Diagnostic Assessment — Left Hip - Labral Scarring (labral Tear)
Example 1 of 1 · fictitious patient (Veteran F)
Diagnostic Assessment
LEFT HIP - LABRAL SCARRING (LABRAL TEAR)
Statement of Principles concerning labral tear (Reasonable Hypothesis) Instrument No. 36 of 2017 and Statement of Principles concerning labral tear (Balance of Probabilities) Instrument No. 37 of 2017.
ADF History
Name: The veteran Date of Birth: [withheld] Occupation: Communications, SASR Enlistment Date: 17 Dec 1993 Discharge Date: Still Serving
Occupational History
As a Communications specialist in the Australian Defence Force a specialist regiment (SASR), the veteran has been exposed to significant physical demands affecting the hip joints. SASR operations require tactical movements including deep squatting, repetitive climbing, crawling, and running with heavy loads over variable terrain that place significant stress on the hip labrum. Communications specialists often work in confined spaces requiring sustained awkward hip positions during equipment setup and operation. Military physical training involves high-intensity activities including loaded marches, obstacle courses, and strength training that create repetitive loading forces on the hip joint structures. These occupational activities represent significant risk factors for the development of labral damage through repetitive microtrauma and mechanical stress.
History
The veteran the veteran a Communications specialist with the Australian a specialist regiment, developed progressive left hip pain with mechanical symptoms. Diagnostic imaging has confirmed labral damage and scarring in the left hip consistent with chronic microtrauma and mechanical stress from his occupational duties.
Timeline
- 24 Jun 2016: Initial presentation with left groin and lateral hip pain during and after physical training. Patient reports deep pain with squatting and rotational movements. • 31 Jun 2016: Physical examination documented limited internal rotation of the left hip with positive impingement testing. Pain reproduction with flexion, adduction, and internal rotation maneuver. • 14 Jul 2016: X-rays of pelvis and left hip performed. Cam-type morphology of the left femoral head-neck junction with alpha angle of 62 degrees. • 26 Jul 2016: Physical therapy assessment noting functional limitations with deep squatting and tactical movements. Pain with specific hip loading exercises. • 18 Aug 2016: Continued symptoms despite conservative management prompted referral for advanced imaging. Mechanical symptoms persist with occupational activities. • 29 Aug 2016: MRI Arthrogram of the left hip performed. Cam-type morphology with evidence of labral damage and scarring anterosuperiorly. No evidence of complete labral tear. • 16 Sep 2016: Orthopedic consultation confirming diagnosis of femoroacetabular impingement syndrome with labral pathology. Symptomatic FAI with evidence of labral scarring consistent with chronic impingement.
Symptoms
The veteran initially presented with deep pain in the left groin and lateral hip region, exacerbated by specific movements including deep squatting, tactical maneuvers, and rotational activities. The pain was characterized as sharp and mechanical in nature, with occasional catching sensations during certain movements. Physical examination revealed limited internal rotation of the left hip with pain at the extremes of motion, positive impingement testing, and discomfort with resisted hip flexion. Current symptoms include persistent activity-related pain that limits full participation in tactical training exercises, difficulty with prolonged sitting in tactical vehicles, and pain after extended periods of load carriage. The mechanical symptoms have been particularly problematic during operations requiring rapid changes in direction, climbing, and deep squatting positions needed for communications equipment setup in field conditions.
Imaging
14 Jul 2016 - X-RAY PELVIS AND LEFT HIP: AP pelvis and lateral left hip views demonstrate cam-type morphology of the left femoral head-neck junction with alpha angle measured at 62 degrees (normal <55 degrees). No significant acetabular overcoverage or retroversion noted. Joint space is preserved. No fracture or dislocation identified.
29 Aug 2016 - MRI ARTHROGRAM LEFT HIP: Following intra-articular contrast injection, images demonstrate cam-type morphology of the femoral head-neck junction with alpha angle of 64 degrees. There is evidence of labral damage and scarring in the anterosuperior quadrant consistent with chronic impingement, but no complete labral tear identified. Mild synovitis is noted. The articular cartilage shows early degenerative changes anterosuperiorly at the site of impingement. No stress fracture or avascular necrosis.
1. What is the formal diagnosis of the condition claimed above? The formal diagnosis is Left Hip Labral Scarring (treated as Labral Tear under SOP provisions) (ICD-10 Code: S73.1). This diagnosis falls under the DVA Statement of Principles concerning labral tear (Reasonable Hypothesis) Instrument No. 36 of 2017 and Statement of Principles concerning labral tear (Balance of Probabilities) Instrument No. 37 of 2017.
