Assessment of atraumatic shoulder conditions in children

Specialty: Children's Orthopaedic
Age group: Children

Criteria for referral to public hospital service

• Recurrent (more than one) dislocated shoulder or shoulder instability despite at least 3 months of active treatment that included: physiotherapy/rehabilitation, medications (anti-inflammatories, paracetamol or corticosteroid injection) and avoidance of triggering events
• Instability associated with structural pathology in a patient (e.g. superior labral anterior posterior (SLAP) lesion, large Bankart lesion)
• Functional impairment that persists despite at least 3 months of active treatment that included: physiotherapy/rehabilitation, medications (anti-inflammatories, paracetamol or corticosteroid injection) due to the following shoulder conditions:
  • adhesive capsulitis (frozen shoulder)
  • chronic rotator cuff tear
  • non-traumatic acromioclavicular (AC) joint problems
  • tendinopathy.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the child, or their carer, and the referring clinician from referral to the health service
• Findings on physical examination including loss of range of movement and neurological examination
• Description of joint affected and onset, nature and duration of symptoms
• If recurrent dislocation
  • ease and method of dislocations
  • details of previous medical and non-medical management including the course of treatments and outcome of treatments
• Hand preference and the functional or psychological impact on quality of life or activities of daily living including impact on work, study, social activities or carer role
• Pain history: onset, location, nature of pain and duration
• History of and response to physiotherapy
• Child’s age
• X-ray of the affected shoulder: anteroposterior (AP), lateral view and axillary lateral views of Glenohumeral joint (including details of the diagnostic imaging practice).

Provide if available

• Ultrasound report (including details of the diagnostic imaging practice)
• MRI scan (including details of the diagnostic imaging practice)
• Allied health assessment(s)
• If inflammation is suspected: full blood examination and inflammatory marker results (erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP))
• Statement about the parent(s) or guardian’s interest in having surgical treatment if that is a possible intervention
• If the child is neurodiverse, gender diverse or has a disability
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If the child is aged 14 to 18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• The following shoulder conditions where there is no functional impairment, or when at least 3 months of active treatment that included: physiotherapy/rehabilitation and medications (anti-inflammatories, paracetamol or corticosteroid injection) has not been trialled:
  • non-traumatic acromioclavicular (AC) joint problems
  • rotator cuff tear
  • shoulder pain or stiffness, including shoulder adhesive capsulitis (frozen shoulder)
  • tendinopathy.