When someone is injured in a car crash and complains of neck pain, most clinicians look for the usual suspects: muscle strain, disc bulge, or vertebral misalignment. But in many cases, there’s a deeper, more serious injury hiding in plain sight — one that is often overlooked, even with advanced imaging like MRI or CT.
That injury is AOMSI — Alteration of Motion Segment Integrity — and for attorneys handling personal injury or motor vehicle accident cases, understanding it could mean the difference between a dismissed claim and a six-figure settlement.
What Is AOMSI?
AOMSI is a biomechanical diagnosis defined by abnormal motion between vertebrae. It’s most often caused by ligament damage in the cervical spine, resulting in excessive movement that compromises stability. In other words, the neck can no longer support the head and spine safely — even if MRIs show no visible tear or fracture.
According to the American Medical Association’s Guides to the Evaluation of Permanent Impairment (6th Edition), AOMSI qualifies a patient for a Category IV impairment rating — a permanent injury with significant medical and legal implications
Why Is It So Often Missed?
There are two main reasons:
- Most providers don’t test for it.
AOMSI can’t be seen on a static X-ray, CT, or MRI. It requires flexion-extension views and specialized measurement protocols — something most general practitioners or radiologists aren’t trained to perform. - The injury is “invisible” without quantification.
A radiologist might glance at a motion X-ray and see “mild movement,” but unless it’s measured in millimeters and degrees using Computerized Radiographic Mensuration Analysis (CRMA), that observation holds no legal weight.
As a result, millions of dollars in long-term injury claims are undervalued or denied every year, simply because AOMSI was never diagnosed — or worse, never even considered.
What This Means for Attorneys
If you’re representing a client with ongoing neck pain following a crash, and their imaging looks “normal,” don’t stop there.
Ask:
- Have flexion-extension films been taken?
- Has CRMA been performed?
- Is there documentation of translation (≥3.5mm) or angular deviation (≥11 degrees)?
If the answer is no, you could be missing the objective proof that turns a “soft tissue” complaint into a permanent impairment claim under the AMA Guides.
How We Help
As a chiropractor trained in ligament injury analysis and forensic biomechanics, I use CRMA and AMA Guide protocols to evaluate for AOMSI in trauma patients. I’ve co-authored The $66,000 Neck Injury and How Not to Be Misdiagnosed — a book dedicated to preventing exactly this kind of diagnostic failure…Download it Here
We provide:
- Proper radiographic protocols and referrals
- CRMA interpretation using board-certified systems
- Comprehensive reports for attorneys and insurers
- Expert witness services for depositions and trials
Final Thought on AOMSI
AOMSI may not show up on the first scan, but it can define the future for your client — medically and legally. Don’t let a missed ligament injury become a missed opportunity for justice.
If you want help reviewing a cervical injury case for AOMSI, feel free to contact my office. I’m available for consultations in Allegheny County, PA, and work with both plaintiff and defense firms to bring clarity to complex neck injury cases.