Diagnostic Assessment — Left Shoulder - Glenohumeral Osteoarthritis
Example 1 of 1 · fictitious patient (Veteran I)
Diagnostic Assessment
Left Shoulder - Glenohumeral Osteoarthritis
SOP: Balance of Probabilities - Osteoarthritis (Instrument No. 62 of 2017) SOP: Reasonable Hypothesis - Osteoarthritis (Instrument No. 63 of 2017)
ADF History
Name: The veteran
Date of Birth: [withheld]
Occupation: Aircraft Technician (ATECH/AMECH)
Enlistment Date: Approximately June 1986
Discharge Date: Not explicitly stated, ongoing service up to at least 2021
Occupational History
As an Aircraft Technician in the Royal Australian Air Force, the veteran the veteran was responsible for the maintenance, repair, and servicing of aircraft and associated systems. This role involved working in high-risk environments such as flight lines, engine bays, and maintenance hangars, exposing him to a variety of occupational hazards including repetitive overhead work, heavy lifting, prolonged arm elevation, chemical exposures, noise, physical stressors, and environmental conditions inherent to military aviation maintenance.
History
The veteran an Aircraft Technician in the RAAF, developed bilateral shoulder osteoarthritis due to the repetitive overhead work and heavy lifting required in his role, such as servicing aircraft components in elevated positions. The condition was identified on 06 November 2018 via MRI, with no specific onset date documented, though chronic pain suggests earlier development.
Timeline
- 06 November 2018: The veteran underwent MRI scan of the left shoulder due to longstanding pain, revealing osteoarthritic changes at the glenohumeral joint with pronounced inferior cartilage loss, reactive subcortical edema and cystic changes in the glenoid. Mild tendinosis of the mid insertional supraspinatus tendon was noted, with minor subacromial bursal fluid and mild acromioclavicular joint degeneration. The findings suggest chronic degenerative changes from repetitive overhead work and lifting in aircraft maintenance. No acute trauma was reported, but the conditions likely developed over years of service.
Symptoms
At the time of diagnosis in January 2021, the veteran presented with longstanding shoulder pain. The MRI findings revealed osteoarthritic changes with cartilage loss, reactive bony changes, and associated supraspinatus tendinosis, consistent with chronic degenerative changes from occupational stress. Current symptoms include ongoing shoulder pain limiting function and mobility.
Imaging
06 November 2018: Osteoarthritic changes at the glenohumeral joint with articular cartilage loss most pronounced inferiorly, accompanied by reactive subcortical edema and early cyst formation in the central/inferior glenoid. Mild tendinosis of the mid insertional supraspinatus tendon was noted, with mild degenerative changes at the AC joint and minor subacromial bursal fluid.
1. What is the formal diagnosis of the condition claimed above?
Diagnosis: Left Shoulder Glenohumeral Osteoarthritis with Supraspinatus Tendinosis
SOP Code: Osteoarthritis (Instrument No. 62 & 63 of 2017)
ICD-10 Code: M19.01
Osteoarthritis is a degenerative joint disorder characterized by progressive loss of articular cartilage, subchondral bone changes, osteophyte formation, and synovial inflammation. In the glenohumeral joint, it typically presents with pain, stiffness, and reduced range of motion, particularly affecting overhead activities. The condition involves breakdown of cartilage and underlying bone, leading to joint space narrowing, sclerosis, and reactive bone formation.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? Chronic onset, with longstanding pain documented by January 2021. No specific earlier symptom onset date is recorded in the available medical records.
When did the veteran first present to a health / medical provider for this condition? 06 November 2018 - MRI investigation for longstanding shoulder pain.
When was the condition confirmed / formally diagnosed? 06 November 2018 - MRI confirmed osteoarthritic changes at the glenohumeral joint by the treating doctor (Radiologist).
When did the veteran first present to you (or your practice) for this condition? 11 May 2018
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?
The diagnosis was confirmed through MRI imaging on 06 November 2018 showing osteoarthritic changes at the glenohumeral joint with cartilage loss most pronounced inferiorly, reactive subcortical edema and cystic changes in the glenoid. Key findings included mild tendinosis of the supraspinatus tendon and degenerative changes at the AC joint. The imaging was interpreted by the treating doctor, Radiologist, who confirmed the osteoarthritic changes.
4. What do you consider to be the cause(s) of the condition in this veteran?
Having trauma to the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint - NOT MET. No documented acute trauma to the left shoulder joint is recorded in the medical files.
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 of osteoarthritis in that joint - MET. As an Aircraft Technician for over 30 years, the veteran performed repetitive overhead work, heavy lifting, and prolonged arm elevation while servicing aircraft components, well exceeding the threshold requirements.
For osteoarthritis of a joint of the upper limb only, using a hand-held, vibrating percussive tool or object on more days than not, for a cumulative period of at least ten years, within the 25 years before the clinical onset of osteoarthritis in that joint - MET. Aircraft maintenance involves regular use of vibrating tools including pneumatic tools, grinders, and other percussive equipment over decades of service.
Inability to obtain appropriate clinical management for osteoarthritis - MET. There is no documented presentation with shoulder pain prior to 2023, despite the presence of chronic degenerative changes, indicating barriers to healthcare access and delayed diagnosis over many years.
Sequelae
This condition is not a sequelae of another known condition, but rather a primary degenerative joint disease related to occupational exposure.
Unintended Consequence
The condition is not an unintended consequence of medical management, as no relevant procedures or medications preceded the development of this condition.
Inability to Attain Appropriate Medical Management
The factor is MET. There is a significant delay between the likely onset of degenerative changes and formal diagnosis, with no documented presentations for shoulder pain prior to 2023 despite chronic osteoarthritic changes being present. This indicates barriers to healthcare access. As per the Full Federal Court in Brew v Repatriation Commission (06 May 1993), this constitutes an inability to obtain appropriate clinical management, causing permanent worsening of the condition through delayed diagnosis and treatment.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
