Direct to an emergency department for:

  • Acutely septic prosthetic joint 
  • Suspected septic arthritis
  • Suspected malignancy
  • Pathological fracture

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.