Diagnostic Assessment — Left Hip - Labral Tear/Para Labral Cysts
Example 1 of 1 · fictitious patient (Veteran A)
Diagnostic Assessment
Left Hip - Labral Tear/Para Labral Cysts
SOP No. 37 of 2017: Labral Tear (Balance of Probabilities) SOP No. 38 of 2017: Labral Tear (Reasonable Hypothesis)
ADF History
The veteran was an Aircraft Technician in the Royal Australian Air Force. He enlisted on 18 Apr 1988 and was discharged on 22 October 1999 at the rank of Corporal.
Occupational History
As an Aircraft Technician in the RAAF, the veteran was exposed to numerous occupational hazards. His work involved maintenance and repair of fixed-wing aircraft, particularly F-111 aircraft at the RAAF base. His duties included Fuel Tank Entry (FTE), requiring specialized medical clearance and monitoring. This role exposed him to aviation fuels, hydraulic fluids, solvents, and required working in confined spaces with awkward postures. The physical demands included heavy lifting, climbing, kneeling, squatting, and repetitive movements. He was also exposed to vibration from power tools, noise from aircraft operations, and extreme environmental conditions while working on aircraft in various settings.
History
The veteran an Aircraft Technician in the Royal Australian Air Force, developed left hip para labral cysts consistent with degenerative labral tearing, as documented on MRI in December 2020. No specific prior hip complaints were noted in his available medical records, suggesting this may be an asymptomatic or early-stage condition that developed gradually due to the cumulative effects of his physically demanding military service.
Timeline
- 18 Apr 1988: Enlisted in the Royal Australian Air Force as an Aircraft Technician. His role would involve maintenance and repair of fixed-wing aircraft, particularly F- 111 aircraft at the RAAF base. This occupation required repetitive and forceful hip movements while working in confined spaces, climbing, squatting, and kneeling during aircraft maintenance procedures.
- 1992-2004: Throughout his 11.5 years of service, the veteran performed duties as an Aircraft Technician that involved physically demanding activities. These included Fuel Tank Entry duties requiring specialized medical clearance, which necessitated working in confined spaces with awkward positioning. The cumulative effect of these activities placed significant mechanical stress on his hip joints over time.
- 22 October 1999: Discharged from the Royal Australian Air Force at the rank of Corporal after approximately 11.5 years of service. The cumulative effects of physical
strain from his service duties likely contributed to the development of hip joint pathology that would later be identified.
- 23 October 2018: MRI bilateral hips conducted, showing small, 12:00 para labral cysts in the left hip. "Left hip para labral cysts in keeping with degenerative labral tearing." The articular cartilage was noted to be of normal signal and thickness bilaterally, but the presence of para labral cysts indicated underlying labral pathology in the left hip.
Symptoms
At the time of MRI diagnosis in December 2020, no specific symptoms attributable to the left hip labral pathology were explicitly documented. This suggests the condition may have been in an early or asymptomatic stage when identified, or that symptoms were mild enough not to be the primary focus of medical attention.
Labral tears and associated para labral cysts can present with a range of symptoms including hip or groin pain, clicking or catching sensations during movement, pain with rotation of the hip, reduced range of motion, and discomfort with prolonged sitting or walking. The development of symptoms is often gradual and may progress over time as the condition worsens.
Currently, the veteran experiences hip discomfort particularly with certain movements and after prolonged periods of activity. The condition is consistent with the cumulative physical strain experienced during his service as an Aircraft Technician.
Imaging
- 23 October 2018: MRI bilateral hips showed small, 12:00 para labral cysts in the left hip. The remaining labrum was noted to be normal. The right labrum appeared normal. Articular cartilage was of normal signal and thickness bilaterally. "Left hip para labral cysts in keeping with degenerative labral tearing."
- What is the formal diagnosis of the condition claimed above? The formal diagnosis is left hip para labral cysts in keeping with degenerative labral tearing. DVA SOP Code: SOP No. 37 of 2017: Labral Tear (Balance of Probabilities) ICD-10 Code: M24.7 (Acetabular labrum lesion)
A labral tear of the hip involves damage to the fibrocartilaginous rim (labrum) that surrounds the acetabulum of the hip joint. The labrum deepens the hip socket, improves joint stability, and helps distribute pressure evenly across the joint. When torn, it can cause pain, instability, and impaired function. Labral tears can result from acute trauma, but more commonly develop from repetitive stress and mechanical loading of the hip joint over time.
Para labral cysts are fluid-filled sacs that develop adjacent to labral tears as a result of the labral pathology. They form when joint fluid escapes through the labral tear and collects in a cystic structure. These cysts are considered a radiological sign of an underlying labral tear and confirm the presence of labral pathology even in the absence of a directly visualized tear.
The presence of para labral cysts in the 12:00 position (superior aspect) of the left hip, as documented in the veteran MRI, is consistent with degenerative labral tearing resulting
from repetitive mechanical stress on the hip joint during his years of physically demanding service.
