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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.