Achilles tendon pathology and rupture
ADULT
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
The list below includes common traumatic injuries that require referral to emergency and should not be referred for elective / fracture clinic categorisation
Adult
Shoulder and elbow conditions
- Clinically indicated e.g. suspected septic arthritis
- Evidence of acute inflammation e.g: haemarthrosis, tense effusion
- Irreducible glenohumeral dislocation with or without fracture
- Upper limb vascular compromise
- Elbow conditions - Dislocation with or without fracture
- Elbow conditions - Trauma with acute neurological or vascular compromise
Wrist and hand
- Uncontrolled sepsis including hand infections
- Upper limb radiculopathy in the presence of suspected cervical spine infection
- Acute development of peripheral nerve compression symptoms following trauma or acute event
- Suspected flexor sheath infection
- Suspected Septic arthritis
Bone & Soft Tumour
- Suspected malignancy
Hip and knee
- Suspected septic arthritis
- Knee extensor mechanism rupture
- Fracture
- Evidence of acute inflammation for example
- haemarthrosis
- tense effusion
- Suspected infection or sudden pain in arthroplasty
- if joint infection is suspected refer immediately to emergency or contact the orthopaedic registrar on call. Do not commence antibiotics unless delay to specialist review is likely
Foot and ankle
- Suspected septic arthritis
- Infected diabetic ulceration (systemic signs/symptoms)
- Displaced fracture of the ankle or hindfoot
- Acute achilles tendon rupture (if no fracture clinic available)
- Avulsion fracture of achilles tendon from calcaneus
Back and/or Neck Pain
- Cauda equina syndrome
- High energy spinal trauma
- Suspected epidural abscess or discitis
Trauma and fractures
- Acute cervical myelopathy
- Acute back or neck pain secondary to neoplastic disease or infection
- Spinal injuries
- Suspected open fracture
- Fracture requiring manipulation or operation
- Suspected acute bone or joint infection
- Acute high energy fracture with/without neurological abnormality
- Injury associated with vascular compromise
- Clavicle fracture
- Osteoporotic / pathological fracture new abnormal neurology
- Joint dislocations
- Open injuries with possible tendon or joint involved
- Nail bed injuries or retained foreign body
- Knee extensor mechanism rupture
- Acute peripheral nerve injury
- Suspected acute compartment syndrome
Hand Trauma
- Acute ligament injury
- Tendon rupture
- Open 'tooth knuckle' injury
Upper and lower limb trauma
- Open, unstable or suspected fractures
Other referrals to emergency not covered within these conditions
- Suspected open fracture
- Fracture requiring manipulation or operation
- Suspected acute bone or joint infection
- Acute high energy fracture with/without neurological abnormality
- Injury associated with vascular compromise
- Clavicle fracture
- Osteoporotic / pathological fracture new abnormal neurology
- Suspected infection or sudden pain in arthroplasty
- If joint infection is suspected refer immediately to emergency or contact the orthopaedic registrar on call
- do not commence antibiotics unless delay to specialist review is likely
- Joint dislocations
- Open injuries with possible tendon or joint involved
- Nail bed injuries or retained foreign body
- Knee extensor mechanism rupture
- Acute peripheral nerve injury
- Suspected acute compartment syndrome
Timing of first review appointments at orthopaedic outpatient's/fracture clinic
- if there is documentation indicating adequate alignment and satisfactory initial treatment of fracture – to be seen within 14 days of referral
- all other fracture cases, delayed presentation of tendon and nerve injuries - to be seen within 7 days of referral
Paediatric
Limping child/reluctant to weight bear
- Limping child with signs of:
- Being unwell, flushed, lethargic, fever, flat, anorexic and/or
- Irritable and stiff joint and/or
- Not improving
- Systemically unwell, febrile or suspicion of septic arthritis
- Concern of infection or trauma
- Suspicion or concern of non-accidental injury
NB See Slipped upper femoral epiphysis (SUFE) CPC
Slipped upper femoral epiphysis (SUFE)
- All suspected or confirmed SUFE should be referred to the ED or local orthopaedic on call registrar service no matter the chronicity
Scoliosis / Kyphosis
- Systemically unwell
- Abnormal neurological reason
Back pain
- Systemically unwell
Tumour – bone and soft tissue
- Suspected malignancy
- Clinically indicated e.g. suspected septic arthritis
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| Category 1 (appointment within 30 calendar days) |
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
2. Essential referral information Referral will be returned without this
- History including pain and associated dysfunction
- Examination findings including Thompson test if rupture suspected and neurovascular status
- MRI not required but negates requirement for other imaging if obtained
- USS for any tendinopathy (not required for Achilles rupture if examination confirms)
3. Additional referral information Useful for processing the referral
- Management to date
- X-ray for tendinopathy
4. Request
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Patient's Demographic Details
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Relevant clinical information about the condition
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Clinical modifiers
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
- Please note that where appropriate and available, the referral may be streamed to an associated public allied health and/or nursing service. This may include initial assessment and management by associated public allied health and/or nursing, which may either expedite or negate the need to see the public medical specialist.
- A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
- Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
Last updated: 3 December 2020
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