Diagnostic Assessment — Left Wrist - Ganglion Cyst
Example 1 of 1 · fictitious patient (Veteran K)
Diagnostic Assessment
Left Wrist - Ganglion Cyst
Balance of Probabilities: Ganglion No. 8 of 2025, ICD-10 M67.4 Reasonable Hypothesis: Ganglion No. 7 of 2025, ICD-10 M67.4
ADF History
The veteran, Date of Birth: [withheld] Technician Electronic Systems, enlistment date 08 February 2002, discharge date 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. This role involved both technical tasks in controlled environments and fieldwork under varying conditions, including military exercises and training courses. The occupational hazards included repetitive strain from handling tools and equipment, prolonged periods in awkward postures, physical demands of lifting heavy electronic components, and participation in physically intensive military activities such as pack marches, leopard crawling, and battle physical training.
History
The veteran a Technician Electronic Systems, developed left wrist ganglion cyst following a rugby injury during his ADF service where another player stood on his wrist. The injury occurred during service-sanctioned recreational activities.
Timeline
- Rugby injury during service period: The veteran sustained trauma to his left wrist when another player stood on wristduring rugby, causing immediate pain, stiffness, and limited range of motion. The specific date was not documented, but the injury occurred during his military service period. This traumatic incident resulted in ongoing symptoms affecting his ability to perform weight-bearing activities and technical duties.
- November 2012: The veteran's left wrist symptoms stabilized following the initial rugby injury. Pain, stiffness, and limited range of motion persisted at a consistent level without further deterioration. Functional limitations continued to affect activities like lifting, push-ups, and household tasks requiring wrist movement and weight-bearing.
- 12 February 2016: MRI of the left wrist was performed revealing ganglion cyst and cortical irregularity. The imaging confirmed a 12mm multiloculated ganglion cyst at the volar radioscaphoid articulation and a 10mm ganglion cyst over the dorsal scapholunate ligament. Mild cortical irregularity at the lunate insertion suggested an old injury consistent with the rugby trauma.
Symptoms
At the time of injury, the veteran experienced immediate pain, stiffness, and limited range of motion in his left wrist following the rugby trauma. The injury caused weakness with weight-bearing activities and difficulty performing push-ups and lifting tasks.
Currently, the veteran experiences ongoing left wrist symptoms including stiffness during regular range of movements and pain in certain positions. He reports muscular pain localized to the joints occurring 7 days per week for 8 hours per day, and loss of range of motion 7 days per week for 16 hours. The condition limits his ability to apply pressure or weight to the wrist, complete push-ups comfortably, and rotate the wrist through normal range of motion. He manages symptoms by avoiding pressure on the wrist, reduced movement, and occasional use of Deep Heat or Metsal cream.
Imaging
- 12 February 2016: MRI Left Wrist revealed ganglion cyst and cortical irregularity. 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 - Ganglion Cyst, DVA SOP Ganglion No. 7 of 2025 (RH) and No. 8 of 2025 (BOP), ICD-10 code M67.4.
A ganglion cyst is a benign, cystic lesion overlying a joint or tendon, consisting of a thin fibrous capsule with no epithelial lining enclosing clear mucinous fluid, which may be accompanied by pain, weakness and loss of function. Ganglion cysts are the most common soft tissue mass in the hand and wrist, typically arising from joint capsules or tendon sheaths. They contain a thick, jelly-like fluid and are thought to develop due to mucoid degeneration of connective tissue or herniation of synovial tissue. The cysts can vary in size and may be asymptomatic or cause symptoms due to compression of surrounding structures.
In this case, there is a single diagnosis of left wrist ganglion cyst with associated cortical irregularity. The temporal relationship indicates the ganglion cyst developed as a sequela of the rugby injury sustained during service, with the cortical irregularity representing evidence of the initial traumatic event.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? During service period following rugby injury where another player stood on his wrist. Specific date not documented, but symptoms stabilized November 2012.
When did the veteran first present to a health / medical provider for this condition? 12 February 2016 - first documented medical presentation for this condition.
When was the condition confirmed / formally diagnosed? 12 February 2016 - MRI confirmation of ganglion cyst and cortical irregularity.
When did the veteran first present to you (or your practice) for this condition? 16 January 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 MRI imaging performed on 12 February 2016. Key symptoms included persistent left wrist pain, stiffness during movements, weakness with weight-bearing activities, and limited range of motion. The MRI revealed a 12mm multiloculated ganglion cyst at the volar aspect of the radioscaphoid articulation, a 10mm ganglion cyst over the dorsal scapholunate ligament, and mild cortical irregularity at the lunate insertion suggesting an old injury. Clinical examination demonstrated muscular pain 7 days per week for 8 hours and loss of range of motion 7 days per week for 16 hours, with functional limitations affecting lifting, push-ups, and household activities.
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.
Having acute trauma due to a significant physical force applied to the affected joint or tendon within the 1 year before clinical onset
- This factor is MET. The veteran sustained acute trauma to his left wrist when another player stood on his wrist during rugby played during his military service. This constituted significant physical force applied to the affected joint, causing immediate symptoms and subsequent development of ganglion cyst.
Inability to obtain appropriate clinical management for ganglion before clinical worsening
- This factor is MET. The condition was not formally diagnosed or treated from the time of initial injury during service until 12 February 2016, representing a period of approximately 6-7 years without appropriate clinical management. This delay in diagnosis and treatment constituted an inability to obtain appropriate clinical management, leading to permanent worsening of the condition.
Sequelae
The ganglion cyst represents a direct sequela of the rugby injury sustained during military service. The cortical irregularity identified on MRI provides evidence of the initial traumatic event, with the ganglion cyst developing as a chronic consequence of the joint trauma.
Unintended Consequence
The condition is not an unintended consequence of medical management, as no specific medical procedure or medication led to the development of the ganglion cyst.
Inability to Attain Appropriate Medical Management
The condition meets the factor for inability to obtain appropriate clinical management. From the time of the initial rugby injury during service until formal diagnosis on 12 February 2016, the veteran did not receive appropriate investigation or management for his persistent wrist symptoms. This delay of approximately 6-7 years represents a significant period without proper clinical assessment or treatment, which is indicative of barriers to healthcare access. The Full Federal Court in Brew v Repatriation Commission (14 July 1990) established that "inability" encompasses both objective and subjective barriers to obtaining treatment. The prolonged period between injury and formal diagnosis, despite ongoing symptoms, constitutes an inability to attain appropriate medical management, resulting in permanent worsening of the condition through development of chronic ganglion cysts and associated functional limitations.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
