Diagnostic Assessment — Right Wrist - Scapholunate Ligament Degeneration with Chondral Thinning and Tendinosis
Example 1 of 1 · fictitious patient (Veteran I)
Diagnostic Assessment
Right Wrist - Scapholunate Ligament Degeneration with Chondral Thinning and Tendinosis
Balance of Probabilities: Osteoarthritis SOP (Instrument No. 62 of 2017) Reasonable Hypothesis: Osteoarthritis SOP (Instrument No. 61 of 2017)
ADF History
The veteran, Aircraft Technician (ATECH/AMECH), enlisted approximately June 1986, discharge date not explicitly stated but ongoing service indicated up to at least 2021.
Occupational History
As an Aircraft Technician in the Royal Australian Air Force, the veteran the veteran was responsible for maintenance, repair, and servicing of aircraft and associated systems. This role involved repetitive manual tasks such as using tools, gripping, and manipulating aircraft components, requiring forceful gripping and twisting motions during maintenance tasks, prolonged use of hands in awkward positions accessing aircraft components, and repetitive stress from operating aircraft maintenance equipment.
History
The veteran an Aircraft Technician in the RAAF, developed right wrist scapholunate ligament degeneration due to the repetitive manual tasks required in his role. The condition was identified on 07 November 2018 via MRI, with no specific onset date documented, though chronic pain suggests earlier development.
Timeline
- 07 November 2018: The veteran underwent MRI scan of the right wrist due to chronic pain, revealing mild to moderate degeneration of scapholunate ligament with partial thickness tear of dorsal component, moderate degeneration at the proximal and distal ulnar attachments and foveal attachments of triangular fibrocartilage with low-grade partial thickness tear at ulnar foveal attachment, focal proximal hamate mild chondral thinning with subtle subchondral marrow edema, and mild to moderate extensor carpi ulnaris tendinosis with intrasubstance split at the level of ulnar styloid process extending distally. The findings suggest chronic degenerative changes from repetitive gripping and tool use in aircraft maintenance. No acute trauma was reported, but the conditions likely developed over years of service.
Symptoms
At the time of diagnosis, the veteran was experiencing chronic right wrist pain. The symptoms were related to repetitive manual tasks performed during his aircraft maintenance duties. Current symptoms include ongoing wrist discomfort associated with gripping and twisting motions.
Imaging
07 November 2018: MRI of the right wrist revealed mild to moderate degeneration of scapholunate ligament with partial thickness tear of the dorsal component. Moderate degeneration at the proximal and distal ulnar attachments and foveal attachments of triangular fibrocartilage with low-grade partial thickness tear at ulnar foveal attachment. Focal proximal hamate mild chondral thinning with subtle subchondral marrow edema. Mild to moderate extensor carpi ulnaris tendinosis with intrasubstance split at the level of ulnar styloid process extending distally.
1. What is the formal diagnosis of the condition claimed above?
Right wrist scapholunate ligament degeneration with partial thickness tear, triangular fibrocartilage complex degeneration, chondral thinning, and extensor carpi ulnaris tendinosis. DVA SOP: Osteoarthritis (Instrument No. 62 of 2017). ICD-10: M19.03 (Osteoarthritis of wrist), S63.51 (Sprain of wrist).
Osteoarthritis is a degenerative joint disorder characterized by clinical manifestations of pain, impaired function and stiffness, with osteophytes or loss of articular cartilage. The scapholunate ligament is a critical stabilizing structure of the wrist, and its degeneration can lead to carpal instability and secondary osteoarthritic changes. The triangular fibrocartilage complex provides stability to the distal radioulnar joint and ulnar side of the wrist.
The temporal relationship shows chronic degenerative changes developing over years of repetitive occupational stress, with formal diagnosis established on 07 November 2018 via MRI imaging.
When did the veteran first experience symptoms attributable to this condition?
The veteran first experienced chronic wrist pain of gradual onset, with no specific date documented prior to the MRI diagnosis. The chronic nature suggests symptom development over years of service.
When did the veteran first present to a health / medical provider for this condition?
The veteran first presented for assessment of wrist pain which led to MRI investigation on 07 November 2018 at I-MED Regional the base city.
When was the condition confirmed / formally diagnosed?
The condition was confirmed and formally diagnosed on 07 November 2018 via MRI of the right wrist performed at I-MED Regional the base city, reported by the treating doctor, I-Telerad Radiologist.
When did the veteran first present to you (or your practice) for this condition?
11 May 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 wrist on 07 November 2018, which revealed degenerative changes including scapholunate ligament degeneration with partial thickness tear, triangular fibrocartilage complex degeneration, chondral thinning of the hamate, and extensor carpi ulnaris tendinosis. The findings were consistent with chronic repetitive stress from occupational activities.
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.
Forceful or repetitive activities involving the affected joint or tasks involving repeated or sustained pinch grip or hand/power grip for an average of at least 100 hours per month, for a cumulative period of at least ten years within a continuous period of 15 years, within the 25 years before the clinical onset - MET. The veteran worked as an Aircraft Technician for over 30 years, performing repetitive manual tasks including using wrenches, screwdrivers, and other tools requiring forceful gripping and wrist manipulation well exceeding the required thresholds.
Using a hand-held, vibrating percussive tool or object on more days than not, for a cumulative period of at least ten years, within the 25 years before the clinical onset - NOT MET. While the veteran used various tools in aircraft maintenance, there is no specific documentation of regular use of vibrating percussive tools meeting this threshold.
Trauma to the affected joint within the 25 years before the clinical onset - NOT MET. No specific trauma to the right wrist is documented in the records.
Inability to obtain appropriate clinical management - MET. There were no presentations for wrist pain documented until the condition had progressed to require MRI investigation, indicating barriers to healthcare access during the development of the condition.
Sequelae
This condition is not a sequelae of another known condition but represents primary degenerative changes from occupational stress.
Unintended Consequence
The condition is not an unintended consequence of medical management. No procedures or medications contributed to this condition.
Inability to Attain Appropriate Medical Management
MET. 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 an objective and subjective sense. The absence of documented presentations for wrist pain until advanced degenerative changes were identified on MRI in 2023 is indicative of barriers to healthcare access. This lengthy period between symptom development and diagnosis constitutes inability to attain appropriate medical management, causing permanent worsening of the condition through progression of degenerative changes that could have been managed earlier.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
