Shoulder and Elbow Conditions


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.

The list below includes common traumatic injuries that require referral to emergency and should not be referred for elective / fracture clinic categorisation

  • Acute cervical myelopathy
  • Acute back or neck pain secondary to neoplastic disease or infection
  • Spinal injuries
  • Suspected open fracture
  • Fracture requiring manipulation or operation
  • Suspected acute bone or joint infection
  • Acute high energy fracture with/without neurological abnormality
  • Injury associated with vascular compromise
  • Clavicle fracture
  • Osteoporotic / pathological fracture new abnormal neurology
  • Suspected infection or sudden pain in arthroplasty
    • if joint infection is suspected refer immediately to emergency or contact the orthopaedic registrar on call
    • do not commence antibiotics unless delay to specialist review is likely
  • Joint dislocations
  • Open injuries with possible tendon or joint involved
  • Nail bed injuries or retained foreign body
  • Knee extensor mechanism rupture
  • Acute peripheral nerve injury
  • Suspected acute compartment syndrome
Useful Management Information

Refer to HealthPathways or local guidelines


  • 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
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 ROM
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 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
Standard Referral Information

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

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, BMI), 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

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

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • 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

Essential referral information

Without this information the referral will be returned

  • General referral information including current BMI
  • History of symptoms – including duration, recurrence of injury and mechanism, severity or evolution of injury, pain and functional impairment, activities of daily living
  • Arm ROM with any neurological examination/signs
  • XR results - AP & lateral shoulder/elbow
  • USS results if suspected rotator cuff pathology


  • Chronic disease requires to be optimized prior to referral or the patients may not proceed to surgery
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 results
Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.


To provide feedback about contents on this website or general referral questions please email or phone 3413 7402.