Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Indications for referring a patient with shoulder pain to secondary care for further evaluation include:
- Urgent referral if any red flags are identified such as trauma with pain and weakness or sudden loss of ability to actively raise the arm, suspecting an acute rotator cuff tear NICE CKS.
- Presence of any shoulder mass or swelling, which may indicate malignancy NICE CKS.
- Signs of infection such as red skin, painful joint, fever, or systemic unwellness, suspecting septic arthritis NICE CKS.
- Trauma causing loss of rotation and abnormal shoulder shape, suggesting possible shoulder dislocation NICE CKS.
- New symptoms of inflammation in several joints, suspecting inflammatory arthritis NICE CKS.
- Systemic symptoms including fever, night sweats, weight loss, or new respiratory symptoms warrant urgent investigation or referral NICE CKS.
- Undiagnosed severe shoulder pain or severe restriction of movement NICE CKS.
- History of trauma with acute presentation, requiring same-day emergency assessment for suspected joint infection, unreduced dislocation, or acute trauma as per clinical judgement NICE CKS.
- Suspected malignancy based on past cancer history, symptoms, signs, mass, unexplained deformity, or lymphadenopathy, following the local 2-week referral pathway NICE CKS.
- Acute rotator cuff tear caused by trauma, requiring urgent orthopaedic referral and specialist shoulder clinic assessment NICE CKS.
- Suspected inflammatory arthritis, following local rheumatology referral pathways NICE CKS.
- Neurological lesions presenting with unexplained wasting or significant motor or sensory deficit, requiring discussion with neurology, neurosurgery, or orthopaedics NICE CKS.
- Recurrent shoulder instability NICE CKS.
- Severe post-traumatic pain or pain significantly impacting work or athletic activities NICE CKS.
- Failure to improve pain and function after 3 months of conservative treatment NICE CKS.