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
  • 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
  • sudden onset significant motor or sensory deficit in upper limb
  • 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.
  • Platelet-rich plasma (PRP) injections for shoulder pain, and repair of long head of biceps ruptures where primary concern is cosmesis.
  • Rheumatological conditions (for example inflammatory arthritis, autoimmune connective tissue or muscle disorders, or osteoporosis without fracture).

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Confirmed or suspected malignancy in the shoulder.
  • Aged < 70 years with acute traumatic full thickness rotator cuff tear and a significant loss of shoulder function.
  • Severe glenohumeral osteoarthritis or rotator cuff arthropathy with severe pain and limitations affecting independence or likely to present to emergency department.
  • Fractures that have had initial management in emergency department or primary care and need further management.

Category 2
Recommended to be seen within 90 calendar days.

  • Traumatic partial thickness rotator cuff tear in surgically fit patient with ongoing shoulder pain.
  • Atraumatic full thickness rotator cuff tears with significant shoulder impairment.
  • Severe glenohumeral osteoarthritis or rotator cuff arthropathy with severe pain and impact on activities of daily living.
  • Unclear diagnosis or non-specific shoulder pain with significant impairment and impact on function seeking further management.

Note: Patients are expected to have undergone ≥ 3-month period of non-operative management (including physiotherapy with an exercise program) and/or corticosteroid injection.

Category 3
Recommended to be seen within 365 calendar days.

  • Atraumatic rotator cuff related shoulder disorders (including partial thickness tears, tendinopathy and/or subacromial pain).
  • Moderate to severe glenohumeral or acromioclavicular joint osteoarthritis or rotator cuff arthropathy.
  • Frozen shoulder in the stiff phase (i.e., stiff with minimal pain) with ongoing significant restriction in movement despite appropriate primary care management*.
  • Unclear diagnosis or non-specific shoulder pain seeking further management.

Note: Patients are expected to have undergone ≥ 3-month period of non-operative management (for example physiotherapy including an exercise program) and/or corticosteroid injection.

*Frozen shoulder should be suspected in patients 40-60 years of age with shoulder pain with or without metabolic risk factors. Criteria for diagnosis include reduced rotation range of motion ≤ 50% (especially external rotation) and normal X-ray. These patients should be managed in primary care with corticosteroid injection to the glenohumeral joint (not the subacromial bursa), or referral to rheumatology and/or physiotherapy and counselled regarding the appropriate timeframes for recovery.

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition, including symptoms and their duration, 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 – anterior to posterior (AP) and lateral views (patients with trauma or reduced range of motion only)
    • 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