Labral Tear N071
Current RMA Instruments
| Reasonable Hypothesis SOP [1] | 36 of 2017 |
| Balance of Probabilities SOP [2] | 37 of 2017 |
Changes from previous Instruments
Bulletin 197 [3]
ICD Coding
- ICD-9-CM Codes: 840.8, 843.8
- ICD-10-AM Codes: S43.7, S73.18
Brief description
A labral tear is a tear involving the lip of fibrocartilagenous tissue (the labrum) of the socket of the hip joint (acetabulum) or the shoulder joint (glenoid). The labrum deepens the functional joint socket and thus serves to help keep the joint in place by providing physical restraint. Only the hip joint and the glenohumeral joint of the shoulder have a labrum, so only these joints are covered by the SOP.
Confirming the diagnosis
Diagnosis is based on the clinical presentation together with MRI scan, CT scan or arthroscopy findings. Clinical manifestations (particularly local pain and tenderness) attributable to a tear need to be present for the diagnosis to be confirmed.
The relevant medical specialist is an orthopaedic surgeon.
Additional diagnoses covered by SOP
- Bankart lesion – this is a detachment of the labrum from the glenoid of the shoulder normally associated with shoulder dislocation. The labral tear part of the lesion is covered by this SOP. If there is also a bony lesion it will be covered by the fracture SOP. See further comments below
- Shoulder SLAP lesion [Superior Labral tear from Anterior to Posterior]. There are multiple different types of SLAP tears
- Traumatic labral tear
Conditions excluded from SOP
- Adhesive capsulitis of the shoulder*
- Chondral defect of the hip or glenohumeral joint* - acute articular cartilage tear SOP
- Congenital/ developmental hip dysplasia (cam or pincer morphology)* - femoroacetabular impingement SOP
- "Degenerative" labral tear (non-traumatic) of the hip or shoulder - see comments
- Femoroacetabular impingement syndrome*
- Osteoarthritis*
- Rotator cuff syndrome*
* another SOP applies - the SOP has the same name unless otherwise specified
Clinical onset
Clinical onset will be when symptoms (chiefly pain) attributable to a labral tear first developed. In the case of acute trauma resulting in labral tear, the clinical onset will be at the time of the trauma.
Clinical worsening
The only SOP worsening factor is for inability to obtain appropriate clinical management. Treatment may be conservative or surgical.
Comments
For an acute labral tear that occurs in conjunction with an acute dislocation injury ("soft" Bankart lesion), the labral tear can be separately determined using this SOP, or can be considered to be a component of the dislocation and determined using the dislocation SOP (provided an appropriate diagnostic label, that includes the labral tear, is used).
This SOP does not cover degenerative labral tears. A degenerative labral tear may be an integral component of osteoarthritis, or of femoroacetabular impingement syndrome, or may also be an incidental finding that is seen on imaging (MRI) but is not of clinical significance. A degenerative labral tear should generally not be diagnosed as a stand-alone condition.
Rulebase for labral tear
- Log in [4] to post comments
Place holder node for Rulebase for labral tear
Inability to obtain appropriate clinical management for labral tear
Labral tear - Inability to obtain appropriate clinical management for labral tear Factor
Last reviewed for CCPS 29 July 2012.
Preliminary questions [41889]
11109 — the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7066 [5] there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.
7334 [6] the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 [6] the condition under consideration permanently worsened.
7378 [5] the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
7379 [7] the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration. 11233 — the veteran satisfies the occurrence provisions for the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration. 898 — the veteran has some operational service. or 899 — the veteran has some eligible service. 11234 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration. 11235 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration. or 11236 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration. Clinical worsening and operational service [11235] or 7390 — the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service. [12] [13] Clinical worsening and eligible service [11236] or 7391 — the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service. [12] [13]
Repetitive throwing or overhead motions
Labral tear - Repetitive throwing or overhead motions Factor
Last reviewed for CCPS 29 July 2012.
