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.
- acute inflammation, e.g. hemarthrosis or tense effusion
For clinical advice, please telephone the relevant specialty service.
Central Adelaide Local Health Network
- Royal Adelaide Hospital (08) 7074 0000
- The Queen Elizabeth Hospital (08) 8222 6000
Northern Adelaide Local Health Network
- Lyell McEwin Hospital (08) 8182 9000
- Modbury Hospital (08) 8161 2000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
- Noarlunga Hospital (08) 8384 9222
Exclusions
- Frozen shoulder (adhesive capsulitis)
Triage categories
Category 1 — appointment clinically indicated within 30 days
- suspected malignancy
Category 2 — appointment clinically indicated within 90 days
- shoulder dislocation with or without suspected or confirmed cuff tear including acromioclavicular and glenohumeral joints
- instability associated with bone structural pathology or ‘bony Bankart lesion’
- calcific tendonitis
Category 3 — appointment clinically indicated within 365 days
- recurrent dislocated shoulder
- shoulder instability
- shoulder osteoarthritis following trial of corticosteroid injection
- elbow tendonitis (golfers/tennis elbow)
- tendonitis/bursitis
- superior labrum anterior to posterior/Bankart lesion
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.
- complete past medical history
- current medication list
- body mass index (BMI)
- previous surgery
- private health cover/compensable status e.g. WorkCover claims
- management history including:
- injury/trauma if relevant
- onset and duration
- pain
- associated features, e.g. functional impairment
- use of immobiliser/splint/cast
- allied health reports
- neurological/neurovascular assessment
- functional range of motion (ROM)
- ultrasound (US) for suspected rotator cuff injury
- plain X-ray anterior posterior/lateral views include radiological details/accession number
Additional information to assist triage categorisation
- complete blood examination (CBE)
- electrolytes, urea, creatinine (EUC)
- liver function tests (LFTs)
- estimated glomerular filtration rate (eGFR)
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- rheumatoid factors
- uric acid
Clinical management advice
Consideration of risks versus benefits of surgical intervention may include:
- age
- frailty
- 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.
Ensure alternative causes for shoulder pain have been considered, these may include inflammatory arthritis, or suspected multiple myeloma.
History of inflammatory disease; consider referral to rheumatology.
Clinical resources
- HealthPathways SA - Frail But Stable Older Adults (log in required)
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.