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Direct to an emergency department for:

  • Irreducible shoulder dislocation
  • Brachial plexus injury after reduction
  • Suspected fracture
  • Traumatic and deformed acromioclavicular (AC) joint injuries

Criteria for referral to public hospital service

  • First episode of shoulder trauma or dislocation in a patient:
    • where their occupation or job requires working with their hands above shoulder height
    • at risk of further dislocations due to ongoing high-impact activities
    • at risk of instability due to structural pathology
  • Acute full thickness cuff tear with functional impairment (including following dislocation) 
  • Recurrent (more than one) dislocated shoulder or shoulder instability despite at least three months of active treatment that included: rehabilitation/physiotherapy, medications and avoidance of triggering events
  • Instability associated with structural pathology in a patient (e.g. superior labral anterior posterior (SLAP) lesion, large Bankart lesion)

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 
  • If referral relates to injury, detail: date, mechanism, severity, recurrence and evolution of injury
  • Findings on physical examination including loss of range of movement and neurological examination
  • If recurrent dislocation
    • ease and method of dislocations
    • details of previous medical and non-medical management including the course of treatments and outcome of treatments
  • Hand preference and how symptoms are impacting on daily activities including impact on work, study or carer role and level of sleep disturbance
  • x-rays of the affected shoulder, instability views: anteroposterior (AP) view of Glenohumeral joint, lateral view, superior-inferior (SI) view and axillary lateral view of the affected shoulder
  • Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs)

Provide if available

  • Ultrasound report (including details of the diagnostic imaging practice)
  • MRI scan (including details of the diagnostic imaging practice)
  • 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.
There are other statewide referral criteria that include reference to shoulder pain:

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

  • 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

  • First episode of shoulder trauma or dislocation without any of the following risk factors:
    • where the person’s occupation or job requires working with their hands above shoulder height
    • at risk of further dislocations due to ongoing high-impact activities
    • at risk of instability due to structural pathology
  • Acute full thickness cuff tear without functional impairment following dislocation 
  • Recurrent (more than two) dislocated shoulder or shoulder instability where at least three months of active treatment that included: medications, rehabilitation or physiotherapy and avoidance of triggering events has not been trialled.