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

• 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

• 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

• 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

• 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