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Adults in primary care with shoulder pain
Patients with pain arising from the neck or another site in the upper limb.
Clinical Features | Disposition |
Combination of Trauma, Pain and Weakness should raise suspicion of Acute Cuff Tear | • Send to ED, or arrange same day X-ray. • If X-ray normal and can't achieve elevation above 90 degrees within 2 weeks, needs urgent assessment within 2-4 weeks with ESP or Ortho. • If X-ray shows fracture, send to ED or MIU. |
Mass or swelling should raise suspicion of tumour | 2WW |
Red skin, Fever or systemically unwell should raise suspicion of infection | Same Day Ortho Assessment |
Trauma or seizure or electrocution in association with loss of function and change in shape should raise suspicion of dislocation | Send to ED |
Unexplained wasting, significant sensory or motor deficit | Urgent referral |
**ADDENDUM November 2021 – Due to the current waits for plain X-rays in some areas, an attached X-ray report will no longer be mandated. However, all referral letters must state that an X-ray has been done or that it has been requested. Please do attach reports if possible as they improve the efficiency of referral triage) **
Please look at the excellent Diagnosis of Shoulder Problems in Primary Care Infographic for assessment and management guidance.
Ultrasound guided injection is anatomically more accurate than landmark-guided injection. However, robustly blinded trials do not show significant improvements in pain relief compared to landmark-guided injection.
Community based injection will in most cases be possible in the GP practice, but at present is not a pre-referral criteria. Community physiotherapy services may have practitioners experienced in injection. If neither the GP or community physiotherapy services are able to provide an injection, we encourage referral to specialist services for this purpose
Where 'Specialist Referral' is indicated, the exact route of referral will vary depending on locality and may include the use of Intermediate Care services, Radiology services or Extended Scope Physiotherapy
Clinical and Logistic advice for GPs/ESPs/ENPs/FCPs etc is readily available (within 24 hours ) from : plh-tr.shoulderandelbowteam@nhs.net
Clinical and Logistic advice for GPs/ESPs/ENPs/FCPs etc is readily available (within 24 hours ) from : plh-tr.shoulderandelbowteam@nhs.net
Referral Service Selection
MyHealth Patient Information - Shoulder Pain
This guideline has been signed off on behalf of NHS Devon CCG
Publication date: December 2017
Updated: February 2022
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