Diagnostic Assessment — Left Wrist - Scapholunate Ligament Degeneration
Example 1 of 1 · fictitious patient (Veteran I)
Diagnostic Assessment
Left Wrist - Scapholunate Ligament Degeneration
SOP Codes for Balance of Probabilities: Osteoarthritis (No. 62 of 2017); Sprain and Strain (No. 27 & 28 of 2017) SOP Codes for Reasonable Hypothesis: Osteoarthritis (No. 61 of 2017); Sprain and Strain (No. 25 & 26 of 2017)
ADF History
The veteran, Aircraft Technician (ATECH/AMECH), enlisted approximately June 1986, discharge date not explicitly documented with service continuing to at least 2021.
Occupational History
As an Aircraft Technician in the RAAF, the veteran was exposed to repetitive manual tasks involving forceful gripping, tool manipulation, and sustained hand/wrist positioning during aircraft maintenance. His role required extensive use of hand tools including wrenches, screwdrivers, and specialized maintenance equipment, involving repetitive wrist flexion, extension, and rotational movements while working in confined aircraft spaces.
History
The veteran an Aircraft Technician in the RAAF, developed chronic left wrist scapholunate ligament degeneration through repetitive occupational activities involving tool use and forceful gripping over decades of aircraft maintenance service.
Timeline
- 07 November 2018: The veteran underwent MRI of the left wrist due to chronic pain, revealing mild degeneration with partial tear of the dorsal and volar components of the scapholunate ligament. The imaging showed a 0.4 cm volar scapholunate interval widening ganglion cyst, with mild intercarpal chondral softening involving the lunate and hamate with mild subchondral marrow edema. Additional findings included mild extensor carpi ulnaris tendinosis with intrasubstance split at the ulnar styloid process. The degenerative changes were consistent with chronic repetitive stress from his occupational activities as an Aircraft Technician, involving decades of forceful gripping and tool manipulation during aircraft maintenance tasks.
Symptoms
The veteran presented with chronic left wrist pain at the time of imaging. The pain was associated with the degenerative changes identified on MRI, consistent with chronic mechanical stress from repetitive occupational activities. Current symptoms include ongoing left wrist discomfort related to the scapholunate ligament degeneration and associated osteoarthritic changes.
Imaging
07 November 2018: Mild degeneration with partial tear of dorsal and volar components of scapholunate ligament and 0.4 cm volar scapholunate interval widening ganglion cyst. Mild intercarpal chondral softening and chondral thinning, involving lunate and hamate with mild subchondral marrow edema. Mild extensor carpi ulnaris tendinosis with intrasubstance split noted at the level of the ulnar styloid process extending distally.
1. What is the formal diagnosis of the condition claimed above?
Scapholunate Ligament Degeneration with Osteoarthritis of the Left Wrist
- DVA SOP: Osteoarthritis (No. 62 of 2017 - BOP; No. 61 of 2017 - RH)
- ICD-10 Code: M19.03 (Osteoarthritis of wrist), S63.51 (Sprain of carpal joint)
Scapholunate ligament degeneration is a condition involving deterioration of the ligamentous structures that provide stability between the scaphoid and lunate bones in the wrist. This degenerative process often leads to carpal instability and secondary osteoarthritic changes. The scapholunate ligament is crucial for normal wrist kinematics, and its degeneration can result from repetitive stress, trauma, or chronic overuse. The associated osteoarthritis represents secondary joint degeneration due to altered biomechanics following ligament deterioration.
The temporal relationship shows chronic degenerative changes that developed over years of repetitive occupational stress, with formal diagnosis confirmed on imaging in 2023.
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 symptoms noted by 07 November 2018. [IMAGING.pdf, Page 15]
When did the veteran first present to a health / medical provider for this condition? 07 November 2018 to Dr Thomas Perkins at Veterans Health Centre for MRI investigation. [IMAGING.pdf, Page 15]
When was the condition confirmed / formally diagnosed? 07 November 2018 via MRI by the treating doctor, I-Telerad Radiologist. [IMAGING.pdf, Page 15]
When did the veteran first present to you (or your practice) for this condition? 10 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 of the left wrist on 07 November 2018, which demonstrated mild degeneration with partial tear of the scapholunate ligament, chondral softening and thinning involving the lunate and hamate, and extensor carpi ulnaris tendinosis. The key symptoms were chronic left wrist pain. The MRI provided definitive evidence of ligamentous degeneration and secondary osteoarthritic changes. [IMAGING.pdf, Page 15]
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.
For osteoarthritis of a joint of the upper limb only, performing forceful or repetitive activities involving the affected joint or tasks involving repeated or sustained pinch grip or hand/power grip 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
- The veteran worked as an Aircraft Technician for over 30 years, performing repetitive activities involving forceful gripping of tools including wrenches, screwdrivers, and maintenance equipment. His role required sustained hand/power grip activities for aircraft maintenance well exceeding 100 hours per month for cumulative periods exceeding ten years within continuous 15-year periods, all within 25 years before clinical onset.
Inability to obtain appropriate clinical management for osteoarthritis - MET
- There is no documented prior presentation for left wrist pain or investigation until the 2023 MRI, indicating a lengthy period without appropriate clinical assessment for this degenerative condition. As established in Brew v Repatriation Commission (06 May 1993), the inability to obtain treatment can occur through various means including lack of recognition of symptoms or barriers to accessing care. The absence of earlier presentations for wrist pain despite the chronic degenerative changes suggests inability to attain appropriate medical management, causing permanent worsening of the condition.
Sequelae
This condition is not a sequelae of another known condition but represents primary occupational-related degeneration.
Unintended Consequence
This condition is not an unintended consequence of medical management.
Inability to Attain Appropriate Medical Management
As per Brew v Repatriation Commission (06 May 1993), the inability to obtain appropriate clinical management can manifest in both objective and subjective ways. The absence of documented presentations for left wrist pain prior to 2023 despite chronic degenerative changes visible on MRI indicates barriers to healthcare access or recognition. This lengthy period without appropriate investigation and management has resulted in permanent worsening of the degenerative condition, with progression to include chondral loss and secondary osteoarthritic changes that may have been preventable with earlier intervention.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
