Right Hand Second Metacarpal - Ossified Hematoma — 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 — Right Hand Second Metacarpal - Ossified Hematoma

Example 1 of 1 · fictitious patient (Veteran C)

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

Right Hand Second Metacarpal - Ossified Hematoma

Balance of Probabilities: No specific SOP - applying factors from Sprain and Strain No. 28 of 2020 and Fracture No. 63 of 2024 Reasonable Hypothesis: No specific SOP - applying factors from Sprain and Strain No. 29 of 2020 and Fracture No. 64 of 2024

ADF History

The veteran, Date of Birth: [withheld] Communications and Information Systems Controller (CISCON), enlistment date 28 July 1986, discharge date 22 Mar 2003.

Occupational History

As a Communications and Information Systems Controller in the Royal Australian Air Force, the veteran was exposed to repetitive manual handling of communication equipment, prolonged computer use with repetitive hand and wrist movements, physical training activities including obstacle courses and combat training, deployment conditions requiring equipment setup and maintenance, and ergonomic stressors from field operations. The role involved significant risk of crush injuries during equipment handling and maintenance, manual handling of heavy technical equipment, and potential for workplace injuries involving moving machinery or equipment.

History

The veteran a Communications and Information Systems Controller in the RAAF, sustained an ossified hematoma of the right second metacarpal following a crush injury where his index finger was crushed between a cabinet at work during service-related activities. The injury resulted in cortical thickening from either an ossified subperiosteal hematoma or cortical remodeling from prior trauma.

Timeline

19 January 2016 - the veteran underwent MRI of the right hand which revealed marked cortical thickening involving the dorsal margin of the right second metacarpal at the level of the mid diaphysis measuring approximately 9 mm anteroposteriorly and extending over a craniocaudal length of approximately 25 mm. This was most likely due to the sequelae of prior trauma, possibly an ossified subperiosteal haematoma in the setting of prior direct trauma or cortical remodeling/prior callus formation secondary to a prior cortical fracture. The injury resulted from the index finger being crushed between a cabinet at work, causing pain and limited range of motion. The overlying second extensor tendon appeared intact with no current fracture or bone marrow edema identified.

Symptoms

At the time of injury, the veteran experienced immediate pain in the index finger following the crush injury between a cabinet at work. The acute symptoms included pain and limited range of motion in the affected finger.

Currently, the veteran experiences ongoing right index finger pain occurring 7 days per week for 14 hours daily. He reports limited range of motion and functional limitations with gripping tasks. The symptoms significantly impact his activities of daily living. The MRI showed no current fracture or bone marrow edema, indicating the condition represents the sequelae of the prior crush injury with ossified hematoma formation.

Imaging

19 January 2016 - MRI right hand: Marked cortical thickening involving the dorsal margin of the right second metacarpal at the level of the mid diaphysis measuring approximately 9 mm AP and extending over a craniocaudal length of approximately 25 mm. This is most likely due to the sequelae of prior trauma, possibly an ossified subperiosteal haematoma in the setting of prior direct trauma or cortical remodelling/prior callus formation secondary to a prior cortical fracture.

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

Right Hand Second Metacarpal Ossified Hematoma - No specific DVA SOP exists (applying factors from Sprain and Strain No. 28 of 2020 and Fracture No. 63 of 2024), ICD-10: M79.89

An ossified hematoma, also known as myositis ossificans or heterotopic ossification, is the formation of bone and cartilage within soft tissues following trauma. In the case of a subperiosteal hematoma, bleeding occurs between the bone surface and the periosteum (outer bone membrane) following direct trauma. Over time, this hematoma can undergo ossification, leading to new bone formation and cortical thickening. This process typically occurs after significant direct trauma such as crush injuries, blunt force impacts, or repetitive microtrauma. The condition represents the body's healing response where the hematoma becomes organized and eventually calcifies and ossifies. Clinically, it presents as a firm, sometimes painful mass with cortical thickening visible on imaging. The condition can cause functional limitation and ongoing discomfort depending on the location and extent of ossification.

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

When did the veteran first experience symptoms attributable to this condition? The veteran first experienced symptoms when his right index finger was crushed between a cabinet at work. The exact date is not specified but occurred prior to the MRI diagnosis in 2022. [IMAGING.pdf, Page 1; PTQ.pdf, Page 1]

When did the veteran first present to a health / medical provider for this condition? The first documented presentation for the ossified hematoma was on 19 January 2016 when he underwent MRI imaging of the right hand. The specific healthcare provider who ordered the MRI is not identified in the documentation. [IMAGING.pdf, Pages 4, 5]

When was the condition confirmed / formally diagnosed? The ossified hematoma was confirmed and formally diagnosed on 19 January 2016 via MRI imaging performed by the treating doctor, which demonstrated marked cortical thickening likely due to an ossified subperiosteal hematoma. [IMAGING.pdf, Pages 4, 5]

When did the veteran first present to you (or your practice) for this condition? 07 May 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 on 19 January 2016. Key symptoms included ongoing right index finger pain and limited range of motion following a crush injury between a cabinet at work. The investigation results showed marked cortical thickening involving the dorsal margin of the right second metacarpal measuring approximately 9 mm anteroposteriorly and extending over 25 mm in length, most likely representing an ossified subperiosteal hematoma from prior trauma. The patient reported persistent pain occurring 7 days per week for 14 hours daily with functional limitations. [IMAGING.pdf, Pages 4, 5; PTQ.pdf, Page 1]

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.

Factors from Sprain and Strain SOP:

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 the injury from a crush injury where his index finger was crushed between a cabinet at work, which constitutes significant physical force applied at the time of onset.

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

The crush injury mechanism involved forceful compression and potentially stretching of tissues at the time of clinical onset.

Factors from Fracture SOP:

having significant physical force applied to or through the affected bone at the time of clinical onset - MET

The crush injury involved significant physical force applied to the second metacarpal region at the time of onset, leading to the formation of the ossified hematoma.

inability to obtain appropriate clinical management for sprain or strain - NOT MET

There is no evidence of inability to obtain appropriate clinical management. The condition was diagnosed via MRI and symptoms are being managed.

inability to obtain appropriate clinical management for fracture before clinical worsening - NOT MET

There is no evidence of inability to obtain appropriate clinical management. The condition was diagnosed and is being managed appropriately.

Sequelae

The ossified hematoma is not a sequelae of another known condition but appears to be a primary result of the crush injury mechanism.

Unintended Consequence

The condition is not an unintended consequence of medical management. No procedures or medications are documented as causing this condition.

Inability to Attain Appropriate Medical Management

The condition does not demonstrate inability to attain appropriate medical management. The ossified hematoma was diagnosed via MRI imaging and the symptoms are being managed. The Full Federal Court in Brew v Repatriation Commission (19 July 1990) enlarges on the meaning of "inability" but in this case, appropriate clinical management was provided following diagnosis. The factor is NOT MET.

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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