Criteria for referral to public hospital service

• Functional impairment that persists despite at least three months of active treatment that included: physiotherapy/rehabilitation, medications (anti-inflammatories, paracetamol or corticosteroid injection) due to the following shoulder conditions:
  • non-traumatic acromioclavicular (AC) joint problems
  • adhesive capsulitis (frozen shoulder)
  • chronic rotator cuff tear
  • tendinopathy
• Existing shoulder replacement with new pain, loosening or other concern.

Information to be included in the referral
 

Information that must be provided

• Reason for referral and expectation, or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
• Description of joint affected and onset, nature and duration of symptoms
• Findings on physical examination including loss of range of movement and neurological examination
• Hand preference and how symptoms are impacting on daily activities including impact on work, study or carer role and level of sleep disturbance
• x-ray of the affected shoulder: anteroposterior (AP), lateral view and axillary lateral views of Glenohumeral joint
• History of and response to physiotherapy
• Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs)
• If referral relates to previous joint replacement, description of new pain, sounds or dislocation and when and where procedure was performed
• If referral relates to tendinopathy, history of smoking and patient’s willingness to start a plan to quit smoking
• Details of any previous shoulder surgery including when and where procedures were performed.

Provide if available

• Ultrasound report (including details of the diagnostic imaging practice)
• MRI scan (including details of the diagnostic imaging practice)
• Allied health assessments
• If inflammation is suspected: full blood examination and inflammatory marker results (erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP))
• Statement about the patient’s interest in having surgical treatment if that is a possible intervention
• If the person identifies as an Aboriginal and Torres Strait Islander
• If the person is part of a vulnerable population.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
There are other statewide referral criteria that include reference to shoulder pain:

• Inflammatory arthritis
• Osteoarthritis of the shoulder
• Shoulder trauma
• Vulnerable populations include
  • people from culturally and linguistically diverse backgrounds
  • older Australians
  • carers of people with chronic conditions
  • people experiencing socio-economic disadvantage
  • people living in remote, or rural and regional locations
  • people with a disability
  • people with mental illness
  • people who are, or have been, incarcerated.

Vulnerable patient groups also include terminally ill patients, patients with experiences of family violence, in out-of-home care, foster care and those in state care.

Referral to a public hospital is not appropriate for

• The following shoulder conditions where there is no functional impairment, or when at least three months of active treatment that included: physiotherapy/rehabilitation and medications (anti-inflammatories, paracetamol or corticosteroid injection) has not been trialled:
  • non-traumatic acromioclavicular (AC) joint problems
  • shoulder pain or stiffness, including shoulder adhesive capsulitis (frozen shoulder)
  • rotator cuff tear
  • tendinopathy.