear was suspected, and the hospital imaging which stated that De Vuono had a “high riding shoulder consistent with chronic complete supraspinatus tendon tear”, Dr. Corrin provided no opinion regarding a tear, whether it was accident-related, a pre-existing condition, or whether it would impact her recovery if subject to the MIG. The fact that Dr. Corrin never gave such insight was fatal to the overall persuasiveness of the report.
- Similarly, considering there was not a fulsome review or comment regarding the CNR’s, no weight was afforded to the report of Dr. Tu dated December 2020, as he discounted the full thickness tear of De Vuono’s right shoulder given that the imaging had poor visibility and suboptimal quality, and because the hospital records characterized her high riding shoulder as consistent with a chronic complete supraspinatus tendon tear.
- Considering there were no records pre-dating the accident that indicated ongoing right shoulder pathology, in addition to the records from a visit immediately following the accident noting De Vuono’s difficulty lifting above her shoulders. As such, the Applicant was removed from the MIG.
- “A full-thickness tear of the right shoulder is an injury that is not included in the definition of a minor injury. The definition of a minor injury, as indicated in section 3 of the Schedule includes a “strain”. A “strain” is further described in the MIG. There, it states that a strain is an injury to one or more muscles, including a partial but not a complete tear. Isolating a “complete tear” from the definition causes me to conclude that a full thickness tear is akin to a complete tear and is therefore not a minor injury.”
Our MIG Monday series discusses the multitude of factors to consider when evaluating a risk position on MIG cases. The Tribunal has ruled on the MIG in 33% of the decisions so far. Each case is nuanced, but with similar factors.
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