REMEDY : BNSSG referral pathways

Shoulder Problems

Checked: 09-10-2018 by vicky.ryan Next Review: 09-10-2019

Shoulder assessment

See the leaflet: Diagnosis of shoulder problems in primary care  - for advice on assessment, treatment and referral of shoulder problems. This document has been reproduced with the permission of Oxford University. This is quick and easy to use as a reference guide to common shoulder problems.

For more detailed advice see the BMJ article:   'Assessment of shoulder pain for non-specialists' including a short video (11 minutes) on shoulder examination. The video is available to non-members but a log in is required to view the full article.

 

Shoulder - physiotherapy

Most shoulder pain is self limiting and will improve within 2 weeks. Analgesia and exercises can help.

Arthritis Research UK has a downloadable leaflet for exercises for shoulder pain.

Please see the Remedy page on Physiotherapy for referral options.

There is also advice on Joint Injections including shoulder injections on the patient.info website

Red Flags

1. Trauma, pain and weakness - consider acute rotator cuff tear and refer urgently - See Acute Shoulder Clinic

2. Mass or swelling - consider tumour. Urgent imaging and refer - See suspected bone and soft tissue cancer - 2WW

3. Red skin, fever or systemically unwell - consider infection. Admit via on call orthopaedics.

4. Trauma, epileptic fit, electric shock leading to loss of rotation and distorted shape - consider unreduced dislocation. Send to A and E.

Referral

For suspected acute rotator cuff tear refer to Acute Shoulder Clinic  via eRS (this service is not via MSK services (MATS, CATS, MIS).

For subacromial  pain not responding to conservative treatment then check the criteria in the Shoulder Impingement Surgery for Subacromial Pain Policy (CBA) prior to referral to local MSK services.

For other shoulder problems where there are no red flags and who are not responding to conservative treatment then consider referral via local MSK services.