Referral criteria from primary care - frozen shoulder

Frozen Shoulder - Referral Criteria for Secondary Care (1)

• cases of atypical presentation or marked functional limitation
• persistence of pain despite primary care interventions beyond three months

When managing possible frozen shoulder then consider red flags for the shoulder pain

Refer to Emergency Department if you suspect fracture, dislocation, or infection

Acute severe shoulder pain needs proper and competent diagnosis. Any shoulder "red flags" identified during primary care assessment needs urgent secondary care referral (2):

• suspected infected joint needs same day urgent referral
• unreduced dislocation needs same day urgent referral
• suspected malignancy or tumour needs urgent referral following the local 2-week cancer referral pathway
• an acute cuff tear as a result of a traumatic event needs urgent referral and ideally should be seen in the next available outpatient clinic
• suspected inflammatory oligo or poly-arthritis or systemic inflammatory disease should be considered as a 'rheumatological red flag' and local rheumatology referral pathways should be followed

Reference:

• Karbowiak M, Holme T, Mirza M, Siddiqui N. Frozen shoulder BMJ 2022; 377 :e068547 doi:10.1136/bmj-2021-068547
• Rangan A, Goodchild L, Gibson J, et al. Frozen Shoulder [published correction appears in Shoulder Elbow. 2016 Jul;8(3):215]. Shoulder Elbow. 2015;7(4):299-307. doi:10.1177/1758573215601779