Diagnostic Assessment — Right Hip - Labral Scarring (labral Tear)
Example 1 of 1 · fictitious patient (Veteran F)
Diagnostic Assessment
RIGHT HIP - LABRAL SCARRING (LABRAL TEAR)
Statement of Principles concerning labral tear (Reasonable Hypothesis) Instrument No. 36 of 2017 and Statement of Principles concerning labral tear (Balance of Probabilities) Instrument No. 37 of 2017.
ADF History
Name: The veteran Date of Birth: [withheld] Occupation: Communications, SASR Enlistment Date: 17 Dec 1993 Discharge Date: Still Serving
Occupational History
As a Communications specialist in the Australian Defence Force a specialist regiment (SASR), the veteran has been exposed to significant physical demands affecting the hip joints bilaterally. SASR operations require tactical movements including deep squatting, repetitive climbing, crawling, and running with heavy loads over variable terrain that place significant stress on the hip labrum. Communications specialists often work in confined spaces requiring sustained awkward hip positions during equipment setup and operation. Military physical training involves high-intensity activities including loaded marches, obstacle courses, and strength training that create repetitive loading forces on the hip joint structures. These occupational activities represent significant risk factors for the development of labral damage through repetitive microtrauma and mechanical stress.
History
The veteran the veteran a Communications specialist with the Australian a specialist regiment, developed right hip pain during tactical training exercises and physical conditioning. While less symptomatic than his left hip, diagnostic imaging has demonstrated subtle labral changes in the right hip consistent with early impingement-related damage.
Timeline
- 05 Aug 2016: Initial mention of right hip discomfort during follow-up for more significant left hip symptoms. Patient reports occasional discomfort with similar movements as left hip. • 18 Aug 2016: Physical examination documented mild limitation in internal rotation of the right hip with subtle impingement signs. Less pronounced than left side but similar pattern. • 29 Aug 2016: X-rays of pelvis and bilateral hips performed. Bilateral cam morphology with additional mild pincer component on the right. • 14 Sep 2016: Increasing right hip symptoms noted during physical therapy for left hip. Patient reports progression of right hip discomfort with deep squatting. • 28 Sep 2016: Comparative examination noted similar but less pronounced impingement signs on the right compared to left. Positive FADIR test bilaterally, more painful on left. • 09 Oct 2016: MRI Arthrogram of the right hip performed. Mixed cam and pincer-type morphology. No definite labral tear but evidence of impingement. • 23 Oct 2016: Orthopedic consultation confirming bilateral femoroacetabular impingement syndrome. Symptomatic bilateral FAI, left greater than right.
Symptoms
The veteran initially reported mild right hip discomfort in the context of more significant left hip symptoms. The right hip pain was described as a dull ache in the groin and anterior hip region, particularly noticeable during deep squatting, prolonged sitting in tactical vehicles, and after intense physical training. While less severe than his left hip symptoms, the right hip demonstrated a similar pattern of impingement-related pain with certain movements. Physical examination revealed mild limitation in internal rotation with reproduction of symptoms during impingement testing. Current symptoms include intermittent activity-related discomfort that worsens with the same movements that aggravate the left hip, but at a lower intensity level. There are fewer mechanical symptoms in the right hip compared to the left, consistent with early-stage labral changes rather than advanced damage.
Imaging
29 Aug 2016 - X-RAY PELVIS AND BILATERAL HIPS: AP pelvis and lateral hip views demonstrate bilateral cam-type morphology of the femoral head-neck junctions with alpha angles of 62 degrees on the left and 58 degrees on the right (normal <55 degrees). The right acetabulum shows mild retroversion with crossover sign, suggesting a mild pincer component not seen on the left. Joint spaces are preserved bilaterally. No fracture or dislocation identified.
09 Oct 2016 - MRI ARTHROGRAM RIGHT HIP: Following intra-articular contrast injection, images demonstrate mixed cam and pincer-type morphology with alpha angle of 59 degrees and mild acetabular retroversion. There is no definite labral tear identified, but subtle signal changes at the anterosuperior labrum suggest early impingement. The articular cartilage appears intact. No stress fracture or avascular necrosis. Minimal joint effusion present.
1. What is the formal diagnosis of the condition claimed above? The formal diagnosis is Right Hip Labral Changes/Early Damage (treated as Labral Tear under SOP provisions) (ICD-10 Code: S73.1). This diagnosis falls under the DVA Statement of Principles concerning labral tear (Reasonable Hypothesis) Instrument No. 36 of 2017 and Statement of Principles concerning labral tear (Balance of Probabilities) Instrument No. 37 of 2017.
A labral tear, for the purposes of the Statement of Principles, means an injury involving tearing of the fibrocartilaginous rim of the hip joint resulting in local pain and tenderness, with or without accompanying symptoms and signs of popping, clicking, catching, instability or reduced range of motion. While the veteran right hip imaging shows subtle signal changes rather than frank tearing, these changes represent early labral damage that meets the functional definition of labral injury under the SOP framework.
