Diagnostic Assessment — Right Thigh - Hamstring Tendinopathy
Example 1 of 1 · fictitious patient (Veteran L)
Diagnostic Assessment
Right Thigh - Hamstring Tendinopathy
Balance of Probabilities SOP: Strain SOP No. 28 of 2020 - Factors (2), (4), (5) Reasonable Hypothesis SOP: Strain SOP No. 29 of 2020 - Factors (2), (4), (5)
ADF History
The veteran, Date of Birth: [withheld] Electronic Warfare Operator, enlistment date 09 Feb 1990, discharge date 17 February 2000.
Occupational History
As an Electronic Warfare Operator in the Australian Army, the veteran was required to maintain high levels of physical fitness through intensive physical training programs. The role involved high-intensity exercises including rapid movements, running, jumping, and heavy lifting activities. Military physical training sessions were conducted regularly and included forceful stretching and high-intensity use of muscles and tendons through activities such as running, kicking, jumping, and climbing typical of military fitness requirements.
History
The veteran an Electronic Warfare Operator, injured his right hamstring during physical training in 2003, initially diagnosed as a strain, which progressed to chronic hamstring tendinopathy due to ongoing occupational demands and inadequate management.
Timeline
13 September 1998: The veteran injured his right hamstring during physical training, diagnosed as a right hamstring strainper the Strain SOP. He experienced immediate pain in the proximal hamstring region, particularly during movement and physical activity. The injury was attributed to high-intensity exercise typical of military physical training requirements for his role as an Electronic Warfare Operator. No immediate imaging was conducted at the time, with initial management likely focused on rest and basic rehabilitation protocols. Physiotherapy was probably initiated to manage symptoms and restore functional capacity. The condition limited his physical performance capabilities and marked the beginning of chronic hamstring problems that would persist throughout his remaining military service.
01 October 2018: An MRI confirmed mild hamstring origin tendinopathy in the right thigh, demonstrating chronic degenerative changes. The veteran reported persistent pain, particularly during physical activities, consistent with his long-standing hamstring problems from military service. The imaging showed mild high signal thickening at the hamstring origins, indicating chronic tendon pathology. The hip extensor, gluteal, and adductor tendons appeared normal, confirming that the pathology was specifically related to the hamstring complex. The tendinopathy was directly linked to the 2003 injury and chronic overuse patterns from his military occupational demands. The condition continued to impact his functional capacity and quality of life in the post-service period.
Symptoms
At the time of the 2003 injury, the veteran experienced immediate pain in the proximal hamstring region, particularly during movement and physical activities required for his military duties. Following the injury, symptoms persisted with ongoing pain during physical tasks and functional limitations affecting his training and operational capabilities. Current symptoms include persistent pain in the right proximal hamstring particularly during physical activities, with confirmed tendinopathy causing ongoing discomfort, stiffness, and functional limitation that affects daily activities and quality of life in the post-service period.
Imaging
01 October 2018: MRI findings revealed mild hamstring origin tendinopathy with mild high signal thickening at the hamstring origins. The imaging showed normal hip extensor, gluteal, and adductor tendons, confirming that the pathology was specifically related to the hamstring complex. The tendinopathy was directly linked to the 2003 injury and chronic overuse from military service.
1. What is the formal diagnosis of the condition claimed above?
Right Thigh - Hamstring Tendinopathy (M76.891), DVA SOP Strain SOP No. 28 of 2020, ICD-10 code M76.891.
Hamstring tendinopathy is a degenerative condition affecting the tendons of the hamstring muscle group at their origin at the ischial tuberosity. This condition involves chronic changes to the tendon structure including collagen breakdown, increased vascularity, and tissue thickening. The hamstring muscles consist of the biceps femoris, semitendinosus, and semimembranosus, which are responsible for knee flexion and hip extension. Tendinopathy typically develops as a result of repetitive stress, overuse, or as a sequela to acute injury, and is characterized by pain, stiffness, and functional limitation.
The temporal relationship shows the initial hamstring strain occurring in 2003 during military physical training, with progression to chronic tendinopathy confirmed by 2023 MRI, indicating the evolution from acute injury to chronic degenerative pathology over the 20-year period.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 13 September 1998 - during physical training.
When did the veteran first present to a health/medical provider for this condition? 13 September 1998 - the veteran first presented to a medical provider, likely a General Practitioner or Military Medic, immediately following the hamstring injury during physical training.
When was the condition confirmed/formally diagnosed? 13 September 1998 - The hamstring strain was diagnosed at the time of injury. 01 October 2018 - The hamstring tendinopathy was formally diagnosed by the treating doctor, Radiologist, at I-MED Radiology through MRI imaging.
When did the veteran first present to you (or your practice) for this condition? 25 November 2017
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?
The diagnosis of right hamstring strain was confirmed by clinical assessment in 2003 based on the mechanism of injury during physical training and immediate onset of proximal hamstring pain. Key symptoms included pain in the proximal hamstring particularly during movement, consistent with forceful stretching or high-intensity use during military training activities.
The diagnosis of hamstring tendinopathy was confirmed by MRI on 01 October 2018, reported by the treating doctor at I-MED Radiology. The MRI showed mild high signal thickening at the hamstring origins with normal hip extensor, gluteal, and adductor tendons. The clinical history of trauma and MRI findings established the diagnosis, linking the chronic tendinopathy to the original 2003 strain and ongoing occupational demands from his military service.
4. What do you consider to be the cause(s) of the condition in this veteran?
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 veteran's hamstring muscles were subjected to forceful stretching and high-intensity use during military physical training in 2003, causing the initial strain that led to chronic tendinopathy.
Forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon - MET
- Ongoing military physical training demands continued to subject the hamstring to forceful stretching and high-intensity use, contributing to the progression from acute strain to chronic tendinopathy.
Inability to obtain appropriate clinical management for sprain or strain - MET
- There is evidence of inadequate clinical management as demonstrated by the 20-year delay between initial injury and comprehensive MRI investigation, and the progression from simple strain to chronic tendinopathy, representing failure to provide appropriate ongoing clinical management per Brew v Repatriation Commission.
Sequelae
The hamstring tendinopathy is a direct sequela of the original 2003 right hamstring strain, developing due to chronic overuse patterns, inadequate rehabilitation, and ongoing occupational demands that prevented proper healing and resulted in progressive tendon degeneration.
Unintended Consequence
This condition is not an unintended consequence of medical management as no specific medical procedures or medications directly caused the condition.
Inability to Attain Appropriate Medical Management
There was a clear inability to attain appropriate medical management as evidenced by the 20-year delay between initial injury in 2003 and comprehensive MRI investigation in 2023. The Full Federal Court in Brew v Repatriation Commission establishes that inability encompasses the lack of ability to get treatment in both objective and subjective senses. The extensive delay between initial presentation and definitive investigation, combined with the progression from simple strain to chronic tendinopathy, constitutes evidence of barriers to healthcare satisfying the inability to attain appropriate medical management factor. This resulted in permanent worsening as the acute strain progressed to irreversible tendon degeneration that could have been prevented or minimized with appropriate early intervention, specialized management, and ongoing monitoring.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication/prescribing history.
- See attached report
