When to Refer

gfx_office66
The quick answer is... whenever you wish! You probably are looking for a little more information so let me try to elaborate.


First of all, please know that I am 100% at your service. If you want a patient seen FAST...just let me know and I'll see them the same or next day. I'm also available if you'd just like to discuss a patient over the phone. Call my office and let them know you are a physician and they will give you my cell phone number

Urgent / Semi-Urgent Referrals:

  • Fractures
    • Fractures about the shoulder are quite common in the elderly and unfortunately extremely painful. I try to see all fracture patients within 2 to 3 days o f their injury. Approximately 50% of proximal humerus fractures need surgery while the other 50% are treated symptomatically
  • Rotator cuff tears
    • ACUTE rotator cuff tears most commonly occur from a traumatic event. These tears typically do better with relatively quick operative intervention (within a month or so). The longer a rotator cuff tear remains untreated the greater the chance that the torn tissue can retract and eventually become un-reparable. I would love to see these patients within a few weeks of their injury.
  • Shoulder Dislocations
    • Much controversy exists regarding shoulder dislocations. In general, dislocations which occur in young atheletes often require operative fixation because they are almost always associated with labral tears. Dislocations which occur in patients between the ages of 25 to 55 usually do great with non-operative intervention. And dislocations in patients older than 55 have a high association with acute (and usually large) rotator cuff tears - so these often end up needing surgery as well. To be on the safe side...it's probably wise to refer shoulder dislocations to me within a week or so. Of course if you think it may still be dislocated - I need to see that the very same day!
  • Frozen Shoulder
    • This is definately NOT an emergency...however it is one of the more painful shoulder conditions. I will usually perform an intraarticular shoulder injection at their first visit. Since the intraarticular injetion is MUCH more difficult than the subacromial injection (and since the subacromial injection typically doesn't work too well), I suggest you refer these patients relatively quickly...within a few weeks.
  • Suspected infection
    • Although spontaneous shoulder infections are extremely rare...they still occur. Feel free to call and I will see the patient the very same day if I am in town.

Non-Urgent Referrals:
  • Shoulder Pain
    • Probably the most common reason for shoulder and arm pain is the continum of bursitis / tendonitis / impingement. This problem is often relieved with a subacromial injection and physical therapy. I am happy to see shoulder pain patients from the very begining of their symptoms. If you prefer to treat them initially I think it is fine to give them one or two subacromial injections prior to referral if you wish. I think it is completely up to you and the patient how you choose to proceed with this referral.
    • MRI's...
      • This is up to you... If you choose to get the MRI prior to referral please make sure the patient asks for a CD-ROM copy of the scan so I can look at the actual films during their visit.
      • One argument for referral before MRI is that sometimes the exact types of scans I order depends on their physical exam. One example is that in patients who I suspect a subscapularis tear - I have the technologist position their arm in an adducted / internally rotated position during the scan. This increases the sensitivity of the scan.
  • Scapular Pain
    • This common shoulder problem is frequently secondary to a muscle imbalance in the peri-scapular muscles and usually responds well to a physical therapy course which focuses on the scapula. I'm happy to see these patients any time.