Shoulder and elbow conditions
Adult

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Useful Management Information

No useful management information

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Suspicion of malignancy First episode of shoulder dislocation in a patient with suspected or identified cuff tear Acute full thickness cuff tear with loss of active range of motion
Category 2 (appointment within 90 calendar days)	First episode of shoulder dislocation in a patient without suspected or identified cuff tear Recurrent dislocated shoulder/shoulder instability Instability associated with structural pathology in a patient e.g. SLAP lesion, large Bankart lesion
Category 3 (appointment within 365 calendar days)	Functional impairment and/or pain of shoulder/elbow and failed maximal medical management AC joint conditions Chronic weakness and degenerative rotator cuff Rotator cuff tendinopathy sub-acromial impingement Pain/stiffness in elbow not responding to maximal medical management Elbow tendonitis Shoulder adhesive capsulitis (frozen shoulder)
If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

Essential Referral Information

History of symptoms – including duration, recurrence of injury and mechanism, severity or evolution of injury, pain and functional impairment, activities of daily living
Arm range of motion with any neurological examination/signs
X -ray results - AP & lateral shoulder/elbow
Ultrasound results (if suspected rotator cuff pathology)

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

Management to date
Relevant allied health report (if available)
According to clinical suspicion
- CT/MRI results
According to clinical suspicion
- protein electrophoresis
- immunoglobulins
- calcium and phosphate
- rheumatoid serology
If inflammation/ infection suspected
- FBC
- ESR
- CRP

Send Referrals To

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Facilities

No facilities listed

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Shoulder and elbow conditionsAdult