Diagnostic Assessment — Right Elbow - Common Flexor Origin Tendinosis
Example 1 of 1 · fictitious patient (Veteran P)
Diagnostic Assessment
Right Elbow - Common Flexor Origin Tendinosis
SOP Codes for Balance of Probabilities: Epicondylitis No. 6 of 2023 SOP Codes for Reasonable Hypothesis: Epicondylitis No. 7 of 2023
ADF History
Name: The veteran, Date of Birth: [withheld] Occupation: Warehouse Operator, Enlistment date: 15/08/2012, Discharge date: 16/06/2015.
Occupational History
As a Warehouse Operator in the Australian Army, the veteran was exposed to repetitive lifting and carrying activities, forceful gripping and manual handling tasks, sustained flexion activities of the wrist and fingers, and repetitive forearm motions required for warehouse operations and military duties.
History
The veteran a Warehouse Operator with the Australian Army, developed common flexor origin tendinosis secondary to his right elbow avulsion fracture injury sustained on 08 July 2011, with the tendinosis condition developing during his military service through repetitive occupational activities involving the flexor muscles of the forearm.
Timeline
- 08 Jul 2011 - Initial traumatic injury to right elbow creating structural damage and altered biomechanics that predisposed to development of secondary tendinosis conditions. The injury affected the overall elbow mechanics and loading patterns of both extensor and flexor muscle groups.
- 13 Jan 2013 - Physiotherapy assessment documented "persistant weakness and dull ache following use" with functional limitations affecting grip and manual activities. The assessment noted "mod thickening noted pronator teres/bicepsaponeurosis" suggesting involvement of flexor muscle groups in the chronic pain pattern.
- 20 Dec 2021 - MRI right elbow demonstrated evidence of "CFO exhibits at least mild tendinosis of the origin". The imaging confirmed structural changes to the common flexor origin tendons with "Mild CFO origin tendinosis"representing chronic degenerative changes secondary to altered loading patterns following the original trauma.
Symptoms
Following the 2013 injury, the veteran developed progressive medial elbow symptoms including pain with gripping activities, weakness with wrist flexion movements, and functional difficulties with activities requiring flexor muscle activation.
Currently, the veteran experiences medial elbow pain and discomfort, particularly with gripping and lifting activities, weakness in forearm flexor muscles, and ongoing functional limitations affecting manual tasks and daily activities.
Imaging
20 Dec 2021 - CFO exhibits at least mild tendinosis of the origin. Mild CFO origin tendinosis.
1. What is the formal diagnosis of the condition claimed above?
Common Flexor Origin Tendinosis - DVA SOP Code: Epicondylitis No. 6 of 2023, ICD-10 Code: M77.1
Common flexor origin tendinosis, also known as medial epicondylitis or golfer's elbow, is a degenerative condition affecting the tendons that attach to the medial epicondyle of the elbow. Tendinosis involves chronic degenerative changes in the tendon tissue including collagen breakdown, mucoid degeneration, and failed healing responses without significant inflammatory components. The condition typically presents with medial elbow pain that worsens with gripping activities and wrist flexion.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? Progressive development from August 2012 following initial injury [CHART REVIEW.docx pages 67-70]
When did the veteran first present to a health / medical provider for this condition? 13 January 2013 to physiotherapy services at the treating doctor Health Centre [CHART REVIEW.docx page 70]
When was the condition confirmed / formally diagnosed? 20 December 2021 by MRI imaging and radiologist the treating doctor [IMAGING - OCR.pdf page 6]
When did the veteran first present to you (or your practice) for this condition? 14 January 2021
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 on 20 December 2021 which demonstrated characteristic changes of tendinosis affecting the common flexor origin with mild degenerative changes documented [IMAGING - OCR.pdf page 6]. Clinical assessment documented persistent weakness and functional limitations consistent with flexor tendon involvement [CHART REVIEW.docx page 70].
Key symptoms included medial elbow pain, weakness with gripping, and pain with wrist flexion activities. Clinical signs showed tenderness over the medial epicondyle region and functional limitations with flexor muscle activation.
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.
Performing forceful activities with the hand or forearm on the affected side, in combination with repetitive or sustained activities for at least 1 hour per day, on more days than not, over a period of at least 3 months before clinical onset - MET
- Military warehouse operations involved daily repetitive gripping, lifting, carrying, and manual handling activities that engaged the flexor muscle groups. These activities were performed regularly throughout his service period, contributing to the development of tendinosis through cumulative loading of the flexor tendons.
Having spondyloarthritis at the time of clinical onset - NOT MET
- No evidence of spondyloarthritis in the medical records.
Taking a fluoroquinolone antibiotic within 14 days before clinical onset - NOT MET
- No evidence of fluoroquinolone antibiotic use documented in the medical records.
Using a hand-held computer mouse for at least 20 hours per week - NOT MET
- No evidence of significant computer mouse use during military service.
Inability to obtain appropriate clinical management for epicondylitis - MET
- There was significant delay between symptom development and definitive diagnosis and treatment. The flexor tendinosis was not properly identified and managed during service, as established by the precedent in Brew v Repatriation Commission. The lengthy period without appropriate specialist assessment and targeted treatment constitutes inability to obtain appropriate clinical management, resulting in permanent worsening.
Unintended Consequence
The condition does not represent an unintended consequence of medical management but rather a natural progression from the original traumatic injury and altered biomechanics.
Inability to Attain Appropriate Medical Management
There was clear inability to attain appropriate medical management as established in Brew v Repatriation Commission. The developing tendinosis was not properly recognized, investigated, or treated during service despite ongoing symptoms affecting both sides of the elbow. The prolonged period between symptom development and definitive diagnosis, lack of specialist referral, and conservative management without appropriate investigation constitutes barriers to healthcare. This inability resulted in permanent worsening with ongoing functional limitations and chronic pain.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
