Shoulder injury
in Rockhampton
After an acute shoulder injury — fall, sport, tackle, or sudden overload — the priority is sorting out what has actually been damaged. Most injuries do not need surgery; the few that do tend to do best when seen early. The practice triages urgent referrals within a week.
What is going on
Acute shoulder injuries fall into a small number of patterns — dislocation, soft-tissue (cuff or labrum) tear, and bony injury (clavicle, proximal humerus, AC joint). The history of the mechanism plus the immediate aftermath usually narrows which of these is in play. Numbness, deformity, complete weakness, or persistent severe pain after a fall all warrant early imaging.
The sooner the right diagnosis is made, the cleaner the treatment pathway. Acute rotator cuff tears repair best within 6–12 weeks; first-time dislocations have decisions to make about immobilisation length and whether stabilisation is sensible; displaced fractures sometimes need fixation, and sometimes do better in a sling. The shoulder anatomy education page sets out how the joint works as background for the diagnoses below.
The diagnoses behind the trauma
Each of the injuries below has a characteristic mechanism and a characteristic recovery pathway. The consult sorts out which fits the presentation and what to do about it.
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Anterior dislocation and instability
The shoulder pops out of joint forwards, usually after a fall on an abducted arm or a tackle. Dislocation in patients under 25 has a high recurrence rate; once the shoulder has dislocated more than once, surgical stabilisation is usually offered. Older patients more often have an associated rotator cuff tear that needs separate attention.
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Acute rotator cuff tear
Sudden weakness or pain after a fall, lift or pull — particularly inability to lift the arm out to the side. Acute full-thickness tears are best repaired within 6–12 weeks before the muscle retracts and the tendon scars. Imaging (ultrasound or MRI) is arranged urgently when the picture suggests this.
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Clavicle fracture
Break of the collarbone, almost always from a direct blow or a fall onto the shoulder. Most heal well in a sling without surgery. Surgical fixation is offered for displaced fractures (more than 2 cm of shortening or significant tilt) and for the small minority that fail to unite.
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Proximal humerus fracture
Break of the upper end of the humerus, classically a fall onto an outstretched hand in an older patient. Most are managed in a sling with early movement; displaced or unstable fractures, particularly four-part patterns, may need fixation or replacement. The decision is individualised to the patient and the fracture pattern.
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AC joint separation
Disruption of the ligaments holding the clavicle to the acromion, from a direct blow to the top of the shoulder — bike falls, tackles, motorbike accidents. Lower-grade separations settle without surgery. Higher-grade separations with marked deformity benefit from surgical stabilisation, particularly in younger or active patients.
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SLAP and biceps tears
Tear of the superior labrum, often from a traction injury or repeated overhead loading — common in throwing athletes and after old shoulder injury. Anterior shoulder pain with mechanical clicking is the typical story. Treatment depends on age and tear pattern; biceps tenodesis is the workhorse for symptomatic tears in middle-aged patients.
The threshold for urgent referral
Acute shoulder injury is best seen sooner rather than later when any of the following apply:
- The shoulder dislocated, even if it has gone back in by itself.
- You cannot lift the arm out to the side after the injury.
- Numbness or pins-and-needles in the arm or hand.
- Visible deformity of the shoulder, clavicle or upper arm.
- Severe pain that is not settling with the first few days of rest and ice.
- An ultrasound or X-ray has shown a cuff tear or fracture.
- The shoulder has dislocated more than once.
For chronic or non-traumatic shoulder pain that has built up over weeks or months, see the shoulder pain page. For all referrals, the GP letter and any imaging — even partial reports — make the first consult more efficient.
How an acute consult works
Acute injury referrals are triaged and offered the next available slot, usually within a week. The first consult runs through the mechanism of injury, what happened immediately afterwards, and what has and has not improved since. Examination focuses on the structures suspected from the history — cuff strength, joint stability, neurovascular function, and tenderness over bony landmarks. Imaging is reviewed; further imaging is arranged from the consult if the picture is incomplete.
Hand and physiotherapy are coordinated on-site through Ruby Doolan's practice (Extend Rehabilitation), so post-consult and post-operative therapy stays in one place. Fees, Medicare rebates and the surgery-quote process are on the fees page; GPs can find the urgent-referral pathway and what to include in the letter on the referrer page.
Across Central Queensland
Patients are seen for acute shoulder injuries from Rockhampton and the wider region. Drive time and scheduling notes are on each catchment page:
Patient questions we hear most
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I've just dislocated my shoulder — what do I do?
If the shoulder is still out of joint, get to an emergency department for reduction. Once it's back in, get a plain X-ray to confirm reduction and exclude fracture, then a sling for two to three weeks. Specialist follow-up should happen within a few weeks because the next decisions — imaging, immobilisation duration, whether to consider stabilisation surgery — depend on age and on whether this is a first or repeat dislocation. The practice triages these urgently.
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I fell on my shoulder a few weeks ago and it isn't getting better — should I worry?
Persistent shoulder pain or weakness more than 4–6 weeks after a fall is worth a specialist look. Common explanations are an unrecognised cuff tear, an undisplaced fracture that has not been investigated, or a labral injury. Most are still managed without surgery, but the longer a structural injury sits unidentified the harder some of them are to fix later. An ultrasound or X-ray organised at GP level before consult is useful.
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Do all clavicle fractures need surgery?
No — most are managed in a broad-arm sling with active mobilisation when comfortable, and heal without intervention over 6–12 weeks. Surgery is offered for fractures that are markedly displaced (more than 2 cm of shortening, or significant tilt), comminuted fractures in active patients, and the small minority of fractures that fail to unite by three months. The decision is made on the X-ray pattern and the patient's age and activity level.
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How urgent is a rotator cuff tear after a fall?
Acute full-thickness tears are best repaired within 6–12 weeks of the injury before the muscle retracts and the tendon scars. After that window, repair is still possible but less reliable. Anyone with sudden weakness lifting the arm after a fall should have an ultrasound urgently and a specialist opinion soon after. Partial tears and chronic-on-acute tears are less time-critical but still warrant assessment.
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Can I drive after a shoulder injury?
Driving needs both hands on the wheel, full upper-limb range of motion to operate steering and indicators, and an unimpaired reaction time. Most patients in a sling cannot safely drive. The practical answer depends on the injury, the side affected, and whether you drive an automatic. The safest rule is to wait until the sling is off and the shoulder can perform an emergency steering correction without pain — the consult or post-op review confirms when that is.
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Will I need imaging before the consult?
Plain X-rays of the shoulder are useful for any acute injury and can usually be organised by your GP. Ultrasound is the next step for suspected cuff tears. CT is sometimes added for complex fractures. MRI is reserved for cases where surgery is being planned. Bringing whatever imaging exists — films and reports both — is more useful than the report alone. Further imaging is arranged from the consult if needed.
Speak to the practice
about your shoulder
Acute injury referrals are triaged urgently. Bring the referral and any imaging you have — the practice handles the rest.
