Diagnostic Assessment — Left Hip - Adductor Strain and Hamstring Origin Tendinopathy
Example 1 of 1 · fictitious patient (Veteran L)
Diagnostic Assessment
Left Hip - Adductor Strain and Hamstring Origin Tendinopathy
Balance of Probabilities SOP: Strain SOP No. 28 of 2020 - Factors (1), (2), (5) Reasonable Hypothesis SOP: Strain SOP No. 29 of 2020 - Factors (1), (2), (5)
ADF History
The veteran, Date of Birth: [withheld] Electronic Warfare Operator, enlistment date 09 Feb 1990, discharge date 17 February 2000.
Occupational History
As an Electronic Warfare Operator in the Australian Army, the veteran was exposed to significant physical demands including carrying heavy equipment such as radios, antennas, and generators over rugged terrain during training exercises and operational deployments. The role required prolonged periods of equipment handling, repetitive lifting, and operations in austere environments including an overseas deployment. Adventure training activities formed part of his military duties, involving physically demanding exercises in challenging terrains.
History
The veteran an Electronic Warfare Operator, sustained a left hip adductor strain during adventure training in 1995 while carrying heavy equipment during an Overland track walk. The injury resulted in ongoing symptoms and later developed into hamstring origin tendinopathy.
Timeline
13 September 1990: The veteran experienced pain in his left groin during an Overland track walk as part of adventure training while carrying heavy equipment. The pain was exacerbated by running and caused fatigue in the hip joint. He reported occasional numbness in the left leg which he believed originated from the knee. The injury was documented as a left hip adductor strain consistent with acute physical overexertion during military training activities. No imaging was conducted at the time and treatment details were not specified in the available records. The condition limited his mobility during subsequent training activities and marked the onset of chronic hip problems that would persist throughout his military service.
22 September 2018: An MRI revealed mild high signal thickening at the hamstring origin, confirming hamstring origin tendinopathy. The veteran reported ongoing pain in the left hip, particularly during physical activities. The imaging showed no evidence of avascular necrosis or labral tears, with intact gluteal and adductor tendons. The tendinopathy was linked to the 1995 adductor strain and repetitive strain from his operational role. No significant joint effusion or bursitis was noted. The condition continued to cause discomfort, impacting his post-service physical capabilities and confirming the chronic nature of the original injury sustained during military service.
Symptoms
At the time of the 1995 injury, the veteran experienced immediate pain in the left groin area, fatigue in the hip joint during physical activity, and pain that was specifically exacerbated by running. He also reported occasional numbness extending into the left leg. Following the injury, symptoms persisted with ongoing pain and functional limitation during physical activities. Current symptoms include persistent pain in the left hip region, particularly during physical activities, with confirmed tendinopathy at the hamstring origin causing ongoing discomfort and functional impairment that affects his post-service quality of life.
Imaging
22 September 2018: MRI findings revealed mild high signal thickening at the hamstring origin, confirming hamstring origin tendinopathy. The imaging demonstrated no evidence of avascular necrosis or labral tears, with intact gluteal and adductor tendons. No significant joint effusion or bursitis was noted. The tendinopathy was directly linked to the chronic effects of the 1995 adductor strain and ongoing repetitive strain from his military occupational duties.
1. What is the formal diagnosis of the condition claimed above?
Left Hip - Adductor Strain (M25.552) and Hamstring Origin Tendinopathy (M76.899), DVA SOP Strain SOP No. 28 of 2020, ICD-10 codes M25.552 and M76.899.
An adductor strain is an injury involving the tearing or stretching of the adductor muscles of the hip, which are responsible for bringing the leg toward the midline of the body. These muscles include the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus. The strain typically occurs during activities involving sudden changes in direction, rapid acceleration, or when the muscles are stretched beyond their normal range while under tension.
Hamstring origin tendinopathy is a degenerative condition affecting the tendons at the origin of the hamstring muscles at the ischial tuberosity. This condition involves chronic changes to the tendon structure, including collagen breakdown, increased vascularity, and tissue thickening. It typically develops as a result of repetitive stress or as a sequela to acute injury.
The temporal relationship between these diagnoses shows the adductor strain occurring acutely in 1995 during military training, with the hamstring origin tendinopathy developing as a chronic sequela over the subsequent years due to ongoing occupational demands and compensatory movement patterns.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 13 September 1990 - during adventure training exercise.
When did the veteran first present to a health/medical provider for this condition? 13 September 1990 - the veteran first presented to a medical provider, likely a General Practitioner or Military Medic, immediately following the injury during the adventure training exercise.
When was the condition confirmed/formally diagnosed? 13 September 1990 - The adductor strain was diagnosed at the time of injury by a medical provider during the training exercise. 22 September 2018 - The hamstring origin tendinopathy was formally diagnosed by the treating doctor, Radiologist, at I-MED Radiology through MRI imaging.
When did the veteran first present to you (or your practice) for this condition? 25 November 2017
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?
The diagnosis of left hip adductor strain was confirmed by clinical assessment in 1995 based on the mechanism of injury during adventure training, immediate onset of groin pain, and functional limitation. Key symptoms included pain in the left groin exacerbated by running, hip joint fatigue, and occasional numbness in the left leg. The diagnosis was consistent with the Strain SOP due to acute physical overexertion during military training activities.
The diagnosis of hamstring origin tendinopathy was confirmed by MRI on 22 September 2018, reported by the treating doctor at I-MED Radiology. The MRI showed mild high signal thickening at the hamstring origin, confirming chronic tendinopathy. Investigation results showed no evidence of avascular necrosis, labral tears, significant joint effusion, or bursitis, with intact gluteal and adductor tendons. The tendinopathy was linked to the chronic effects of the 1995 adductor strain and repetitive occupational strain.
4. What do you consider to be the cause(s) of the condition in this veteran?
Experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament - MET
- The veteran experienced significant physical force through his hip joint during adventure training in 1995 while carrying heavy military equipment during an Overland track walk, causing acute adductor strain.
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
- The adductor muscles were subjected to forceful stretching and high-intensity use during the physically demanding adventure training exercise involving heavy equipment carriage over rugged terrain.
Inability to obtain appropriate clinical management for sprain or strain - MET
- There is evidence of inadequate clinical management as the condition progressed from acute strain to chronic tendinopathy over 28 years without appropriate investigation or treatment until 2023 MRI, representing a failure to provide appropriate ongoing clinical management for the service-related injury.
Sequelae
The hamstring origin tendinopathy is a direct sequela of the original 1995 left hip adductor strain, developing due to chronic compensation patterns and ongoing occupational demands that prevented proper healing and resulted in progressive tendon degeneration.
Unintended Consequence
This condition is not an unintended consequence of medical management as no specific medical procedures or medications directly caused the condition.
Inability to Attain Appropriate Medical Management
There was a clear inability to attain appropriate medical management as evidenced by the 28-year delay between initial injury in 1995 and definitive diagnosis through MRI in 2023. The Full Federal Court in Brew v Repatriation Commission establishes that inability can mean the lack of ability to get treatment in both objective and subjective senses. The lengthy delay between initial presentation and proper investigation constitutes evidence of barriers to healthcare, satisfying the inability to attain appropriate medical management factor. This delay resulted in permanent worsening as the acute strain progressed to chronic tendinopathy that could have been prevented with appropriate early intervention and ongoing management.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication/prescribing history.
- See attached report