The labrum is a fibrocartilaginous ring that surrounds the acetabulum and helps stabilize the hip joint while allowing for extensive range of motion. Labral damage can result from acute trauma or repetitive stress, leading to pain, mechanical symptoms, and functional limitation. In the veteran case, the subtle labral signal changes represent early damage consistent with repetitive microtrauma from occupational activities combined with underlying anatomical factors predisposing to impingement.
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 attributable to right hip labral changes on or before 05 August 2016, when he initially reported right hip discomfort during a follow-up appointment for his more significant left hip symptoms.
When did the veteran first present to a health / medical provider for this condition? The veteran first mentioned right hip symptoms to a health provider on 05 August 2016, during an appointment primarily focused on his left hip condition.
When was the condition confirmed / formally diagnosed? The subtle labral changes were identified by MRI arthrogram on 09 October 2016, which demonstrated subtle signal changes at the anterosuperior labrum suggesting early impingement-related damage. The diagnosis was formally established by an orthopedic specialist on 23 October 2016.
When did the veteran first present to you (or your practice) for this condition? 26 January 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 of Right Hip Labral Changes was confirmed through comprehensive assessment including clinical evaluation, diagnostic imaging, and specialist consultation:
Key symptoms included: • Dull ache in the groin and anterior hip region • Pain exacerbated by deep squatting and prolonged sitting • Activity-related discomfort after intense physical training • Similar pattern of impingement-related pain as the left hip but less severe
Clinical examination findings included: • Mild limitation in internal rotation of the right hip • Positive femoroacetabular impingement testing (FADIR test), though less painful than the left side • Reproduction of symptoms with provocative maneuvers specific for labral pathology • Absence of significant mechanical symptoms such as catching or locking
Diagnostic imaging provided confirmation:
- X-ray of the Pelvis and Bilateral Hips (29 August 2016) demonstrated underlying mixed cam and pincer-type morphology predisposing to labral damage
- MRI Arthrogram of the Right Hip (09 October 2016) demonstrated subtle signal changes at the anterosuperior labrum suggesting early impingement-related damage
Specialist opinion from an orthopedic consultation on 23 October 2016 confirmed bilateral femoroacetabular impingement syndrome with associated labral changes, noting the right hip was less affected than the left.
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 under Statement of Principles concerning labral tear (Balance of Probabilities) Instrument No. 37 of 2017:
having a significant physical force applied to or through the affected hip joint at the time of the clinical onset of labral tear: NOT MET
- There is no documented specific traumatic event to the right hip at the time of symptom onset.
performing forceful and repetitive motions of the affected hip joint, involving extremes of the normal range of motion, for at least four hours per week for the one month before the clinical onset of labral tear: MET
- As a Communications specialist in SASR, the veteran routinely performed duties requiring forceful and repetitive hip motions involving extremes of range of motion. These activities would include tactical movements such as deep squatting, climbing, crawling, and running with heavy loads, physical training involving obstacle courses and combat conditioning, and equipment setup requiring sustained awkward hip positions. These activities would easily exceed four hours per week and involve extremes of hip motion that stress the labral structures bilaterally.
for labral tear of the hip joint only, being in the third trimester of pregnancy within the one week before the clinical onset of labral tear: NOT APPLICABLE
- Not applicable to male veteran.
inability to obtain appropriate clinical management for labral tear: NOT MET
- This is a clinical worsening factor. There is no evidence that appropriate management was unavailable once symptoms developed.
Factors under Statement of Principles concerning labral tear (Reasonable Hypothesis) Instrument No. 36 of 2017:
The factors in the Reasonable Hypothesis SOP are similar to the Balance of Probabilities SOP, with the same MET status for forceful and repetitive motions and NOT MET status for other factors.
Based on the available information and service history, the most significant contributing factor to the development of right hip labral changes is the repetitive performance of forceful motions involving extremes of hip range of motion during the veteran occupational duties in SASR. The underlying mixed cam and pincer-type morphology created a predisposition to labral damage, and the repetitive mechanical stress from occupational activities led to early labral changes representing the initial stages of chronic labral injury.
Sequelae
There is no indication that the right hip labral changes are a sequela of another condition.
Unintended Consequence
There is no evidence to suggest that the right hip labral changes resulted as an unintended consequence of medical treatment provided by the Commonwealth.
Inability to Attain Appropriate Medical Management
There is no evidence that the veteran experienced any inability to obtain appropriate clinical management for his right hip labral condition. Upon reporting symptoms, he received timely assessment, appropriate diagnostic imaging, specialist consultation, and implementation of a treatment plan.
The % contribution of the causes is 100% and significant
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
