Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • development of peripheral nerve compression symptoms following trauma or acute event

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 - appointment clinically indicated within 30 days

  • acute sudden onset severe carpal tunnel symptoms suggestive of acute nerve compression

Category 2 — appointment clinically indicated within 90 days

  • progressive neurologic changes with muscle wastage
  • symptom recurrence post-surgical decompression

Category 3 — appointment clinically indicated within 365 days

  • intermittent symptoms without weakness or wasting after 6 months maximum medical management
  • median/ulnar entrapment neuropathy without weakness or wasting when no response to equal to or greater than 6 months of maximal management
  • symptomatic nerve entrapment without muscle wastage and weakness with the following failed maximal medical management equal to or greater than 6 months duration

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • past medical/surgical history
  • current medications and dosages
  • allergies and sensitivities
  • presenting symptoms
  • nerve conduction study
  • management history including:
    • injury/trauma if relevant
    • onset and duration
    • severity
    • pain
    • associated features, e.g. functional impairment
    • use of immobiliser/splint/cast
    • treatments trialled/implemented prior to referral
  • sensory or motor deficit distribution, e.g. median, ulnar, or radial nerves

Additional information to assist triage categorisation

  • ultrasound median or ulnar nerve
  • previous related allied health reports and summaries

Clinical management advice

Please note that hand and wrist referrals can be managed by the following specialist services:

For mild to moderate carpal tunnel syndrome, consider allied health referral for hand therapy prior to specialist outpatient referral.

It is strongly recommended that people who smoke or vape stop 3 months prior to consultation. Smoking/vaping is associated with delayed healing. Refer to Clinical management advice and resources for further information.

If the patient requires urgent attention and/or fulfils category 1 triage criteria, please contact the on-call registrar to discuss and ensure your referral has been received.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.