A labral tear, for the purposes of the Statement of Principles, means an injury involving tearing of the fibrocartilaginous rim of the hip joint resulting in local pain and tenderness, with or without accompanying symptoms and signs of popping, clicking, catching, instability or reduced range of motion. While the veteran imaging shows labral scarring rather than acute tearing, this represents chronic damage to the labral tissue that meets the functional definition of labral injury under the SOP.
The labrum is a fibrocartilaginous ring that surrounds the acetabulum and helps stabilize the hip joint while allowing for extensive range of motion. Labral damage can result from acute trauma or repetitive stress, leading to pain, mechanical symptoms, and functional limitation. In the veteran case, the labral scarring represents chronic damage consistent with repetitive microtrauma from occupational activities combined with underlying anatomical factors predisposing to impingement.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The veteran first experienced symptoms attributable to left hip labral damage on or before 24 Jun 2016, when he initially presented with left groin and lateral hip pain during and after physical training.
When did the veteran first present to a health / medical provider for this condition? The veteran first presented to a health provider for this condition on 24 Jun 2016, when he reported to the ADF Medical Centre with complaints of left groin and lateral hip pain during and after physical training.
When was the condition confirmed / formally diagnosed? The labral damage was definitively confirmed by MRI arthrogram on 29 August 2016, which demonstrated evidence of labral damage and scarring in the anterosuperior quadrant. The diagnosis was formally established by an orthopedic specialist on 16 September 2016.
When did the veteran first present to you (or your practice) for this condition? 26 January 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 of Left Hip Labral Scarring was confirmed through comprehensive assessment including clinical evaluation, diagnostic imaging, and specialist consultation:
Key symptoms included: • Deep groin and lateral hip pain exacerbated by specific movements • Pain with deep squatting and rotational activities • Mechanical symptoms including catching sensations during certain movements • Activity-related pain affecting occupational performance
Clinical examination findings included: • Limited internal rotation of the left hip with pain at end range • Positive femoroacetabular impingement testing • Discomfort with resisted hip flexion • Reproduction of symptoms with provocative maneuvers
Diagnostic imaging provided definitive confirmation:
- X-ray of the Pelvis and Left Hip (14 July 2016) demonstrated underlying cam-type morphology predisposing to labral damage
- MRI Arthrogram of the Left Hip (29 August 2016) definitively demonstrated evidence of labral damage and scarring in the anterosuperior quadrant consistent with chronic impingement
Specialist opinion from an orthopedic consultation on 16 September 2016 confirmed the diagnosis of labral pathology with scarring consistent with chronic impingement.
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.
Factors under Statement of Principles concerning labral tear (Balance of Probabilities) Instrument No. 37 of 2017:
having a significant physical force applied to or through the affected hip joint at the time of the clinical onset of labral tear: NOT MET
- There is no documented specific traumatic event to the left hip at the time of symptom onset.
performing forceful and repetitive motions of the affected hip joint, involving extremes of the normal range of motion, for at least four hours per week for the one month before the clinical onset of labral tear: MET
- As a Communications specialist in SASR, the veteran routinely performed duties requiring forceful and repetitive hip motions involving extremes of range of motion. These activities would include tactical movements such as deep squatting, climbing, crawling, and running with heavy loads, physical training involving obstacle courses and combat conditioning, and equipment setup requiring sustained awkward hip positions. These activities would easily exceed four hours per week and involve extremes of hip motion that stress the labral structures.
for labral tear of the hip joint only, being in the third trimester of pregnancy within the one week before the clinical onset of labral tear: NOT APPLICABLE
- Not applicable to male veteran.
inability to obtain appropriate clinical management for labral tear: NOT MET
- This is a clinical worsening factor. There is no evidence that appropriate management was unavailable once symptoms developed.
Factors under Statement of Principles concerning labral tear (Reasonable Hypothesis) Instrument No. 36 of 2017:
The factors in the Reasonable Hypothesis SOP are similar to the Balance of Probabilities SOP, with the same MET status for forceful and repetitive motions and NOT MET status for other factors.
Based on the available information and service history, the most significant contributing factor to the development of left hip labral scarring is the repetitive performance of forceful motions involving extremes of hip range of motion during the veteran occupational duties in SASR. The underlying cam-type morphology created a predisposition to labral damage, and the repetitive mechanical stress from occupational activities led to chronic labral injury manifesting as scarring.
Sequelae
There is no indication that the left hip labral scarring is a sequela of another condition.
Unintended Consequence
There is no evidence to suggest that the left hip labral scarring resulted as an unintended consequence of medical treatment provided by the Commonwealth.
Inability to Attain Appropriate Medical Management
There is no evidence that the veteran experienced any inability to obtain appropriate clinical management for his left hip labral condition. Upon reporting symptoms, he received timely assessment, appropriate diagnostic imaging, specialist consultation, and implementation of a treatment plan.
The % contribution of the causes is 100% and significant
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
