MSK & Orthopaedics

Policies

Arthroscopic hip surgery Arthroscopic lavage and debridement (not routinely commissioned) Arthroscopic shoulder decompression Botulinum toxin type A injection to masticatory muscles Carpal tunnel syndrome release Dupuytren’s contracture release in adults Exogen ultrasound bone healing (exogen therapy) Extra corporeal shockwave therapy (ESWT), ankle, elbow, heel, hip, shoulder (not routinely commissioned) Ganglion excision Helmet therapy for treatment of positional plagiocephaly/brachycephaly in children Hip and knee replacement Hip arthroplasty (choice of implant) Ilizarov technique / Taylor spatial frame (TSF) (frame surgery) Lumbar radiofrequency facet joint denervation Open, wide bore and upright magnetic resonance imaging (MRI) Spinal epidural injections Spinal fusion surgery Tenotomy for curly toes in children Trigger finger release in adults Ultrasound guided injection (USGI) of soft tissue or joints Vertebral augmentation for painful osteoporotic vertebral fractures

Pathways

Acromioclavicular (AC) joint pain Anterior knee pain Back pain (acute motor loss) Back pain (cauda equina syndrome) Bone protection service Carpal tunnel syndrome Elbow osteoarthritis Elbow tendinopathy FAI syndrome Gout Greater trochanteric pain syndrome (GTPS) Hip impingement syndrome Knee ligament injury Lower limb, hip and knee osteoarthritis Lumbar spine Plantar fasciitis Podiatry community service Sports hernia Stiff shoulder Sub-acromial pain syndrome and rotator cuff disorders Wrist and hand osteoarthritis Wrist and hand tendon

Additional information

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Please send all referrals for MSK, Orthopaedic surgery and Orthopaedic opinion to the MSK service. Please only refer exclusions directly to Trauma and Orthopaedics.
MSK Exclusion Criteria (Next Review: April 2025)
Patients with Red Flags should be referred by their GP straight to secondary care. Patients who are found to have red flags, once within the service, should be referred back to their GP or elsewhere if clinically urgent and appropriate.
Exclusion criteria:
• Suspected cancer;
• Existing Rheumatoid or other known inflammatory arthritis unless recommended by Rheumatology team;
• Active psychiatric condition which would significantly interfere with assessment or treatment process and minimise likely benefit;
• Immediate life threatening condition;
• Dupytron’s Contracture
• Spinal scoliosis
• Suspected fracture and/or unreduced dislocation;
• Suspected infection caused by an MSK complaint;
• MSK or any other conditions in children (aged 17 and under);
• Patients not registered with a NHS Vale of York Clinical Commissioning Group GP Practice;
• Any non-related MSK conditions;
• ‘Red flag’ symptoms (e.g. severe/constant pain, systemically unwell (fever, malaise, rigors), significant weight loss suggestive of serious infection or malignancy as declared in the GP letter of referral, or discovered at first consultation in the service – this is not an exhaustive list;
• Non mechanical pain – constant, progressive, unrelated to posture/activity;
• Undiagnosed neurological symptoms unless recommended by Neurology team;
• Pregnancy related MSK condition;
• Immediate post-operative rehabilitation;
• Gynaecology related physiotherapy;
• Suspected cauda equina signs and symptoms;
• Post-operative complications, i.e. loose prosthesis.
• Soft tissue lumps and bumps e.g. ganglions

Orthopaedic Optimising Outcomes

GP Communications

Local Authorities' Exercise Programmes and Referrals

Latest Developments of Fracture Clinic Services

Patients seen in accident and emergency with musculoskeletal injury who do not require immediate admission are referred into the fracture clinic run by a cohort of orthopaedic doctors, senior orthopaedic practitioners and more recently sports and exercise physicians, all of whom have a subset of specialist skills. Historically these patients were booked into the next available clinic slot.

More recently a virtual fracture has been developed in department in which all these patients are booked into a list or ‘virtual clinic’ which is reviewed by a consultant every weekday morning with the images and documentation. Patients are then booked into the most appropriate specialist clinic at the most appropriate time or discharged with telephone advice. This has reduced unnecessary early reviews, reduced transfer of patients between subspecialists and has provided an additional layer of safety for patients in which missed injuries are picked up early.

Due to the risks of corona virus exposure there has also been a significant push to telephone consultations rather than face to face. These clinics have been welcomed by the majority of patients who have found the experience easier and less time consuming, and generally more likely to run on time. This is likely to remain in the long term with plans afoot to develop telephone pods specifically for phone consultations and the development of video reviews.