Diagnostic Assessment — Left Shoulder - Degenerative Labral Tearing, Rotator Cuff Tendinopathy and AC Joint Degenerative Change
Example 1 of 1 · fictitious patient (Veteran L)
Diagnostic Assessment
Left Shoulder - Degenerative Labral Tearing, Rotator Cuff Tendinopathy and AC Joint Degenerative Change
Balance of Probabilities SOP: Labral Tear SOP No. 37 of 2017 - Factors (2), (4); Osteoarthritis SOP No. 62 of 2017 - Factors (6), (47) Reasonable Hypothesis SOP: Labral Tear SOP No. 36 of 2017 - Factors (2), (4); Osteoarthritis SOP No. 61 of 2017 - Factors (6), (47)
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 required to perform physically demanding tasks including carrying heavy equipment such as radios, antennas, and generators. The role involved extensive overhead activities, repetitive lifting, and prolonged physical training sessions. Military physical training included forceful and repetitive motions of the shoulder joint involving extremes of normal range of motion through activities such as loading ammunition, physical employment standards training, and participating in obstacle courses and infantry minor tactics courses typical of military service.
History
The veteran an Electronic Warfare Operator, developed gradual onset left shoulder pain in 2003 following physical training sessions, initially considered a strain, which progressed to degenerative labral tearing, rotator cuff tendinopathy, and acromioclavicular joint degenerative changes.
Timeline
13 September 1998: The veteran reported gradual onset left shoulder pain after physical training sessions, diagnosed as a left shoulder strain per the Strain SOP. The pain was predominantly anterior in nature and was significantly worsened by overhead activities and adduction movements required in his military role. He experienced severe functional limitation, being unable to work above shoulder height, which directly impacted his operational tasks as an Electronic Warfare Operator. No immediate imaging was conducted at the time of injury, with initial management focused on conservative treatment approaches. Physiotherapy was likely initiated to manage symptoms and maintain functional capacity. The condition marked the onset of chronic shoulder problems that would significantly impact his remaining military service and lead to progressive degenerative changes.
01 October 2018: An MRI revealed extensive pathology including degenerative labral tearing with a 7 mm paralabral cyst, mild rotator cuff tendinopathy affecting the supraspinatus, and mild AC joint degenerative change. The veteran reported persistent pain, particularly during physical activities, consistent with his long-standing shoulder problems from military service. The rotator cuff tendons showed mild supraspinatus tendinopathy with preserved muscle volume and no fatty infiltration, indicating chronic overuse rather than acute injury. The AC joint changes demonstrated early degenerative processes consistent with repetitive stress from his military duties. The findings were directly linked to the 2003 injury and repetitive strain patterns from his occupational role as an Electronic Warfare Operator. The condition continued to limit his functional capacity and quality of life in the post-service period.
Symptoms
At the time of the 2003 injury, the veteran experienced gradual onset anterior shoulder pain that was significantly worsened by overhead activities and adduction movements, with severe functional limitation preventing work above shoulder height. Following the injury, symptoms persisted with ongoing pain during physical tasks and functional restrictions affecting his military duties. Current symptoms include persistent left shoulder pain particularly during physical activities, with confirmed degenerative labral tearing causing mechanical symptoms, rotator cuff tendinopathy contributing to weakness and pain, and AC joint degenerative changes causing ongoing discomfort and functional limitation that significantly affects daily activities and quality of life.
Imaging
01 October 2018: MRI findings revealed degenerative labral tearing with a 7 mm paralabral cyst, mild rotator cuff tendinopathy affecting the supraspinatus with normal muscle volume and no fatty infiltration, and mild AC joint degenerative change. The rotator cuff showed mild supraspinatus tendinopathy with preserved structural integrity. The findings were directly linked to the 2003 injury and repetitive strain from military service duties.
1. What is the formal diagnosis of the condition claimed above?
Left Shoulder - Degenerative Labral Tearing (M75.101), Rotator Cuff Tendinopathy (M75.110), and AC Joint Degenerative Change (M19.019), DVA SOP Labral Tear SOP No. 37 of 2017 and Osteoarthritis SOP No. 62 of 2017, ICD-10 codes M75.101, M75.110, and M19.019.
