When should I consider referring a patient with a rotator cuff injury to a specialist for further evaluation or surgical intervention?

Consider referring a patient with a rotator cuff injury to a specialist urgently if there is:

• Acute trauma with pain, weakness, or sudden loss of active arm elevation, suspecting an acute rotator cuff tear.
• Persistent pain and weakness 2-3 weeks after a shoulder dislocation, indicating possible rotator cuff tear.
• Failure to improve in pain and function after 3 months of conservative treatment.
• Severe post-traumatic pain or significant impact on work or athletic activities.
• Recurrent shoulder instability or history of traumatic dislocation, especially in younger patients.

Urgent referral to orthopaedics or a specialist shoulder clinic is recommended for acute rotator cuff tears caused by trauma and for suspected rotator cuff tears following dislocation.

Further imaging (ultrasound or MRI) is advised for people over 40 to assess rotator cuff integrity and guide the need for surgery.

Early referral is important to allow timely surgical repair when indicated, particularly in younger patients or those with high functional demands.