Diagnostic Assessment — Right Hip - Labral Tear with Tendinosis and Greater Trochanteric Bursitis
Example 1 of 1 · fictitious patient (Veteran I)
Diagnostic Assessment
Right Hip - Labral Tear with Tendinosis and Greater Trochanteric Bursitis
SOP Balance of Probabilities: Labral Tear No. 37 of 2017, Gluteal Tendinopathy No. 95 of 2023 SOP Reasonable Hypothesis: Labral Tear No. 38 of 2017, Gluteal Tendinopathy No. 96 of 2023
ADF History
The veteran, Date of Birth: [withheld] Aircraft Technician (ATECH/AMECH), enlistment date approximately June 1986, discharge date ongoing service indicated to at least 2021.
Occupational History
As an Aircraft Technician in the Royal Australian Air Force, the veteran the veteran was exposed to significant occupational hazards including prolonged standing, squatting, climbing aircraft, repetitive bending and awkward postures while accessing aircraft components, heavy lifting of aircraft parts and equipment, working in confined spaces, and exposure to chemicals, fuels and solvents. The role required sustained physical exertion and repetitive hip movements during maintenance tasks in high-risk environments such as flight lines and engine bays.
History
The veteran an Aircraft Technician in the RAAF, developed bilateral hip conditions due to the cumulative physical demands of his military service involving prolonged standing, squatting, and climbing during aircraft maintenance activities. The conditions were formally diagnosed on 09 November 2018 via MRI imaging, though the onset was likely chronic and developed over years of occupational stress.
Timeline
- 09 November 2018 - the veteran underwent MRI scan of the right hip due to chronic pain, revealing anterosuperior labral tear with mild degeneration, mild gluteus medius and minimus insertional tendinosis, and mild greater trochanteric bursitis with bursal fluid. The findings showed a suspicious femoral head-neck junction osseous bump with small intraosseous cystic changes suggesting possible femoroacetabular impingement. No acute trauma was reported, but the conditions likely developed over years of service involving prolonged standing, squatting, and climbing to access aircraft components during maintenance tasks. The pain was likely exacerbated by the repetitive physical demands of his role as an Aircraft Technician, including accessing confined aircraft spaces and sustained physical exertion in maintenance environments.
Symptoms
The veteran experiences chronic right hip pain that developed insidiously over time due to the repetitive occupational demands of aircraft maintenance. The pain is likely aggravated by prolonged standing, squatting, and hip flexion movements required during his work as an Aircraft Technician. Current symptoms based on the imaging findings would include lateral hip pain and tenderness in the region of the greater trochanter, with pain potentially radiating to the buttock region. The labral tear may cause symptoms of catching, clicking, or instability with certain hip movements, particularly during activities requiring hip flexion and rotation.
Imaging
09 November 2018 - MRI RIGHT HIP revealed anterosuperior labral tear with mild degeneration and attenuation. Mild right gluteus medius and minimus insertional tendinosis with mild greater trochanteric bursitis. Suspicious femoral head-neck junction osseous bump with small intraosseous cystic changes at femoral head-neck junction. Clinical co-relation for femoroacetabular impingement requested. No femoral head avascular necrosis.
1. What is the formal diagnosis of the condition claimed above?
Right Hip Labral Tear - DVA SOP Labral Tear No. 37 of 2017 (BOP) and No. 38 of 2017 (RH), ICD-10 M24.15. A labral tear is an injury involving tearing of the fibrocartilaginous rim of the hip joint, resulting in local pain and tenderness, with or without accompanying symptoms of popping, clicking, catching, instability or reduced range of motion. The labrum is a ring of cartilage that surrounds the hip socket, providing stability and helping to distribute forces across the joint.
Right Hip Gluteal Tendinopathy with Greater Trochanteric Bursitis - DVA SOP Gluteal Tendinopathy No. 95 of 2023 (BOP) and No. 96 of 2023 (RH), ICD-10 M70.2 (tendinosis) and M70.6 (bursitis). Gluteal tendinopathy is a symptomatic inflammatory or degenerative disease of the gluteus medius or gluteus minimus tendons at or near their insertion into the greater trochanter of the hip. Greater trochanteric bursitis involves inflammation of the bursa overlying the greater trochanter, often associated with gluteal tendinopathy.
The temporal relationship indicates these are related conditions, with the gluteal tendinopathy likely contributing to altered biomechanics and subsequent development of greater trochanteric bursitis. The labral tear may be a separate but concurrent condition related to similar occupational stressors involving repetitive hip movements and loading.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The conditions developed with chronic onset over years of occupational stress, with formal identification on 09 November 2018 [IMAGING.pdf, Pages 10, 19].
