Nerve-root dysfunction
Radiculopathy after a NSW motor accident
Radiculopathy is not another word for pain running down an arm or leg. Under the current Motor Accident Guidelines it means impairment caused by dysfunction of a spinal nerve root, supported by two or more specified clinical signs found on examination.
Motor accident mechanism
What can happen in a motor accident?
Rear-end crash
A cervical or lumbar disc may become symptomatic after sudden loading, but nerve-root dysfunction still requires clinical verification.
Side-impact crash
Rotation and lateral loading may produce unilateral foraminal or disc symptoms that must be mapped to the affected root.
Motorcycle fall
Compression, traction or direct impact can affect a nerve root, disc or foraminal structures.
Pedestrian impact
Direct trauma and a fall can cause disc, fracture or nerve-root injury with different neurological patterns.
Injuries and diagnoses that may follow
- cervical radiculopathy
- lumbar or lumbosacral radiculopathy
- disc-related nerve-root compression
- foraminal narrowing with nerve-root dysfunction
- post-fracture or post-operative radiculopathy
Symptoms that should be recorded accurately
- shooting or burning arm or leg pain
- pins and needles
- numbness in a dermatomal distribution
- focal myotomal weakness
- reduced grip, walking or lifting function depending on the root
Urgent medical signs
Rapidly progressive weakness, foot drop, gait change or bladder/bowel symptoms requires urgent medical assessment.
Clinical evidence
What medical findings matter?
The diagnosis should identify the root, side and signs. Table 6.8 defines how atrophy, reflex asymmetry, SLR, weakness and sensory loss are verified.
| Record or test | What it can establish | What it cannot establish alone |
|---|---|---|
| Reflex testing | Repeated marked asymmetry between involved and normal limbs can provide one qualifying sign. | A vague note that reflexes are reduced, without side-to-side comparison, may be insufficient. |
| SLR or nerve-tension test | A positive lumbosacral test reproduces thigh or leg pain in the appropriate dermatomal distribution. | Back pain or hamstring tightness is not positive SLR for this purpose. |
| Circumference measurement | Table 6.8 uses at least 2 cm in the thigh or 1 cm in the arm, forearm or calf, measured at identical levels. | Visual impression of wasting without reproducible measurement may not establish atrophy. |
| Power and sensory testing | Must be reproducible and anatomically localised to the affected root. | Global weakness caused by pain inhibition is excluded by clause 6.141. |
| MRI and EMG/NCS | May support the root level and alternative diagnosis. | Imaging and electrodiagnostic tests cannot establish radiculopathy alone; clause 6.142 says EMG is rarely necessary and not solely diagnostic. |
Part 5 classification
Is this likely to be threshold or non-threshold?
For a neck or spine injury, radiculopathy is essential to deciding whether neurological symptoms take the injury beyond soft tissue. If fewer than two qualifying signs are established, clause 5.9 says the injury is assessed as threshold, even if pain radiates in a nerve-like pattern.
Evidence that may support a threshold classification
- radiating pain with no objective signs
- only one qualifying sign
- global weakness from pain
- sensory complaints that cannot be reproduced anatomically
Evidence that may support a non-threshold injury
- two or more qualifying signs in one anatomically coherent root pattern
- a consistent accident mechanism and symptom chronology
- supporting imaging that matches, but does not replace, the signs
- specialist reasoning excluding competing peripheral or central causes
Radiculopathy means two or more clinical signs, not pain alone
Clauses 5.7-5.9 and 6.138-6.142 require dysfunction of a spinal nerve root with two or more of the following signs found on examination:
- 1.loss or asymmetry of reflexes
- 2.positive sciatic nerve-root tension signs
- 3.muscle atrophy or decreased limb circumference
- 4.muscle weakness anatomically localised to the appropriate spinal nerve-root distribution
- 5.reproducible sensory loss anatomically localised to the appropriate spinal nerve-root distribution
Pain, burning or tingling that follows a nerve-root pattern but lacks objective neurological findings is a non-verifiable radicular complaint under Table 6.8. If the neck or spine symptoms do not meet the radiculopathy criteria, clause 5.9 says the injury is assessed as threshold.
Part 6 permanent impairment
How is WPI assessed for this injury?
Verified radiculopathy is a DRE III differentiator in Table 6.7. More serious structural patterns can fall in DRE IV or V under the applicable descriptors. The category must be based on the complete assessment, not simply the threshold decision.