Investigative Documents
Claimant Report - Forceful and Repetitive Activities [CR9326] Preliminary questions [41890]
41894 [23] the veteran performed forceful and repetitive throwing or overhead motions involving side and site of the body for at least eight hours per week for the one month before the clinical onset of the condition under consideration. 41895 — the veteran satisfies the occurrence provisions for forceful and repetitive throwing or overhead motions and VEA service for the clinical onset of the condition under consideration. 898 — the veteran has some operational service. or 899 — the veteran has some eligible service. 41896 — the veteran has established the causal connection between forceful and repetitive throwing or overhead motions and VEA service for the clinical onset of the condition under consideration. 41897 — the veteran has established a causal connection between forceful and repetitive throwing or overhead motions and operational service for the clinical onset of the condition under consideration. or 41898 — the veteran has established a causal connection between forceful and repetitive throwing or overhead motions and eligible service for the clinical onset of the condition under consideration. Clinical onset and operational service [41897] or
41902 — the identified illness or injury that caused the veteran to perform the forceful and repetitive throwing or overhead motions involving side and site of the body is causally related to operational service. [26] Clinical onset and eligible service [41898] or
41906 — the identified illness or injury that caused the veteran to perform the forceful and repetitive throwing or overhead motions involving side and site of the body is causally related to eligible service. [29] [30]
Significant physical force
Labral tear - Significant physical force Factor
Last reviewed for CCPS 29 July 2012.
Investigative Documents
Claimant Report - Significant Physical Force [CR9325] [31] Medical Report - Significant Physical Force [MR9428] Preliminary questions [41909] 41924 — the veteran satisfies the occurrence provisions for the significant physical force and VEA service for the clinical onset of the labral tear. 898 — the veteran has some operational service. or 899 — the veteran has some eligible service. 41925 — the veteran has established the causal connection between the significant physical force and VEA service for the clinical onset of the labral tear. 41926 — the veteran has established a causal connection between the significant physical force and operational service for the clinical onset of the labral tear. or 41927 — the veteran has established a causal connection between the significant physical force and eligible service for the clinical onset of the labral tear. Clinical onset and operational service [41926] or
41931 [36] the veteran had the significant physical force to side and site of the body at the time of the clinical onset of the labral tear as a consequence of the identified illness or injury. 41932 — the identified illness or injury that caused the labral tear due to the significant physical force to side and site of the body is causally related to operational service. [37] [38] Clinical onset and eligible service [41927] or
41931 [36] the veteran had the significant physical force to side and site of the body at the time of the clinical onset of the labral tear as a consequence of the identified illness or injury. [37]
41936 — the identified illness or injury that caused the labral tear due to the significant physical force to side and site of the body is causally related to eligible service. [42] [38]
Links
[1] http://www.rma.gov.au/assets/SOP/2017/036.pdf
[2] http://www.rma.gov.au/assets/SOP/2017/037.pdf
[3] http://clik.dva.gov.au/system/files/media/Bulletin%20197.pdf
[4] http://clik.dva.gov.au/user/login?destination=comment/reply/63699%23comment-form
[5] http://clik.dva.gov.au/ccpsn071rc-0
[6] http://clik.dva.gov.au/node/70596
[7] clikpopup://CCPS/labral tear/ACM - contributed to worsening
[8] clikpopup://CCPS/ACM/NoContribution
[9] clikpopup://CCPS/ACM/NotOpService
[10] clikpopup://CCPS/ACM/NotOperDuties
[11] clikpopup://CCPS/rejectwilful
[12] clikpopup://CCPS/ACM/NoIllness
[13] clikpopup://CCPS/reject7390,7391No
[14] clikpopup://CCPS/labral tear/ACM - onset prior to operational service
[15] clikpopup://CCPS/ACM/OnsetFailOper
[16] clikpopup://CCPS/ACM/NotEligService
[17] clikpopup://CCPS/ACM/NotEligDuties
[18] clikpopup://CCPS/Labral tear/ACM - onset prior to eligible service
[19] clikpopup://CCPS/ACM/OnsetFailElig
[20] http://clik.dva.gov.au/dates-0
[21] clikpopup://CCPS/reject41891No
[22] clikpopup://CCPS/reject41892No
[23] clikpopup://CCPS/41894
[24] clikpopup://CCPS/reject41894No
[25] clikpopup://CCPS/reject41899No
[26] clikpopup://CCPS/reject41902No
[27] clikpopup://CCPS/41903
[28] clikpopup://CCPS/reject41903No
[29] clikpopup://CCPS/reject41906No
[30] clikpopup://CCPS/reject41902,41906No
[31] http://clik.dva.gov.au/ccpsclaimant-4
[32] http://clik.dva.gov.au/standard-commentary-78
[33] http://clik.dva.gov.au/reasons-decision-86
[34] http://clik.dva.gov.au/reasons-decision-74
[35] clikpopup://CCPS/reject41928No
[36] clikpopup://CCPS/N071/41931
[37] clikpopup://CCPS/reject41931No
[38] clikpopup://CCPS/reject41932,41936No
[39] clikpopup://CCPS/N071/41933
[40] clikpopup://CCPS/reject41933No
[41] clikpopup://CCPS/reject41934No
[42] clikpopup://CCPS/reject41936No