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.
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
Northern Adelaide Local Health Network
Southern Adelaide Local Health Network
Dupuytren’s nodules without presence of functional impairment or contracture
Category 1 — appointment clinically indicated within 30 days
- severe contracture resulting in skin ulceration with or without infection
Category 2 — appointment clinically indicated within 90 days
- fixed flexion deformity +/- 60° metacarpal phalangeal joint (MCPJ) +/- 40° proximal interphalangeal joint (PIPJ)
- multiple joints or recurrent contracture with functional impairment post-surgery
- rapidly progressing contracture
Category 3 — appointment clinically indicated within 365 days
- flexion contractures +/- 30° MCPJ +/- 25° PIPJ
- functional impairment
For information on referral forms and how to import them, please view general referral information.
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.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- complete past medical history including relevant surgical history
- current medication list
- management history including:
- injury/trauma if relevant
- onset and duration
- associated features, e.g. functional impairment
- use of immobiliser/splint/cast
- treatments trialled/implemented prior to referral
- functional range of motion (ROM)
- tabletop testing (ability to flatten hands palms first onto tabletop)
- plain X-ray, include radiological details/accession number
Please note that hand and wrist referrals can be managed by the following specialist services:
- plastics and reconstructive surgery.
Consideration of risks versus benefits of surgical intervention may include:
- additional comorbidities
- patient expectations of outcome
- patient suitable for surgery, engagement in self-management
- body mass index (BMI) and weight loss
- smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation.
Optimisation of chronic medical conditions should occur as part of initial assessment and conservative management as this may impact on suitability for surgical intervention.
Proximal interphalangeal joint (PIPJ) contractures are more serious than metacarpal phalangeal joint (MCPJ) contractures.