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Peripheral entrapment neuropathies including CTS (Plastic and Reconstructive Surgery)

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


  • Airway compromise
  • Uncontrolled bleeding
  • Acute burns
  • Uncontrolled sepsis including hand infections
  • Complex facial fractures
  • Compound fractures
  • Threat to limb viability
  • Hand fractures (open or closed)
  • Acute fingertip injuries
  • Tendon injuries
  • Acute development of peripheral nerve compression symptoms following trauma or acute event
  • Lacerations and wounds not suitable for primary health management e.g. lip lacerations, large facial lacerations, lacerations with altered sensation, large skin defects.

Paediatric

  • Amniotic band compromising circulation

 

 

  • Refer to HealthPathways or local guidelines
  • CTS can be referred to the following specialities but will be triaged in a unified manner by all specialities concerned:
    • Orthopaedics
    • Plastic and Reconstructive surgery
    • Neurosurgery
    • General Surgery
    • Neurology
  • Chronic disease requires to be optimized prior to referral or the patients may not proceed to surgery

 

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Severe disabling symptoms with weakness and wasting and NCS confirmation of diagnosis
  • Category 2
    (appointment within 90 calendar days)
    • Very frequent/continuous symptoms without weakness or wasting and any one of:
      • rapid progression
      • recurrence after surgical decompression
      • failed maximum medical management (refer Healthpathways)
  • Category 3
    (appointment within 365 calendar days)
    • Intermittent symptoms without weakness or wasting after 6 months maximum medical management
    • Ulnar entrapment neuropathy without weakness or wasting when no response to ≥ 6 months of maximal management

     

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

  • Detailed clinical examination with sensory mapping, presence of neurological deficit and functional assessment (include impacts on ADL and employment)
  • Management to date (include allied health input and steroid injections)
  • NCS required for Cat 1 cases only (where available and does not cause significant delay to patient accessing outpatient service)

3. Additional referral information Useful for processing the referral

  • XR results - AP and lateral (of region) (if available)
  • Nerve conduction studies (NCS) (where available and does not cause significant delay to patient accessing outpatient service)
  • OT/Physio report when available

4. Request

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.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate 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.