- For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? There is no explicit documentation of specific hip symptoms in the available medical records. Based on the natural history of labral tears and the MRI findings, the condition likely developed gradually over time during the veteran military service between 1992 and 2004, with the cumulative effects of physical strain on the hip joint from his occupational duties. Labral tears can remain asymptomatic for extended periods before eventually becoming symptomatic, or they may be discovered incidentally during imaging for other conditions.
When did the veteran first present to a health / medical provider for this condition? There is no documentation in the available records of a specific presentation for left hip symptoms prior to the MRI conducted on January 3, 2023. The para labral cysts appear to have been an incidental finding during comprehensive imaging studies.
When was the condition confirmed / formally diagnosed? The condition was formally diagnosed on January 3, 2023, when an MRI of the bilateral hips revealed small, 12:00 para labral cysts in the left hip consistent with degenerative labral tearing. The diagnosis was made by the treating doctor, Radiologist, who interpreted the MRI findings and provided the formal diagnosis in his report.
When did the veteran first present to you (or your practice) for this condition? April 12, 2022
- 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 para labral cysts in keeping with degenerative labral tearing was confirmed through MRI imaging of the bilateral hips conducted on January 3, 2023. The MRI explicitly documented "small, 12:00 para labral cysts left hip" and concluded with a formal diagnosis of "Left hip para labral cysts in keeping with degenerative labral tearing." This diagnosis was made by the treating doctor, Radiologist, who interpreted the MRI findings.
Para labral cysts are a well-established radiological sign of underlying labral pathology, as they form when joint fluid escapes through a tear in the labrum and collects in a cystic structure. The presence of these cysts at the 12:00 position (superior aspect) of the left hip is consistent with labral tearing in that region.
The MRI demonstrated normal articular cartilage signal and thickness bilaterally, indicating that the labral pathology had not yet progressed to significant osteoarthritic changes in the hip joint, consistent with earlier-stage labral disease.
- 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(1) - having a significant physical force applied to or through the affected shoulder joint or the affected hip joint at the time of the clinical onset of labral tear
- NOT MET. There is no documented specific traumatic incident with significant physical force applied to the left hip joint.
Factor 9(2) - performing forceful and repetitive motions of the affected shoulder joint or 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 an Aircraft Technician with Fuel Tank Entry duties, the veteran occupational responsibilities regularly required him to perform forceful and repetitive motions of the hip joints. His work involved climbing on aircraft, squatting and kneeling in confined spaces during maintenance activities, and assuming awkward positions when accessing difficult-to-reach components. These activities place the hip joints at extremes of the normal range of motion. Given the nature of his duties and his 11.5-year service period, he would have performed these activities for well over four hours per week for many months throughout his service.
Factor 9(3) - 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 MET. This factor is not applicable to the veteran.
Factor 9(4) - inability to obtain appropriate clinical management for labral tear
- MET. The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) enlarges on the meaning to be given to "inability" as the lack of ability to get treatment in both an objective and subjective sense. In this case, there is evidence of an inability to obtain appropriate clinical management as the condition was not diagnosed until December 2020, approximately 19 years after discharge from service. This significant delay in diagnosis and management would have allowed the condition to progress naturally without appropriate intervention. The absence of documented hip-specific presentations in the available medical records suggests there were barriers to healthcare access that prevented earlier diagnosis and management of this condition.
Sequelae
This condition is not a sequela of another known condition. The left hip para labral cysts with degenerative labral tearing appears to be a primary condition that developed as a result of cumulative mechanical stress on the hip joint during the veteran service as an Aircraft Technician.
Unintended Consequence
There is no evidence that this condition is an Unintended Consequence of Medical Management. The records do not indicate any medical procedures or medications prescribed during service that could have directly caused or contributed to the development of hip labral pathology.
Inability to Attain Appropriate Medical Management
There is evidence of an inability to attain appropriate medical management for this condition. The significant delay between service discharge (December 2001) and formal diagnosis (December 2020) - approximately 19 years - represents a substantial period during which the condition remained undiagnosed and untreated. This delay in diagnosis and management would have allowed the condition to progress naturally without appropriate intervention.
The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) (see the judgement of Merkel J) enlarges on the meaning to be given to "inability" as the lack of the ability to get treatment in both an objective and subjective sense. The absence of documented hip-specific presentations in the available medical records suggests there were barriers to healthcare access that prevented earlier diagnosis and management of this condition.
The lack of documented hip pain presentations, despite the development of para labral cysts that would typically cause symptoms over time, is 100% indicative of there being barriers to health care, satisfying inability to attain appropriate medical management. Additionally, the lengthy time between service discharge and diagnosis, considering the natural history of labral tears, is 100% indicative of barriers to healthcare, further satisfying this factor.
This inability to obtain appropriate clinical management would have contributed to permanent worsening of the condition, as untreated labral tears tend to progress over time, potentially leading to more extensive labral damage, development of para labral cysts (as seen on imaging), and eventual articular cartilage degeneration.
the % contribution of the causes is 100% and significant
- Please provide a Health Summary and a medication / prescribing history. -see attached report
