Diagnostic Assessment — Left Elbow - Common Extensor Tendon Strain
Example 1 of 1 · fictitious patient (Veteran N)
Diagnostic Assessment
Left Elbow - Common Extensor Tendon Strain
SOP Balance of Probabilities: Sprain and Strain No. 28 of 2020 SOP Reasonable Hypothesis: Sprain and Strain No. 29 of 2020
ADF History
The veteran, Chef, 09 January 2009, 27 Mar 2016.
Occupational History
Military chef duties involve repetitive gripping and lifting activities, sustained forearm muscle contractions during food preparation, heavy lifting of kitchen equipment and supplies, and repetitive wrist extension movements during cooking activities. These activities place significant stress on the common extensor tendon origin at the lateral epicondyle. Physical training requirements including pull-ups, climbing, and equipment handling contribute additional stress to the extensor muscle-tendon complex. The occupation requires sustained gripping of utensils and forceful manipulation of heavy kitchen equipment.
History
The veteran the veteran developed left elbow common extensor tendon strain during his military service as a Chef in the Australian Defence Force from February 2011 to Apr 2018. The condition likely developed through repetitive occupational activities involving food preparation, heavy lifting, and military training exercises that stressed the common extensor tendon origin.
Timeline
- 29 December 2018 - MRI bilateral elbow revealed pathology isolated to the left side. There was localised signal hyperintensity associated with the fibres of the left common extensor origin in keeping with mild tendinosis. The right common extensor origin was intact and defined normally, demonstrating the unilateral nature of the pathology. The radiologist's impression specifically noted mild left-sided common extensor origin tendinosis with normal MRI of the right elbow. The findings were consistent with chronic strain and degenerative changes from repetitive occupational use.
Symptoms
The veteran developed insidious onset of left elbow pain during his military service, particularly with gripping and lifting activities. Current symptoms include lateral elbow pain that worsens with wrist extension and gripping activities, tenderness over the lateral epicondyle, and pain with resisted forearm movements. The symptoms are consistent with common extensor tendon strain and lateral epicondylitis.
Imaging
29 December 2018 - MRI bilateral elbow: Localised signal hyperintensity associated with the fibres of the left common extensor origin in keeping with mild tendinosis.
1. What is the formal diagnosis of the condition claimed above?
Left Elbow Common Extensor Tendon Strain, DVA SOP: Sprain and Strain No. 28 of 2020, ICD-10: S56.4.
A common extensor tendon strain involves tearing or stretching of the muscle or tendon fibers at the lateral epicondyle, associated with the onset of pain and tenderness. The common extensor origin includes the extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris tendons. Strain injuries occur due to forceful stretching or high intensity use of these muscles during repetitive gripping, lifting, and wrist extension activities. The condition represents acute or chronic injury to the muscle-tendon complex from overuse or sudden forceful contraction.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? Unknown specific date during military service 2013-2020. No specific documentation of symptom onset found in the provided records.
When did the veteran first present to a health / medical provider for this condition? 24 September 2018 during DVA assessment with Dr Thomas Perkins at Veterans Health Centre [Email - General & Service Details.pdf, page 1].
When was the condition confirmed / formally diagnosed? 29 December 2018 by Radiologist the treating doctor via MRI bilateral elbow imaging [IMAGING.pdf, page 1].
When did the veteran first present to you (or your practice) for this condition? 19 Jun 2018.
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed by MRI imaging conducted by Radiologist the treating doctor on 29 December 2018. The imaging revealed localised signal hyperintensity associated with the fibres of the left common extensor origin in keeping with mild tendinosis [IMAGING.pdf, page 1]. The right common extensor origin was intact and defined normally, demonstrating the unilateral nature of the pathology. The radiologist's impression specifically noted mild left-sided common extensor origin tendinosis with normal MRI of the right elbow.
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Factor 9(2): forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon
- MET. Military chef duties involved continuous forceful stretching and high intensity use of the common extensor tendon through repetitive gripping of utensils, heavy lifting of kitchen equipment, forceful manipulation of cooking implements, and sustained wrist extension activities during food preparation.
Factor 9(4): forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon
- MET. Ongoing military duties throughout his 7-year service continued to involve forceful stretching and high intensity use of the common extensor tendon, contributing to progressive worsening and development of the tendinosis observed on imaging.
Sequelae
This condition is not a sequelae of another known condition but represents primary occupational common extensor tendon strain from military service activities.
Unintended Consequence
This condition is not an unintended consequence of medical management. No procedures or medications were administered that contributed to the development of this condition.
Inability to Attain Appropriate Medical Management
There was an inability to attain appropriate medical management during military service. The condition was not diagnosed or treated during the veteran's 7-year military service despite ongoing occupational exposure to causative factors. Per the Full Federal Court in Brew v Repatriation Commission (07 July 1993), inability encompasses both objective and subjective lack of ability to obtain treatment. The absence of presentations for elbow pain during military service indicates barriers to healthcare, satisfying inability to attain appropriate medical management. This inability resulted in permanent worsening as the condition progressed from reversible muscle strain to irreversible tendinosis with signal changes demonstrated on MRI imaging.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
