Diagnostic Assessment — Right Wrist - Scapholunate Ligament Sprain
Example 1 of 1 · fictitious patient (Veteran C)
Diagnostic Assessment
Right Wrist - Scapholunate Ligament Sprain
Balance of Probabilities: Sprain and Strain No. 28 of 2020 Reasonable Hypothesis: Sprain and Strain No. 29 of 2020
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 falls during training exercises, manual handling of heavy technical equipment, and repetitive wrist-intensive tasks during equipment operation and maintenance.
History
The veteran a Communications and Information Systems Controller in the RAAF, sustained a scapholunate ligament sprain to his right wrist following a fall where he used his hand to break his fall during service-related activities. The injury occurred during his military service and resulted in ongoing pain and limited range of motion.
Timeline
- 19 January 2016 - the veteran underwent MRI of the right wrist which revealed a partial tear of the volar and membranous bands of the scapholunate ligament complex with the dorsal band remaining intact. He reported ongoing wrist pain and limited range of motion following a fall where he used his hand to break the fall. The patient described persistent pain occurring 7 days per week for 14 hours daily, with functional limitations in gripping and manual tasks. Management included physiotherapy, exercise physiology, and anti-inflammatory medications including Panadol and ibuprofen gel, with symptoms reported as persisting and affecting activities like pushing and lifting.
Symptoms
At the time of injury, the veteran experienced immediate wrist pain and reduced range of motion following the fall on his outstretched hand. The acute symptoms included pain localized to the wrist joint with difficulty in gripping and wrist movement.
Currently, the veteran experiences ongoing right wrist pain occurring 7 days per week for 14 hours daily. He reports functional limitations in gripping and manual tasks, with persistent pain and limited range of motion. The symptoms significantly impact his activities of daily living including lifting, pushing, and performing household tasks. He continues to use physiotherapy, exercise physiology, and anti-inflammatory medications for symptom management.
Imaging
- 19 January 2016 - MRI right wrist: Partial tear of the volar and membranous bands of the scapholunate ligament complex noted. The dorsal band of the scapholunate ligament complex appears intact.
1. What is the formal diagnosis of the condition claimed above?
Right Wrist Scapholunate Ligament Sprain - DVA SOP: Sprain and Strain No. 28 of 2020 (Balance of Probabilities), ICD-10: S63.519
Scapholunate ligament sprain is an injury to the ligamentous complex that connects the scaphoid and lunate bones in the wrist. The scapholunate ligament is the most important intrinsic ligament of the wrist and consists of three components: the dorsal, membranous (interosseous), and volar bands. The dorsal band is the strongest and most important for wrist stability. When injured, this ligament can lead to scapholunate dissociation and carpal instability. Scapholunate ligament injuries commonly occur from falls on an outstretched hand with the wrist in dorsiflexion and ulnar deviation, or from rotational injuries. The injury can range from partial tears affecting one or more components of the ligament complex to complete ruptures leading to carpal instability patterns.
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 of right wrist pain and limited range of motion following a fall where he used his hand to break the fall. The exact date of symptom onset 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 right wrist scapholunate ligament sprain was on 19 January 2016 when he underwent MRI imaging. The specific healthcare provider who ordered the MRI is not identified in the documentation. [IMAGING.pdf, Pages 3, 5]
When was the condition confirmed / formally diagnosed? The scapholunate ligament sprain was confirmed and formally diagnosed on 19 January 2016 via MRI imaging performed by the treating doctor, which demonstrated a partial tear of the volar and membranous bands of the scapholunate ligament complex. [IMAGING.pdf, Pages 3, 5]
When did the veteran first present to you (or your practice) for this condition? 30 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 wrist pain and limited range of motion following a fall where the patient used his hand to break the fall. The investigation results showed a partial tear of the volar and membranous bands of the scapholunate ligament complex, with the dorsal band remaining intact. The patient reported persistent pain occurring 7 days per week for 14 hours daily, with functional limitations in gripping and manual tasks. [IMAGING.pdf, Pages 3, 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.
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 scapholunate ligament sprain from a fall where he used his hand to break the fall, which constitutes significant physical force applied through the wrist joint at the time of clinical onset.
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 managed with physiotherapy, exercise physiology, and anti-inflammatory medications.
Sequelae
The scapholunate ligament sprain is not a sequelae of another known condition but appears to be a primary injury from the fall 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 scapholunate ligament sprain was diagnosed via MRI imaging and managed with conservative treatment including physiotherapy, exercise physiology, and anti-inflammatory medications. 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
