Left Wrist - ECU Sprain — DVA claim example (Diagnostic Assessment)

Example document — fictitious patient. Every report published here is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious: names, dates of birth, service numbers, units, locations and treating clinicians have been withheld or altered and all dates changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment — Left Wrist - ECU Sprain

Example 1 of 1 · fictitious patient (Veteran N)

Example document — fictitious patient. This report is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious and bears no relationship to any real person, living or deceased. Names, dates of birth, contact details, service numbers, units, locations and treating clinicians have been withheld or altered and all dates have been changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment

Left Wrist - ECU Sprain

SOP Balance of Probabilities: Sprain and Strain No. 28 of 2020 SOP Reasonable Hypothesis: Sprain and Strain No. 29 of 2020

ADF History

The veteran, Chef, 09 January 2009, 27 Mar 2016.

Occupational History

Military chef duties involve repetitive wrist movements with ulnar deviation, rotational activities during food preparation, heavy lifting requiring ECU tendon activation for wrist stabilization, and sustained gripping activities. The extensor carpi ulnaris tendon is critical for wrist extension and ulnar deviation, particularly during lifting and twisting motions common in kitchen operations. Physical training activities including climbing, rope work, and equipment handling place additional stress on the ECU tendon complex through forceful wrist extension and stabilization requirements.

History

The veteran the veteran developed left wrist ECU tendon sprain during his military service as a Chef in the Australian Defence Force from February 2011 to Apr 2018. The condition developed concurrent with his TFCC sprain, representing the complex nature of wrist injuries involving multiple structures during occupational overuse.

Timeline

07 January 2019 - MRI both wrists revealed significant left wrist ECU tendon pathology adjacent to the TFCC injury. There was a small split tear of the adjacent ECU tendon best appreciated on the axial set of images with some fluid distension of the sheath indicating active tenosynovitis. The radiologist specifically noted tear of the TFCC with a small split tear and tenosynovitis of the adjacent ECU. The findings demonstrated that the ECU tendon had sustained structural damage with ongoing inflammatory changes, consistent with chronic occupational overuse. The combination of tendon tear and tenosynovitis indicated both acute injury and chronic inflammatory response from repetitive trauma.

Symptoms

The veteran developed insidious onset of left wrist pain during his military service, particularly affecting the ulnar aspect of the wrist. Current symptoms include pain along the ulnar border of the wrist that worsens with ECU tendon activation, pain with wrist extension and ulnar deviation, swelling and tenderness over the ECU tendon, and functional limitation with gripping and lifting activities. The symptoms are consistent with ECU tendon pathology and chronic tenosynovitis.

Imaging

07 January 2019 - MRI both wrists: Small split tear of the adjacent ECU tendon best appreciated on the axial set of images with some fluid distension of the sheath.

1. What is the formal diagnosis of the condition claimed above?

Left Wrist ECU Tendon Sprain (Split Tear with Tenosynovitis), DVA SOP: Sprain and Strain No. 28 of 2020, ICD-10: S66.2.

An ECU tendon sprain involves injury to the extensor carpi ulnaris tendon, which functions to extend and adduct the wrist. The ECU tendon passes through a fibro-osseous tunnel at the ulnar styloid and is subject to injury during forceful wrist movements, particularly with combined extension and ulnar deviation. Sprain injuries involve tearing or stretching of the tendon fibers, associated with the onset of pain and tenderness. Tenosynovitis represents inflammation of the tendon sheath, often occurring secondary to repetitive trauma or overuse. Split tears represent partial thickness injuries where some tendon fibers remain intact while others are disrupted.

The temporal relationship shows concurrent development with the TFCC sprain, representing the complex biomechanical relationship between wrist stabilizing structures during repetitive occupational trauma.

2. For each diagnosis identified, please also provide the following dates:

When did the veteran first experience symptoms attributable to this condition? Unknown specific date during military service 2013-2020. No specific documentation of symptom onset found in the provided records.

When did the veteran first present to a health / medical provider for this condition? 24 September 2018 during DVA assessment with Dr Thomas Perkins at Veterans Health Centre [Email - General & Service Details.pdf, page 1].

When was the condition confirmed / formally diagnosed? 07 January 2019 by Radiologist the treating doctor via MRI both wrists imaging [IMAGING.pdf, page 1].

When did the veteran first present to you (or your practice) for this condition? 15 July 2018.

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 by MRI imaging conducted by Radiologist the treating doctor on 07 January 2019. The imaging revealed a small split tear of the adjacent ECU tendon best appreciated on the axial set of images with some fluid distension of the sheath indicating tenosynovitis [IMAGING.pdf, page 1]. The radiologist specifically commented on the tear of the TFCC with small split tear and tenosynovitis of the adjacent ECU, demonstrating the concurrent nature of these related wrist injuries.

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.

Factor 9(2): forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon

MET. Military chef duties involved continuous forceful stretching and high intensity use of the ECU tendon through repetitive wrist extension and ulnar deviation during food preparation, heavy lifting with wrist stabilization requirements, and forceful gripping activities requiring ECU tendon activation.

Factor 9(4): forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon

MET. Ongoing military duties throughout his 7-year service continued to involve forceful stretching and high intensity use of the ECU tendon, contributing to progressive worsening and development of the split tear with tenosynovitis observed on imaging.

Sequelae

This condition is not a sequelae of another known condition but developed concurrently with the TFCC sprain as part of the complex wrist injury pattern from occupational overuse.

Unintended Consequence

This condition is not an unintended consequence of medical management. No procedures or medications were administered that contributed to the development of this condition.

Inability to Attain Appropriate Medical Management

There was an inability to attain appropriate medical management during military service. The condition was not diagnosed or treated during the veteran's 7-year military service despite ongoing occupational exposure to causative factors. Per the Full Federal Court in Brew v Repatriation Commission (07 July 1993), inability encompasses both objective and subjective lack of ability to obtain treatment. The absence of presentations for wrist pain during military service indicates barriers to healthcare, satisfying inability to attain appropriate medical management. This inability resulted in permanent worsening as the condition progressed from reversible tendon strain to irreversible structural damage including split tear with chronic tenosynovitis as demonstrated on MRI imaging.

The % contribution of the causes is 100% and significant.

5. Please provide a Health Summary and a medication / prescribing history. -see attached report

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