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Shoulder and elbow conditions

Emergency referrals

All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:

  • Royal Brisbane and Women's Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000
  • Redcliffe Hospital (07) 3883 7777
  • Caboolture Hospital (07) 5433 8888

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Refer directly to emergency if:
    • clinically indicated e.g. suspected septic arthritis
    • evidence of acute inflammation, e.g:
      • haemarthrosis
      • tense effusion
  • Suspicion of malignancy
  • First episode of shoulder dislocation in all patients >40 years old

Category 2

Appointment within 90 days is desirable

  • First episode of shoulder dislocation in a patient <25 years old
  • Recurrent dislocated shoulder/shoulder instability
  • Instability associated with structural pathology in a patient <40 years old e.g. SLAP lesion, large Bankart lesion
  • History of trauma suggests acute event / tear (rather than degenerative) rotator cuff tear

Category 3

Appointment within 365 days is desirable

  • 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 your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • 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

Other important information for referring practitioners

Not an exhaustive list

Management

  • Analgesia/NSAIDs as appropriate
  • Physiotherapy
  • Activity modification
  • Advice to avoid dislocation (recurrent)
  • Shoulder rehabilitation program
  • Chronic disease requires to be optimized prior to referral or the patients may not proceed to surgery
  • Consider corticosteroid injection for:
    • rotator cuff tendinopathy
    • AC joint pain
    • frozen shoulder where pain predominates (early stages)
    • shoulder OA if patient is unwilling/unsuitable for surgical management
    • sub-acromial impingement

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • General referral information
  • History of:
    • symptoms
    • duration
    • recurrence of injury and mechanism
    • severity or evolution of injury
  • Arm ROM with any neurological examination/signs
  • XR results – AP & lateral shoulder/elbow
  • USS results if suspected rotator cuff pathology

Additional referral information (useful for processing the referral)

  • Management to date
  • Physiotherapy assessment report
  • 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 results

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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

  • 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

  • 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
  • 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
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • 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

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • 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.)
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