​Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar:

  • acute traumatic shoulder dislocations, including unreduced or locked dislocations, and shoulder dislocations or pain following seizures or electrocution
  • atypical shoulder pain that may be associated with chest pain or shortness of breath or stridor that could indicate cardiac or respiratory cause
  • displaced or unstable fractures that cannot be managed in primary care
  • signs of septic arthritis (local inflammation, pain, fever, and systemically unwell)
  • signs of vascular injury or compromise
  • unexplained mass or swelling.

When public outpatient services are not routinely provided

Patient already on a surgical waitlist in another local health district for the same condition.

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Primary acute shoulder dislocation (following emergency management).
  • Shoulder dislocation associated with any of the following:
    • rotator cuff pathology
    • fracture (excluding isolated Hills Sachs fracture)
    • signs of neurological injury
    • ongoing severe pain post reduction.

Note: Shoulder dislocations in patients who experience seizures need to have appropriate medical control of seizures for consideration of any surgical procedures for instability. Consider referral to a neurologist for seizure management prior to orthopaedic referral as appropriate.

Category 2
Recommended to be seen within 90 calendar days.

  • History of previous traumatic primary shoulder dislocation and any of the following:
    • recurrent shoulder dislocation with low force mechanism
    • recurrent shoulder dislocation in a patient with higher-level work or sporting demands
    • recurrent shoulder dislocation and aged < 25 years.

Note: Patients are strongly encouraged to initiate non-operative management (for example physiotherapy including an exercise program) while awaiting orthopaedic review

Category 3
Recommended to be seen within 365 calendar days.

  • Recurrent dislocation in a person with lower-level work or functional demands with a history of previous traumatic primary dislocation.
  • Chronic anterior shoulder instability.
  • Chronic multidirectional shoulder instability.

Note: Patients are expected to have completed ≥ 6-month period of non-operative management (for example physiotherapy including an exercise program) prior to referral

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition, including symptoms and their duration, mechanism, severity, location of pain and impact on function.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • whether pain is related to trauma (if so, provide date of injury and mechanism)
    • examination findings (including neurological examination where indicated)
    • x-ray: shoulder – axillary, anterior to posterior (AP), lateral and Grashey (AP oblique internal rotation) views
    • ultrasound: shoulder (patients with suspected rotator cuff pathology only).

If available

  • MRI result: shoulder.
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ or among a vulnerable, disadvantaged or priority population.
  • If the patient is willing to have surgery (where clinically relevant).
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

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Current as at: Monday 17 June 2024
Contact page owner: System Purchasing