Warning
Same day referral to Emergency Department for assessment
  • Suspected fracture
  • Suspected unreduced shoulder dislocation
  • Suspected septic arthritis  - Erythema, fever, systemically unwell

Red flags

Serious Pathology as a cause of MSK conditions is rare

Any Red Flag concerns need to be managed prior to MSK referral

  • Unexplained Mass/ previous Cancer
  • Sudden onset of weakness
  • Escalating pain- Progressive symptoms that doesn’t respond to conservative Rx
  • Suspected inflammatory arthritis – See Local Rheumatology Pathways

Rotator cuff injury

  • Acute trauma / injury ( under 12 weeks)
  • Loss of shoulder active movement , disabling pain/weakness
  • Unable to sustain active movement against resistance

If < 60 years old urgent SCI referral to orthopaedics.

If >60 years old consider US and referral to physiotherapy

Frozen shoulder

  • Typically 40-60 years, more common in diabetic patients
  • Capsular pattern- decreased abduction (hand out to side of body) , loss of hand behind back movement and hand behind head.
  • Patient reports stiffness
  • Likely a normal XR
  • Previous trauma may indicate Glenohumeral OA on Xray

Primary Care Management: NSAIDs, refer Physiotherapy, steroid injection

Consider referral to orthopaedics if worsening function/ reduced range, night pain, failed conservative management – X-rays can be ordered at same time

 

Acromio-clavicular pain

  • Pain local over ACJ area/ overhead pain
  • Usually > 30 years normally follows previous trauma
  • More common in men
  • Painful arc ( pain around 90 degrees of abduction)
  • +ve cross arm test ( touch back of opposite shoulder)

Primary Care Management: NSAIDs, refer physiotherapy, steroid injection

Consider referral to orthopaedics if failed conservative management and poor QOL – X-rays can be ordered at same time

Rotator cuff tendinopathy/subacromial bursitis

  • More common 35-75 years
  • Tends to follow repetitive movements/ low trauma fall
  • Painful arc of pain ( into abduction) passive movement always full
  • Pain on resisted abduction ( always exclude tear first)

Primary Care: NSAIDs, refer physiotherapy, steroid injection into sub-acromial space

Consider referral to orthopaedics as end of line treatment if failed conservative management and poor QOL – US may be ordered at same time

Note

Please note – primary care referrals to orthopaedics more suitable to MSK physiotherapy will be redirected and you will be notified.

Editorial Information

Last reviewed: 05/07/2024

Next review date: 06/07/2026

Reviewer name(s): Erin Archibald.