This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Referral criteria from primary care - shoulder pain

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The patient should be referred to an orthopaedic specialist if there is

  • pain and significant disability lasting more than six months
    • this is continuing pain and disability despite attention to occupation or sporting factors and, if appropriate, physiotherapy and steroid injections
  • history of instability ("Has your shoulder ever partly or completely come out of joint?" "Are you worried that your shoulder might slip on certain movements?") or acute, severe post-traumatic acromioclavicular pain
  • diagnostic uncertainty
  • red flag criteria e.g.
    • history of cancer
      • symptoms and signs of cancer
      • unexplained deformity, mass, or swelling:? possible tumour
    • red skin, fever, systemically unwell - suggestive of infection
    • trauma, epileptic fit, electric shock; loss of rotation and normal shape - could the presentation represent an unreduced dislocation
    • trauma, acute disabling pain and significant weakness, positive drop arm test - possible acute rotator cuff tear
    • unexplained significant sensory or motor deficit:? neurological lesion > neurosurgical referral


  1. Mitchell C et al. Shoulder pain: diagnosis and management in primary care. BMJ 2005; 331:1124-8

Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.