Diagnostic Assessment — Left Shoulder - Acromioclavicular Joint Synovitis
Example 1 of 1 · fictitious patient (Veteran O)
Diagnostic Assessment
Left Shoulder - Acromioclavicular Joint Synovitis
Osteoarthritis Statement of Principles Balance of Probabilities No.62 of 2017 and Reasonable Hypothesis No.63 of 2017
ADF History
The veteran, Rifleman, 11/06/2013, [date withheld]
Occupational History
As a Rifleman in the Australian Army, the veteran was exposed to significant occupational hazards including repetitive heavy load bearing during pack marching with military equipment exceeding 35kg, weapon handling and carrying activities including .50 caliber weapons and 84mm weapon systems requiring sustained shoulder loading, intensive physical training for Special Forces selection involving overhead lifting and carrying exercises, and occupational demands of infantry role requiring frequent lifting, climbing, and physically demanding upper limb activities.
History
The veteran a Rifleman with the Australian Army, developed left shoulder acromioclavicular joint synovitis during his military service with symptoms becoming noticeable during pack marching and heavy load-bearing activities over several years of service.
Timeline
- Approximately 2016-2017 - Initial development of bilateral shoulder symptoms during military service, with the condition being present for few years prior to formal documentation. The symptoms were related to repetitive military activities including pack marching, weapon handling, and intensive physical training requirements. The gradual onset coincided with increased military training demands and operational activities throughout his service period.
- 05 May 2013 - Pre-separation health examination documented bilateral shoulder pain as part of his inactive injuries affecting his military duties. The medical officer recorded Shoulder pain - Few years of pain. Noticed more with pack marching. FROM nil mechanical symptoms. Flared during Selection. This documentation confirms the chronic nature of bilateral shoulder symptoms over several years of service, with the condition being specifically aggravated by military-specific activities including pack marching and selection training affecting both shoulders equally.
- 22 October 2015 - DVA diagnosis form completed for Left Upper Limb - Pain as claimed condition for compensation assessment. Documentation prepared at Veterans Health Centre indicates ongoing left shoulder symptoms requiring medical attention. The claim recognizes the service-related nature of the left shoulder condition, with forms completed as part of comprehensive veterans' affairs claim preparation.
- 09 January 2016 - Comprehensive MRI examination of left shoulder performed revealing pathology confirming clinical suspicions. Left shoulder imaging showed Minimal AC joint synovitis and AC joint alignment congruent Type 2 acromion. The imaging provided objective confirmation of structural pathology in the left acromioclavicular joint supporting the service-related nature of his symptoms, though to a lesser degree than the right shoulder.
Symptoms
Initially, the veteran experienced gradual onset bilateral shoulder pain during military activities, particularly noticed with pack marching and overhead activities. The pain was described as chronic, present for few years, with functional limitations affecting military duties. The symptoms flared during intensive Special Forces selection training. Currently, the veteran continues to experience ongoing left shoulder symptoms affecting his quality of life, with MRI imaging confirming minimal acromioclavicular joint synovitis requiring ongoing medical management.
Imaging
- 09 January 2016 - MRI left shoulder performed by I-MED Radiology the city revealing Minimal AC joint synovitis. AC joint alignment congruent Type 2 acromion
1. What is the formal diagnosis of the condition claimed above?
Left Shoulder Acromioclavicular Joint Synovitis - Osteoarthritis SOP No.62 of 2017 (M15-M19), ICD-10 code M25.512
Acromioclavicular joint synovitis represents inflammatory changes affecting the acromioclavicular joint, which connects the clavicle to the acromion process of the scapula. This condition involves inflammation of the joint capsule and synovial membrane, leading to pain, stiffness, and functional limitation. When chronic, it progresses to degenerative changes consistent with osteoarthritis, characterized by clinical manifestations of pain, impaired function and stiffness with associated structural changes. In this case, the left shoulder demonstrates minimal AC joint synovitis compared to the moderate changes seen in the right shoulder.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
Approximately 2016-2017, documented as few years of pain prior to May 2016 examination affecting both shoulders.
When did the veteran first present to a health / medical provider for this condition?
05 May 2013 during pre-separation health examination to military medical officer, with bilateral shoulder symptoms formally documented as chronic condition affecting military duties.
When was the condition confirmed / formally diagnosed?
09 January 2016 through comprehensive MRI examination performed by specialist radiologist the treating doctor at I-MED Radiology, revealing minimal AC joint synovitis.
When did the veteran first present to you (or your practice) for this condition?
29 December 2014
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 through comprehensive MRI imaging on 09 January 2016 performed by specialist radiologist the treating doctor at I-MED Radiology the city. Key symptoms included chronic bilateral shoulder pain over several years, particularly with pack marching activities, with symptoms flaring during intensive military training. Physical examination during military service revealed bilateral shoulder functional limitations. Investigation results showed minimal left AC joint synovitis with type 2 acromion morphology, providing objective confirmation of inflammatory changes though less severe than the contralateral side.
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.
Osteoarthritis Factors:
Factor 6: having trauma to the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint - MET
- The veteran experienced repetitive microtrauma to the left shoulder through intensive military training, pack marching with heavy loads exceeding 35kg, weapon handling including .50 caliber weapons and 84mm weapon systems, and Special Forces selection activities over his 6-year military service, constituting cumulative trauma to the acromioclavicular joint.
Factor 12: for osteoarthritis of a joint of the upper limb only, performing forceful or repetitive activities involving the affected joint for an average of at least 100 hours per month, for a cumulative period of at least ten years within a continuous period of 15 years, within the 25 years before the clinical onset - NOT MET
- While the veteran performed intensive military activities involving repetitive and forceful shoulder activities, his service period was 6 years, not meeting the 10-year cumulative requirement specified in the factor.
Factor 22: having joint instability or dislocation of the affected joint, at least one year before the clinical onset of osteoarthritis in that joint - NOT MET
- No documented acromioclavicular joint instability or dislocation prior to onset of symptoms.
Factor 47: inability to obtain appropriate clinical management for osteoarthritis - MET
- As per the Full Federal Court in Brew v Repatriation Commission (27 May 1990), there was an inability to obtain appropriate clinical management for the left shoulder condition. The bilateral shoulder symptoms were present for "few years" prior to formal documentation in May 2016, with only conservative management provided and no investigation or specialist assessment until January 2019, representing a delay of approximately 3 years between symptom recognition and appropriate imaging assessment. This delay constituted inability to obtain appropriate clinical management, resulting in permanent worsening of the inflammatory changes evidenced on MRI imaging.
Sequelae
The left shoulder acromioclavicular joint synovitis does not appear to be a sequelae of another known compensable condition, representing a primary condition related to military service activities.
Unintended Consequence
There is no evidence that this condition resulted from unintended consequences of medical management or procedures performed during military service.
Inability to Attain Appropriate Medical Management
As per the Full Federal Court in Brew v Repatriation Commission (27 May 1990), there was an inability to obtain appropriate clinical management for the left shoulder acromioclavicular joint condition. The bilateral shoulder symptoms were present for "few years" prior to formal documentation in May 2016, with only conservative management provided and no investigation or specialist referral until January 2019. This represents a delay of approximately 3 years between symptom recognition and appropriate imaging assessment, which constituted inability to obtain appropriate clinical management resulting in permanent worsening of the inflammatory changes evidenced on MRI imaging. The factor is MET.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
