Clavicle and shoulder trauma in children

Specialty: Children's Orthopaedic
Age group: Children

Criteria for referral to public hospital service

• First episode of shoulder trauma or dislocation in a patient
  • at risk of further dislocations due to ongoing high-impact activities
  • at risk of instability due to structural pathology
  • multidirectional instability associated with overhead movements
• Acute full thickness cuff tear with functional impairment (including following dislocation)
• Child older than 14 years with completely displaced clavicle fractures (that is off ended)
• Persistent pain (longer than 2 weeks) not improving at the fracture site, with ongoing disability.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the child, or their carer, and the referring clinician from referral to the health service
• Description of joint affected and onset, nature and duration of symptoms
• Date, mechanism, severity, recurrence and evolution of injury
• Pain history: onset, location, nature of pain and duration
• Findings on physical examination including loss of range of movement and neurological examination
• Child’s age
• Hand preference and the functional or psychological impact on quality of life or activities of daily living including impact on work, study, social activities or carer role
• X-rays for shoulder conditions affected shoulder, instability views: anteroposterior (AP) view of Glenohumeral joint, lateral view, superior-inferior (SI) view and axillary lateral view of the affected shoulder (including details of the diagnostic imaging practice).

Provide if available

• Ultrasound report (including details of the diagnostic imaging practice)
• MRI scan (including details of the diagnostic imaging practice)
• Statement about the parent(s) or guardian’s interest in having surgical treatment if that is a possible intervention
• If the child is neurodiverse, gender diverse or has a disability
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If younger than 18 years if they may have been harmed, or at risk of harm
• If the child is aged 14 to 18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• First episode of shoulder trauma or dislocation without any of the following risk factors
  • at risk of further dislocations due to ongoing high-impact activities
  • multidirectional instability associated with overhead movements
  • at risk of instability due to structural pathology
• Acute full thickness cuff tear without functional impairment following dislocation.