HNY Policy and Pathway Repository - York

MUSCULOSKELETAL SERVICE DIRECTORY OF SERVICE (DOS) The musculoskeletal service provides support to people with new or recurrent pain problems associated with their joints, soft tissues, and nerves. The service is split into two parts: The MSK physiotherapy team provide support, advice, and physiotherapy treatment to patients with new or recurrent MSK problems as well as those living with a long term MSK condition. The MSK advanced practice team support patients along established outpatient diagnostic pathways to determine the correct treatment and management options available to them and act as an interface to secondary care orthopaedic services.   Inclusion and exclusion criteria The MSK service accepts referrals for adult patients (>17 years) with new, recurrent, or long term MSK pain symptoms, providing they have no urgent medical need, and their symptoms are not attributable to an underlying systemic cause that requires alternative management. Indicative exclusions include: Non-MSK conditions E.g.: neurological conditions, podiatry referrals, inflammatory joint disease, fibromyalgia, balance disorders, mobility problems (including walking aid referrals), pregnancy related back pain, primary headache without neck pain, diastasis recti, bone health management referrals. Suspicion of serious pathology (i.e. malignancy, infection) Cauda equina syndrome, or symptoms suggestive of this diagnosis Acute motor loss symptoms or other progressive neurology Active cancer diagnosis or treatment unless pain symptoms explicitly proven to be an un-related condition Acute trauma including traumatic fracture or acute tendon rupture (except rotator cuff in patients >70 years), locked knee, hemarthrosis. Consider alternative urgent pathways (ED, urgent care centre, acute knee clinic, acute shoulder clinic) Suspected fragility fracture Active immunosuppressive therapy - unless infective cause explicitly excluded (normal bloods, no systemic signs) Specialist diagnostic work up or surgical opinion for scoliosis/spinal deformity Post-surgical problems i.e. painful prosthesis Undifferentiated lumps and bumps Patients requiring secondary care MDT pain clinic input - Referrers are encouraged to utilise secondary care pain services for patients with persisting spinal pain symptoms, that have not improved with previous input from the musculoskeletal service. Important information for referrers The MSK service does not provide emergency or immediate care. Patients referred with symptoms that have the potential to deteriorate while awaiting clinical review should be appropriately safety netted by the referrer, and/or an alternative referral option (i.e. ED) should be considered. The MSK service is a physiotherapy led service and may, within the scope of Non-Medical Referrer Agreements, commission investigations to assist in the diagnosis and management of musculoskeletal pathology. Occasionally these investigations will demonstrate unexpected or untoward findings such as metastatic disease. In these circumstances the referring GP practice will be contacted to take over the management of the patient as it is not within the scope of physiotherapy practice to manage a new cancer diagnosis.

 

• AHP MSK Physiotherapy Referral Forms
• Arc self-help information

Acute Services information

• Acute Knee Service
• Acute Shoulder Service

Orthopaedic Optimising Outcomes

• MSK Elective Surgical Procedure Flowchart
• MSK Elective Surgical Opinion Flowchart 

GP Communications

• YourPhysio Poster
• HCV ICS list of self-management patient resources

Local Authorities' Exercise Programmes and Referrals

• See Exercise / Wellness section on the Community Services page

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.