Diagnostic Assessment — Left Wrist - Chronic Sprain
Example 1 of 1 · fictitious patient (Veteran K)
Diagnostic Assessment
Left Wrist - Chronic Sprain
Balance of Probabilities: Sprain and Strain No. 28 of 2020 Reasonable Hypothesis: Sprain and Strain No. 27 of 2020
ADF History
The veteran, Technician Electronic Systems, enlisted 08 February 2002, discharged 02 December 2010.
Occupational History
As a Technician Electronic Systems in the Australian Army, the veteran was responsible for maintenance, repair, and operation of electronic systems, including communication equipment and vehicle electronics such as those used in the ASLAV (Australian Light Armoured Vehicle). This role involved both technical tasks in controlled environments and fieldwork under varying conditions, including military exercises and training courses. The occupational hazards were multifaceted, encompassing physical, environmental, and ergonomic challenges. Technicians are frequently exposed to repetitive strain from handling tools and equipment, prolonged periods in awkward postures, and physical demands of lifting or moving heavy electronic components. Additionally, his role required participation in physically intensive military activities and recreational sports programs sanctioned by the ADF.
History
The veteran a Technician Electronic Systems in the Australian Army, sustained a left wrist injury during a rugby match while serving, when another player stood on his wrist, resulting in chronic sprain with ongoing pain, stiffness, and functional limitation.
Timeline
- During ADF Service (Pre-November 2012): The veteran sustained a traumatic injury to his left wrist during a rugby match when another player stood on his wrist. The injury occurred during service-sanctioned recreational activities. The trauma resulted in immediate pain, stiffness, and limited range of motion in the left wrist. Symptoms included stiffness during wrist movements and pain in certain positions. The veteran reported that symptoms stabilized in November 2012, indicating ongoing chronic effects from the initial sprain injury.
- 12 February 2016: MRI of the left wrist revealed mild cortical irregularity at the lunate insertion suggesting old injury, confirming the chronic nature of the sprain injury sustained during military service. The imaging findings were consistent with chronic sequelae of the traumatic wrist injury from rugby. Clinical assessment confirmed ongoing symptoms of chronic sprain including pain, stiffness, and functional limitation. The condition was noted to limit weight-bearing activities and had a significant impact on daily functioning.
Symptoms
At the time of the rugby injury during military service, the veteran experienced immediate onset of left wrist pain, swelling, and limited range of motion following the trauma when another player stood on his wrist. The acute symptoms progressed to chronic manifestations that stabilized in November 2012. Current symptoms include stiffness during regular range of movements, pain felt in certain positions of the wrist, muscular pain localized to joints 7 days per week for 8 hours, and loss of range of motion 7 days per week for 16 hours. The condition significantly limits functional activities, with inability to carry shopping bags at the supermarket and a weight limit of 10kg. Symptoms worsen when applying weight or lifting items, making the wrist weaker and preventing comfortable completion of push-ups. Rotating the wrist through regular range of movement causes pain. Relief is obtained by not applying pressure or weight to the wrist and reducing movement.
Imaging
- 12 February 2016: MRI left wrist showed 12mm multiloculated ganglion cyst at volar radioscaphoid articulation, 10mm ganglion cyst over dorsal scapholunate ligament, and mild cortical irregularity at lunate insertion suggesting old injury.
1. What is the formal diagnosis of the condition claimed above?
Left Wrist - Chronic Sprain, DVA SOP Sprain and Strain No. 27 of 2020 (Reasonable Hypothesis) and No. 28 of 2020 (Balance of Probabilities), ICD-10 code S63.502S (Unspecified sprain of left wrist, sequela).
A chronic sprain represents the long-term sequelae of an acute sprain injury involving the tearing or stretching of one or more joint ligaments. Unlike acute sprains, chronic sprains are characterized by persistent symptoms including pain, stiffness, weakness, and functional limitation that continue beyond the normal healing period. Chronic sprains often result from incomplete healing of the initial ligamentous injury, leading to ongoing joint instability, altered biomechanics, and compensatory changes. The condition may be associated with the development of secondary complications such as ganglion cysts, as seen in this case, which can arise from chronic joint irritation and altered joint mechanics following ligamentous injury.
The temporal relationship shows this condition originated from an acute traumatic sprain during military service that progressed to a chronic condition with persistent symptoms and functional impairment, stabilizing in November 2012.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
During ADF service when he sustained the rugby injury, with symptoms stabilizing in November 2012. [PTQ.pdf, Page 3; CHATY REVIEW - WILLIAM THURLOW - TOM.docx, Timeline section]
When did the veteran first present to a health / medical provider for this condition?
12 February 2016, when he presented for assessment of ongoing left wrist symptoms to a Medical Officer. [CHATY REVIEW - WILLIAM THURLOW - TOM.docx, Timeline section]
When was the condition confirmed / formally diagnosed?
12 February 2016, when the chronic sprain was diagnosed based on clinical presentation and MRI findings showing cortical irregularity consistent with old injury. [CHATY REVIEW - WILLIAM THURLOW - TOM.docx, Timeline section]
When did the veteran first present to you (or your practice) for this condition?
07 September 2015
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 clinical assessment and MRI imaging performed on 12 February 2016. The MRI revealed mild cortical irregularity at the lunate insertion suggesting an old injury, confirming the chronic nature of the sprain. Key symptoms included persistent stiffness during wrist movements, pain in certain positions, muscular pain 7 days per week for 8 hours, and loss of range of motion 7 days per week for 16 hours. Functional limitations included inability to carry shopping bags with a weight limit of 10kg, difficulty with push-ups, and pain with rotational movements. The clinical history of traumatic injury during rugby when another player stood on his wrist, combined with imaging evidence of chronic changes, supported the diagnosis of chronic sprain. [PTQ.pdf, Pages 2-3; CHATY REVIEW - WILLIAM THURLOW - TOM.docx, Conditions and Timeline sections]
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.
Experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament - MET
- The veteran sustained a direct traumatic injury to his left wrist during a rugby match while serving in the ADF when another player stood on his wrist. This represents a significant physical force applied to the wrist joint causing the initial sprain injury. Rugby was a service-sanctioned recreational activity that formed part of military fitness and morale programs.
Inability to obtain appropriate clinical management for sprain or strain - MET
- There was a significant delay of approximately 6 years between symptom stabilization in November 2012 and first medical presentation in March 2019. This lengthy delay between the chronic condition onset and medical diagnosis constitutes inability to attain appropriate medical management as per the precedent established in Brew v Repatriation Commission. The absence of medical presentations for this wrist condition during the 6-year period indicates barriers to healthcare access, satisfying the inability to obtain appropriate clinical management factor.
Sequelae
This condition is not a sequelae of another known condition but represents a primary chronic sprain injury resulting from trauma sustained during military service recreational activities.
Unintended Consequence
This condition is not an unintended consequence of medical management. No medical procedures or medications were administered that resulted in this condition.
Inability to Attain Appropriate Medical Management
The condition meets the criteria for inability to attain appropriate medical management. There was more than six years between symptom stabilization in November 2012 and first medical presentation in March 2019. This lengthy time period considering the natural history of sprain injuries is indicative of barriers to healthcare access, satisfying the inability to attain appropriate medical management factor as established in the Full Federal Court decision in Brew v Repatriation Commission (14 July 1990). The lack of medical presentations during this extended period indicates both objective and subjective inability to access appropriate care, which has resulted in permanent worsening of the condition through development of secondary complications including ganglion cysts and progressive functional limitation.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
