HNY Policy and Pathway Repository - Humber

When patients present to primary care with shoulder pain, DO NOT  refer for ultrasound diagnostic or ultrasound guided steroid injection. Please follow Guidelines on Management below

In Absence of Red Flags

Step 1

Xray first, If NO red flags on xray and you suspect adhesive capsulitis, rotator cuff pathology including CHRONIC tears , calcific tendinopathy  or if xray shows glenohumeral joint /acromioclavicular joint OA :

Step 2

Refer to MSK services for physiotherapy assessment and rehabilitation

Landmark guided injection if appropriate. Can have up to two landmark guided injections in the 4-6 months post referral .If no improvement after 4-6 months:

Step 3

(For Hull this step will be undertaken directly by Healthshare)

Refer directly into orthopaedics. Do not refer to ultrasound for a diagnostic scan or a guided injection. Orthopaedics to use ultrasound when they deem it appropriate

Any red flags refer URGENTLY into the appropriate secondary care specialty. Red flags are:

• Any history or suspicion of malignancy
• Any suspicious mass or swelling
• Suggestions of infection, e.g. red skin, fever or systemically unwell
• Trauma, pain and weakness, or suspicion of an acute rotator cuff tear in patients aged 65 and under go through A&G for orthopaedics .
• Trauma, epileptic fit or electric shock leading to loss of rotation and abnormal shape.

No Guidelines on Management Listed

DO NOT REFER

Do not refer to this management pathway if you suspect a rheumatological cause - refer to rheumatology

Referral Criteria

All patients over 18 to be referred as per guidelines on Management

Referrals

For Xray – use eRs referral system- MUST include appropriate clinical information to justify imaging request under IR (ME) IR and include the phrase ‘AS PER SHOULDER PAIN REFERRAL PATHWAY’

• For Physiotherapyrefer to -
  • Hull Community MSK Service - (Healthshare escalates at stage 3) 
  • CHCP physiotherapy in the East Riding
• For orthopaedic referral-use standard Choose and Book referral method UNLESS concerned regarding red flags - then refer into appropriate secondary care specialty depending on clinical concern urgently.

Evidence Based Interventions - List 2 Guidance

Relevant clinical details. For shoulder Xray requests please indicate the referral is as per Shoulder Pain Referral Pathway