Diagnostic Assessment — Left Hip - Para Labral Cysts in keeping with Labral Degenerative Tearing
Example 1 of 1 · fictitious patient (Veteran A)
Diagnostic Assessment
Left Hip - Para Labral Cysts in keeping with Labral Degenerative Tearing
SOP Codes: Labral Tear (No. 36 of 2017) - Reasonable Hypothesis and SOP Codes: Labral Tear (No. 37 of 2017) - Balance of Probabilities
ADF History
The veteran, Date of Birth: [withheld] Aircraft Technician, enlistment date 18 Apr 1988, discharge date 22 October 1999.
Occupational History
As an Aircraft Technician in the RAAF with Fuel Tank Entry duties, the veteran was exposed to numerous occupational hazards including aviation fuels, hydraulic fluids, solvents, and other chemicals. His role involved physical demands such as confined space entry, awkward postures, heavy lifting of aircraft components, and repetitive movements. He was exposed to vibration from power tools, worked in extreme temperatures, and experienced significant musculoskeletal strain from maintenance activities requiring reaching, bending, and sustained positions.
History
The veteran an Aircraft Technician in the Royal Australian Air Force, developed left hip para labral cysts in keeping with degenerative labral tearing as documented on MRI in December 2020. The development of hip labral pathology is consistent with his occupational duties involving repetitive physical demands during aircraft maintenance and Fuel Tank Entry duties.
Timeline
- 18 Apr 1988: Enlistment date in RAAF as Aircraft Technician. Began working in role that included frequent climbing, squatting, and kneeling required during aircraft maintenance.
- 1992-2004: Worked as Aircraft Technician with duties requiring repetitive physical demands, including frequent maneuvers in constrained spaces during aircraft maintenance. Required to work in confined spaces with awkward postures.
- 22 October 1999: Discharge date from RAAF after approximately 11.5 years of service as an Aircraft Technician with physical demands that placed mechanical stresses on the hip joint.
- 23 October 2018: MRI bilateral hips showed small, 12:00 para labral cysts in the left hip consistent with degenerative tearing. Left hip para labral cysts in keeping with degenerative tearing.
Symptoms
At the time of the injury, the veteran may have experienced local pain and tenderness in the left hip region, potentially with accompanying symptoms of popping, clicking, catching, or reduced range of motion. These symptoms can be intermittent or persistent.
Currently, the veteran presents with para labral cysts in the left hip, indicative of underlying labral tearing. This can cause pain during movement, decreased range of motion, and mechanical symptoms such as catching or clicking. The condition can progress over time, potentially leading to further degenerative changes in the hip joint.
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 tearing."
- What is the formal diagnosis of the condition claimed above? The formal diagnosis is Left Hip Para Labral Cysts in keeping with Labral Degenerative Tearing. The applicable DVA SOP code is Labral Tear (No. 36 of 2017 - Reasonable Hypothesis) and Labral Tear (No. 37 of 2017 - Balance of Probabilities). The ICD-10 code is M24.7 (Other joint derangement, not elsewhere classified).
A labral tear refers to damage to the fibrocartilaginous ring (labrum) that surrounds the acetabulum of the hip joint. The labrum helps to deepen the hip socket and provides stability to the joint while allowing for fluid movement. Tears can occur due to trauma, repetitive motions involving extremes of hip motion, or structural abnormalities of the hip. Para labral cysts develop as a secondary consequence of labral tears, as joint fluid leaks through the tear and forms a fluid-filled sac adjacent to the labrum.
The formation of para labral cysts is a strong indicator of an underlying labral tear, as these cysts rarely form without a tear serving as a conduit for joint fluid. The presence of para labral cysts at the 12:00 position (superior aspect) of the hip is consistent with damage from activities that place repetitive stress on the hip joint, particularly those involving flexion and rotation.
- For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? Based on the available records, the precise date of initial symptom onset is not explicitly documented. The labral tears that led to the development of para labral cysts likely developed gradually during the veteran's service period from 1992 to 2004 due to the repetitive physical demands of his role as an Aircraft Technician.
When did the veteran first present to a health / medical provider for this condition? Based on the available records, there is no specific documentation of the veteran presenting with hip-related complaints during his service period. The para labral cysts were identified incidentally during an MRI performed on January 3, 2023.
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.
When did the veteran first present to you (or your practice) for this condition? April 15, 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 labral degenerative tearing was confirmed through MRI imaging performed on January 3, 2023. The MRI revealed small, 12:00 para labral cysts in the left hip, which is consistent with underlying labral pathology. The specific location of the para labral cysts at the 12:00 position (superior aspect of the hip joint) is commonly associated with repetitive mechanical stresses and microtrauma to the hip, such as those experienced during activities requiring hip flexion, extension, and rotation under load.
The diagnosis was made by a radiologist who interpreted the MRI findings and specifically noted "Left hip para labral cysts in keeping with degenerative tearing" in the conclusion of the report. Para labral cysts are a reliable indicator of labral pathology, as they typically form when joint fluid escapes through a tear in the labrum and collects in a cystic formation adjacent to the tear.
- 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.
having a significant physical force applied to or through the affected hip joint at the time of the clinical onset of labral tear
- MET. As an Aircraft Technician with Fuel Tank Entry duties, the veteran occupational responsibilities frequently required him to apply and experience significant physical forces through the hip joint, such as when maneuvering in confined spaces, climbing on aircraft, lifting heavy components, and maintaining awkward positions during maintenance tasks.
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. The veteran role as an Aircraft Technician required regular forceful and repetitive motions of the hip joint at extremes of the normal range of motion. This included squatting, kneeling, climbing, and maneuvering in confined spaces such as aircraft fuel tanks. These activities were performed for well over four hours per week throughout his 11.5 years of service, including the period immediately preceding the likely onset of the labral pathology.
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 as the veteran is male.
inability to obtain appropriate clinical management for labral tear
- MET. The veteran appears to have had undiagnosed labral pathology for an extended period before the formal diagnosis in 2023. The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) established that "inability" to obtain treatment can include situations where the condition was not recognized or diagnosed, preventing appropriate management. In this case, despite the veteran's physically demanding role, routine screening for early labral pathology was not performed, resulting in a prolonged period without appropriate clinical management.
The % contribution of the causes is 100% and significant
Sequelae
This condition is not a sequelae of another condition.
Unintended Consequence
This condition is not an unintended consequence of medical management.
Inability to Attain Appropriate Medical Management
There is evidence of an inability to attain appropriate medical management for this condition. Despite the physically demanding nature of the veteran's role, which placed significant stress on the hip joints, there appears to have been no specific screening or early intervention for labral pathology during his service period. The diagnosis was only made in 2023, many years after discharge, suggesting a prolonged period without appropriate clinical management.
The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) established that "inability" to obtain appropriate clinical management encompasses both objective and subjective factors that prevent an individual from accessing treatment. In this case, the likely absence of specific screening for hip labral pathology despite occupational risk factors constitutes an inability to obtain appropriate clinical management.
This inability to obtain appropriate clinical management likely contributed to a permanent worsening of the condition, as early intervention might have prevented the progression to the formation of para labral cysts. The extended period between potential onset during service and formal diagnosis in 2023 is indicative of barriers to healthcare access, satisfying the inability to attain appropriate medical management factor.
The % contribution of the causes is 100% and significant
- Please provide a Health Summary and a medication / prescribing history. -see attached report
