Orthopaedic presentations out of scope

Public outpatient services in NSW are generally not provided to patients presenting with these conditions.

On this page

  1. Adult patients (aged 16 years or over)
  2. Paediatric patients (aged 0 to 15 years)

Adult patients (aged 16 years or over)

Presenting condition Out of scope (not routinely provided) criteria
Ankle or foot injury (acute)
  • Diabetic neuropathic conditions.
    Note: consider referral to a High Risk Foot Service.
  • Patients who would otherwise be referred to a fracture clinic.
  • Simple ankle sprain.
Ankle or foot osteoarthritis
  • Clinical symptoms not severe enough to require surgical opinion for intervention.
  • Cosmetic foot surgery.
  • Diabetic Charcot foot.
    Note: consider to referral to a High Risk Foot Service.
  • Osteoarthritis where non-operative management has not been undertaken.
  • Patient already on surgical waitlist in another local health district for the same condition.
Back pain
  • Complex, persistent axial spinal back pain where surgical indications are not present.
    Note: consider referral to a rheumatology or multidisciplinary pain service.
  • Patient already on surgical waitlist in another local health district for the same condition.
  • Spondyloarthropathies.
    Note: consider referral to rheumatology.
  • Uncomplicated fragility fractures of the axial spine.
Hip osteoarthritis
  • Clinical symptoms not severe enough to require surgical opinion for intervention.
  • Osteoarthritis where non-operative management has not been undertaken.
  • Patient already on surgical waitlist in another local health district for the same condition.
Knee osteoarthritis
  • Clinical symptoms not severe enough to require surgical opinion for intervention.
  • Osteoarthritis where non-operative management has not been undertaken.
  • Patient already on surgical waitlist in another local health district for the same condition.
  • Uncomplicated inflammatory arthropathy (including crystal arthropathies).
    Note: consider referral to rheumatology.
Knee pain (acute)
  • Mild knee osteoarthritis or soreness.
  • Uncomplicated degenerate meniscal tears.
  • Uncomplicated inflammatory arthropathy (including crystal arthropathies).
    Note: consider referral to rheumatology.
Scoliosis or kyphosis

Intradural pathology based on MRI.
Note: consider referral to neurosurgery.

Shoulder instability

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

Shoulder pain
  • 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).
Wrist or hand osteoarthritis

Inflammatory arthropathy (including crystal arthropathies).
Note: consider referral to rheumatology.

Wrist or hand pain
  • Patient who would otherwise be referred to a fracture clinic.
  • Uncomplicated inflammatory arthropathy (including crystal arthropathies).
    Note: consider referral to rheumatology.
Non-condition specific
  • Assessment prior to application for the Australian Defence Force, Police, NDIS, disability, pension, release of superannuation.
  • Dupuytren’s nodule without functional impairment or contracture.
  • Non-specific headach​e without red flags concerning features or not requiring surgical intervention.
    Note: consider referral to neurology.
  • Patient already on surgical waitlist in another local health district for the same condition.
  • Patient who would otherwise be referred to a fracture clinic.

Paediatric patients (aged 0 to 15 years)

Presenting condition Out of scope (not routinely provided) criteria
Back pain

Nil out of scope criteria.

Baker’s cyst

Solid mass on ultrasound.
Note: consider diagnoses other than Baker’s cyst (for example tumour) and refer to most appropriate speciality.

Bow legs

Bow legs and aged < 1 year old (in an otherwise normal child).

Club foot

Nil out of scope criteria.

Curly toes
  • Curly toes and child aged < 3 years.
  • Other structural abnormalities (for example webbing).
Developmental hip dysplasia
  • Asymmetric skin creases with normal imaging.
  • Risk factors for developmental hip dysplasia with normal imaging (see Required​ for imaging guidelines).
Flat feet
  • Child aged < 8 years with functional impairment (for example recurrent falls) as a result of flat foot.
    Note: consider referral to physiotherapy.
  • Flexible flat foot (i.e. arch reconstitutes on heel raise) without pain.
In-toeing

Child with in-toeing who has been walking for < 6 months.

Knee injury
  • Chronic recurrent multifocal osteomyelitis (also known as non-bacterial osteitis).
    Note: consider referral to rheumatology.
  • Jumper’s knee.
    Note: consider referral to sports medicine or physiotherapy.
  • Non-traumatic knee pain with no diagnosis in the presence of normal hip and knee imaging.
    Note: consider referral to sports medicine or physiotherapy. Consider referred pain from the hip and hip X-rays.
  • Non-traumatic monoarticular swelling with no structural damage on MRI.
    Note: consider referral to rheumatology.
  • Osgood-Schlatter disease.
    Note: consider referral to sports medicine or physiotherapy.
  • Suspected inflammatory diagnosis (for example juvenile idiopathic arthritis, juvenile rheumatoid arthritis).
    Note: consider referral to rheumatology.
Knock knees

Nil out of scope criteria.

Note: typically children aged 3-4 years have knock knee alignment that improves over time. Reassurance at this age is recommended.

Limp

Nil out of scope criteria.​​

Metatarsus adductus

Nil out of scope criteria.

Out-toeing

Out-toeing and aged < 2 years (in otherwise normal child).

Perthes disease

Nil out of scope criteria.

Scoliosis or kyphosis
  • Kyphosis < 50 degrees in a skeletally mature child without pain.
  • Scoliosis < 10 degrees in a skeletally mature child without pain.
Slipped upper femoral epiphysis

Nil out of scope criteria.

Toe walking

Toe walking with full passive ankle range of motion.

Non-condition specific
  • Assessment prior to application for disability.
  • Ingrown toenail.

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