What are the indications for referring a patient with shoulder pain to secondary care for further evaluation?

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 ¹.
• Presence of any shoulder mass or swelling, which may indicate malignancy ¹.
• Signs of infection such as red skin, painful joint, fever, or systemic unwellness, suspecting septic arthritis ¹.
• Trauma causing loss of rotation and abnormal shoulder shape, suggesting possible shoulder dislocation ¹.
• New symptoms of inflammation in several joints, suspecting inflammatory arthritis ¹.
• Systemic symptoms including fever, night sweats, weight loss, or new respiratory symptoms warrant urgent investigation or referral ¹.
• Undiagnosed severe shoulder pain or severe restriction of movement ¹.
• History of trauma with acute presentation, requiring same-day emergency assessment for suspected joint infection, unreduced dislocation, or acute trauma as per clinical judgement ¹.
• Suspected malignancy based on past cancer history, symptoms, signs, mass, unexplained deformity, or lymphadenopathy, following the local 2-week referral pathway ¹.
• Acute rotator cuff tear caused by trauma, requiring urgent orthopaedic referral and specialist shoulder clinic assessment ¹.
• Suspected inflammatory arthritis, following local rheumatology referral pathways ¹.
• Neurological lesions presenting with unexplained wasting or significant motor or sensory deficit, requiring discussion with neurology, neurosurgery, or orthopaedics ¹.
• Recurrent shoulder instability ¹.
• Severe post-traumatic pain or pain significantly impacting work or athletic activities ¹.
• Failure to improve pain and function after 3 months of conservative treatment ¹.