When did the veteran first present to a health / medical provider for this condition? The veteran first presented for imaging assessment on 09 November 2018 to I-MED Regional the base city for evaluation of hip pain [IMAGING.pdf, Pages 10, 19].
When was the condition confirmed / formally diagnosed? The conditions were confirmed and formally diagnosed on 09 November 2018 via MRI imaging by the treating doctor, I-Telerad Radiologist [IMAGING.pdf, Pages 10, 19].
When did the veteran first present to you (or your practice) for this condition? 10 Apr 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 through MRI imaging of the right hip performed on 09 November 2018. Key findings included anterosuperior labral tear with mild degeneration and attenuation, mild gluteus medius and minimus insertional tendinosis with mild greater trochanteric bursitis, and a suspicious femoral head-neck junction osseous bump suggesting possible femoroacetabular impingement. The radiological interpretation was provided by the treating doctor, I-Telerad Radiologist, with clinical correlation recommended for femoroacetabular impingement [IMAGING.pdf, Pages 10, 19].
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 Labral Tear - BOP Factors:
Having a significant physical force applied to or through the affected hip joint at the time of clinical onset - NOT MET
- No documented acute trauma or significant physical force incident to the right hip joint.
Performing forceful and repetitive motions of the affected hip joint, involving extremes of normal range of motion, for at least four hours per week for one month before clinical onset - MET
- As an Aircraft Technician, the veteran performed repetitive hip movements including prolonged squatting, climbing aircraft, and accessing confined spaces requiring hip flexion and rotation for well over four hours per week throughout his military career spanning over 30 years.
Inability to obtain appropriate clinical management for labral tear - MET
- There is no evidence of prior presentation or management for hip pathology until the formal diagnosis in 2023, representing a significant delay in diagnosis and appropriate clinical management for a condition that likely developed over years of occupational stress.
For Gluteal Tendinopathy - BOP Factors:
Running or jogging an average of at least 60 kilometres per week for 4 weeks before clinical onset - NOT MET
- No evidence of this level of running activity documented.
Undertaking weight bearing exercise involving repeated activity of the hip for minimum intensity of 5 METS, for at least 6 hours per week, for at least 4 weeks before clinical onset - MET
- Aircraft maintenance work involves sustained weight bearing activity including climbing, prolonged standing, and accessing aircraft components, exceeding 5 METS intensity for well over 6 hours per week throughout his career.
Increasing frequency, duration or intensity of hip activity by at least 100 percent to minimum intensity of 5 METS for at least 4 hours per day within one week before clinical onset - NOT MET
- No documented acute increase in activity immediately before onset.
Having direct trauma to the affected tendon within 4 weeks before clinical onset - NOT MET
- No documented direct trauma to the gluteal tendons.
Having surgery to the hip within 4 weeks before clinical onset - NOT MET
- No hip surgery documented.
Having a systemic inflammatory disease before clinical onset - NOT MET
- No systemic inflammatory diseases documented.
Having significantly abnormal gait for at least 4 weeks before clinical onset - NOT MET
- No abnormal gait documented, though this may have developed secondary to the hip pathology.
Being obese at time of clinical onset - NOT MET
- No BMI ≥30 documented; highest recorded BMI was approximately 25.8.
Inability to obtain appropriate clinical management before clinical worsening - MET
- No evidence of prior presentation or management for gluteal tendinopathy until formal diagnosis in 2023, representing inability to obtain appropriate clinical management.
Sequelae
The gluteal tendinopathy and greater trochanteric bursitis may be sequelae of altered hip biomechanics due to the labral tear, or conversely, the labral tear may have developed secondary to altered mechanics from the gluteal pathology. These conditions are interrelated and likely developed concurrently due to the same occupational stressors.
Unintended Consequence
There is no evidence that these conditions resulted from medical treatment or procedures. The conditions appear to be primary occupational injuries rather than unintended consequences of medical management.
Inability to Attain Appropriate Medical Management
This factor is MET for both conditions. There is no documented presentation for hip pain or pathology prior to the 2023 imaging study, despite these being chronic degenerative conditions that likely developed over years. The Full Federal Court in Brew v Repatriation Commission (06 May 1993) enlarges on the meaning of "inability" as the lack of ability to get treatment in both objective and subjective sense, including psychological or emotional incapacity that could prevent seeking treatment, or threat of sanctions that would make veterans not seek required treatment.
The absence of any presentations for hip pain over decades of service, despite the development of significant structural pathology, is 100% indicative of barriers to healthcare, satisfying the inability to attain appropriate medical management factor. This inability has caused permanent worsening of both the labral tear and gluteal tendinopathy conditions, as early intervention could have prevented progression of the degenerative changes and potentially avoided the need for more complex future management.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
