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Dr Kalman Piper

For referrers

GPs, physiotherapists, and other clinicians

A practical guide for referring colleagues. How to send a patient, what imaging is useful before referral, what to expect on wait times, and condition-specific notes from Dr Piper's practice.

How to refer

Sending a patient

Referrals are accepted by HealthLink, fax, email, or by patient hand-delivery. Patients can also book online; reception will request a referral if Medicare rebates apply.

Send the referral

What to include

  • Patient demographics and Medicare details
  • Affected side and dominant hand
  • Symptom history, mechanism if traumatic, and prior treatment including any previous surgery on the shoulder or elbow
  • Examination findings if relevant
  • Imaging reports and copies of the actual scans where possible
  • Relevant medical history, especially diabetes, anticoagulation, smoking status, and BMI
  • Workers compensation or third-party claim details if applicable

Imaging

Useful imaging before referral

Imaging is not always required before referral, particularly for assessment-only consultations. When a clear surgical question is present, the following imaging is usually most helpful:

  • Suspected rotator cuff tear: Plain x-rays (AP and outlet view) plus MRI of the shoulder. Ultrasound can be useful in primary care but MRI is more accurate for surgical planning.
  • First-time dislocation or instability: Plain x-rays after reduction (post-reduction films) plus MRI. CT is added when bone loss is suspected, particularly for recurrent dislocators.
  • Suspected SLAP tear: MRI arthrogram is more sensitive than standard MRI for labral pathology.
  • Frozen shoulder: Plain x-rays to exclude arthritis. MRI is not required for the diagnosis but can be useful when the clinical picture is mixed.
  • Shoulder arthritis or cuff arthropathy: Plain x-rays (AP, outlet, and axillary views). CT is added if shoulder replacement is being considered, for pre-operative planning.
  • Trauma: Plain x-rays as the first investigation. CT for displaced or comminuted proximal humerus fractures and scapular fractures.

If imaging has been ordered or is in progress, the patient can be referred without waiting for the report. Reception can hold the appointment until imaging is completed.

Triage

When to refer urgently

The following situations should prompt earlier review rather than the standard wait. For acute trauma, please contact Dr Piper directly or send the patient via the Westmead Hospital emergency department.

  • Acute traumatic rotator cuff tear in a younger patient

    Earlier surgery improves the chance of tendon healing. Refer within the first few weeks where possible.

  • Recurrent dislocations

    Recurrence rates climb quickly with repeated dislocations, particularly in young active patients. Refer after the second dislocation rather than waiting.

  • Displaced proximal humerus fracture

    Refer urgently. The window for fixation versus replacement narrows quickly, especially in older patients.

  • Suspected septic arthritis

    Send to the emergency department. Do not wait for an outpatient appointment.

  • Acute shoulder weakness with high-energy mechanism

    Consider nerve or massive cuff injury. Refer for urgent review.

  • Workers compensation claims

    Earlier specialist review helps establish causation and expedites the treatment pathway. Mention claim details in the referral.

Reference

Detailed condition pages

The condition and procedure pages on this site cover anatomy, pathology, treatment options, and recovery in patient-friendly terms. Useful as adjunct material for patient education during a consultation.