Degenerative labral tearing involves injury to the fibrocartilaginous rim of the shoulder joint resulting in local pain and tenderness, often with accompanying symptoms of popping, clicking, catching, instability, or reduced range of motion. Degenerative tears typically result from repetitive stress and overuse rather than acute trauma.
Rotator cuff tendinopathy is a degenerative condition affecting the tendons of the rotator cuff muscles, particularly the supraspinatus. This involves chronic changes to the tendon structure including collagen breakdown, increased vascularity, and tissue thickening, typically developing from repetitive overhead activities and chronic overuse.
Acromioclavicular joint degenerative change represents early osteoarthritis of the AC joint, characterized by loss of articular cartilage and osteophyte formation. This typically develops from repetitive stress and overuse of the shoulder joint.
The temporal relationship shows the initial shoulder strain in 2003, with progressive development of degenerative changes confirmed by 2023 MRI, indicating chronic progression from acute injury to complex degenerative pathology.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 13 September 1998 - following physical training sessions.
When did the veteran first present to a health/medical provider for this condition? 13 September 1998 - the veteran first presented to a medical provider, likely a General Practitioner or Military Medic, following the onset of shoulder pain after physical training.
When was the condition confirmed/formally diagnosed? 13 September 1998 - The shoulder strain was diagnosed at the time of symptom onset. 01 October 2018 - The degenerative labral tearing, rotator cuff tendinopathy, and AC joint degenerative change were 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 shoulder strain was confirmed by clinical assessment in 2003 based on gradual onset anterior shoulder pain following physical training, worsened by overhead activities and adduction movements. Key symptoms included severe functional limitation preventing work above shoulder height, consistent with repetitive strain from military duties.
The diagnoses of degenerative labral tearing, rotator cuff tendinopathy, and AC joint degenerative change were confirmed by MRI on 01 October 2018, reported by the treating doctor at I-MED Radiology. The MRI showed thickening of the anterior and inferior labrum with a 7 mm paralabral cyst, mild supraspinatus tendinopathy with preserved muscle volume, and mild AC joint degeneration. The clinical history and MRI findings established the diagnoses, linking them to the 2003 strain and ongoing occupational demands.
4. What do you consider to be the cause(s) of the condition in this veteran?
Performing forceful and repetitive motions of the affected shoulder 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 performed forceful and repetitive shoulder motions during military physical training and operational duties including loading ammunition, physical employment standards training, and obstacle courses for well over four hours per week in the period before onset.
Having trauma to the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint - MET
- The 2003 shoulder strain constitutes trauma to the shoulder joint within 25 years before the clinical onset of AC joint degenerative changes, satisfying this factor for osteoarthritis development.
Inability to obtain appropriate clinical management for labral tear - MET
- There is evidence of inadequate clinical management as demonstrated by the 20-year delay between initial injury and comprehensive MRI investigation, and the progression from simple strain to complex degenerative pathology, representing failure to provide appropriate ongoing clinical management per Brew v Repatriation Commission.
Inability to obtain appropriate clinical management for osteoarthritis - MET
- The progression from shoulder strain to degenerative AC joint changes without appropriate intervention demonstrates inability to obtain appropriate clinical management that could have prevented or minimized the degenerative progression.
Sequelae
The degenerative labral tearing, rotator cuff tendinopathy, and AC joint degenerative changes are direct sequelae of the original 2003 left shoulder strain, developing due to chronic overuse patterns, inadequate rehabilitation, and ongoing occupational demands that prevented proper healing and resulted in progressive degenerative changes.
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 20-year delay between initial injury in 2003 and comprehensive MRI investigation in 2023. The Full Federal Court in Brew v Repatriation Commission establishes that inability encompasses the lack of ability to get treatment in both objective and subjective senses. The extensive delay between initial presentation and definitive investigation, combined with the progression from simple strain to complex degenerative pathology including labral tearing and AC joint arthritis, constitutes evidence of barriers to healthcare satisfying the inability to attain appropriate medical management factor. This resulted in permanent worsening as the acute strain progressed to irreversible degenerative changes that could have been prevented or minimized with appropriate early intervention, specialized management, and ongoing monitoring.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication/prescribing history.
- See attached report