CTP spine method: clause 6.111 requires the DRE method. The spinal ROM model and AMA4 Table 75 are not used, and clause 6.123 says loss of motion segment integrity is not applied.
| Category | Human-language guide to the verified CTP rule |
|---|---|
| DRE I | Symptoms are present, but the medical assessor finds no objective clinical findings that place the injury in a higher category. This is the rule stated in clause 6.129. |
| DRE II | The assessor finds qualifying clinical findings, such as guarding, reproducible non-uniform motion or non-verifiable radicular complaints, or a specified stable fracture pattern, but not verified radiculopathy or a higher structural inclusion. |
| DRE III | This category includes verified radiculopathy and specified fracture or dislocation patterns identified in Table 6.7. Radiating pain without the required neurological signs is not enough. |
| DRE IV | This is a higher structural category. One verified example is multiple qualifying vertebral fractures without radiculopathy under clause 6.151(a). Fusion and disc replacement are treated as multilevel structural compromise under clause 6.145, but surgery does not by itself supply a fixed percentage. |
| DRE V | This is the higher structural category where the applicable descriptor includes radiculopathy. Clause 6.151(b), for example, places multiple qualifying vertebral fractures with radiculopathy in category V. |
A DRE category is not a percentage to calculate from symptoms. The assessor must use the region-specific AMA4 descriptors on pages 102-107 as modified by clauses 6.125-6.132 and explain the tables or figures used, as required by clause 6.122.
- Two signs must be found on examination for the radiculopathy conclusion.
- C2/C3 sensory loss has the special clause 6.139 method.
- EMG/NCS is not a substitute for clinical signs.
- Separate spinal regions may be combined; findings within one region are not added.
What does not establish the result by itself?
- shooting pain, burning or tingling alone
- one sign alone
- global pain-limited weakness
- MRI nerve contact alone
- EMG result alone
Accident-specific examples
Arm pain plus MRI foraminal narrowing
Without two clinical signs, this remains a non-verifiable radicular complaint for the Part 5 test despite the scan.
S1 symptoms with absent ankle reflex and positive dermatomal SLR
These may be two qualifying signs if repeatedly verified and anatomically consistent.
Leg weakness recorded only as 4/5 globally because of pain
Clause 6.141 says global weakness related to pain or inhibition is not weakness from spinal nerve malfunction.
Claim file preparation
Evidence checklist
Practical next steps
What should you do next with a radiculopathy claim?
Start with the insurer's most recent written decision and identify what is actually disputed: treatment, weekly payments or work capacity, threshold injury, permanent impairment, causation, or damages. These are separate questions and may require different evidence and review procedures. Record the date of the decision and every review deadline shown before gathering further material.
- 01
Preserve the claim and the decision under review
Keep the claim number, accident date, insurer letter, certificate of fitness and any internal review or Personal Injury Commission correspondence together. Do not assume that a treatment approval or payment of statutory benefits decides fault, damages eligibility or WPI.
- 02
Obtain evidence that answers the disputed issue
For this injury, the useful starting material includes root-specific symptom map and repeated reflex findings. Clinical testing may include Reflex testing and SLR or nerve-tension test. Ask the treating practitioner to record the diagnosis, accident causation, objective findings, treatment response and current functional limits rather than symptoms alone.
- 03
Use the correct review process
Compare the insurer's reasons with the records it relied on. A threshold-injury decision, treatment refusal, weekly-payment decision and WPI assessment do not all follow the same review process. The decision letter should identify available internal review or dispute steps and the applicable deadline.
If the decision, medical material or deadline is unclear, send the key documents for a focused review before lodging a broad objection. See the CTP disputes guide or contact NSW CTP Claim. Advice depends on the facts, evidence and current law; a review cannot guarantee a claim outcome.
Assessment source
Radiculopathy threshold and DRE source
Assessment source: Motor Accident Guidelines v10.1 clauses 5.7-5.9 and 6.138-6.142; Table 6.8 definitions; Table 6.7 DRE categories; AMA4 Chapter 3.3 only as modified by Part 6.
Threshold injury: Two or more specified clinical signs are required. If the neurological symptoms do not meet the radiculopathy criteria, clause 5.9 says the neck or spine injury is assessed as threshold.
What the assessor checks
- two-of-five clinical-sign rule
- Table 6.8 verification definitions
- DRE III for verified radiculopathy
- EMG and imaging are not solely diagnostic
What does not establish the result by itself
- radiating pain
- one sign
- global weakness
- MRI or EMG alone
Official sources
Related NSW CTP guides
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Frequently asked questions
- What are the five radiculopathy signs?
- Reflex loss/asymmetry, positive sciatic nerve-root tension signs, atrophy/decreased circumference, anatomically localised weakness and reproducible anatomically localised sensory loss.
- Do I need all five signs?
- No. The Guidelines require two or more, found on examination and interpreted in the correct anatomical distribution.
- Is radiating pain one of the five signs?
- No. Pain or tingling without objective findings is described as a non-verifiable radicular complaint.
- Does EMG prove radiculopathy?
- No. Clause 6.142 says electrodiagnostic tests are rarely necessary and the diagnosis should not be made solely from them.
- Does radiculopathy automatically mean more than 10% WPI?
- No. It informs DRE placement, commonly DRE III, but the region-specific impairment assessment and all applicable rules still control the WPI.