Peripheral nerve compression including carpal tunnel syndrome, ulnar nerve entrapment neuropathy, common peroneal and lateral cutaneous nerve of thigh compression syndromes

ADULT

  • 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.

    • Acute development of peripheral nerve compression symptoms following trauma
    • 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
    • Chronic disease requires to be optimised prior to referral or the patients may not proceed to surgery
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Peripheral nerve compression syndrome with
    • rapidly progressing and or severe neurological deficit or
    • associated with disabling pain syndrome
Category 2
(appointment within 90 calendar days)
  • Frequent and / or progressive peripheral nerve compressive symptoms with corresponding clinical signs
  • Recurrence of significant symptoms or clinical signs after surgical decompression
Category 3
(appointment within 365 calendar days)
  • Intermittent or mild symptoms of peripheral nerve compression failing to respond to reasonable and appropriate non- operative measures of greater than 6 months duration and considered to warrant assessment for surgical decompression

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

  • Duration and rate of progression of clinical symptoms
  • Clinical examination findings including neurological findings relating to compression neuropathy syndrome in question
  • Treatment trialled to date including physiotherapy and occupational therapy.
  • Relevant co-morbities e.g. diabetes, obesity, history of trauma

3. Additional referral information Useful for processing the referral

  • Nerve conduction studies (desirable and every effort to obtain, but should not cause significant delay for Cat 1 referrals)

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.)

  • 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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