Document type
Clinical pathways
Place
East and North Hertfordshire
Output type
Clinical Pathways
Pathway
Shoulder Pain Pathway

Shoulder Pain

PLEASE NOTE FOR MOST MSK PATHWAYS –

  • DO NOT ORDER MSK MRIs FROM PRIMARY CARE.
  • UNLESS THE PATIENT HAS A RED FLAG MOST MSK PATHWAYS REQUIRE A PERIOD OF CONSERVATIVE MANAGEMENT AND REFERRAL ONLY ON NON-RESOLUTION ONTO TO PHYSIO OR MSK TRIAGE SERVICES (SEE DETAIL FOR EACH PATHWAY ATTACHED).
  • PLEASE NOTE MSK TRIAGE SERVICES CAN ORDER MRIs AND OTHER DIAGNOSTICS

ONLY REFER DIRECT TO SECONDARY CARE IF RED FLAGS OR PRIOR APPROVAL HAS BEEN OBTAINED

Shoulder Pain

Assess for Red Flags and manage accordingly if present (see pathway)

If no red flags:

  • Exclude referred pain from the neck, diaphragm, heart, lungs, & polymyalgia rheumatica
  • Plain x-ray should only be used to confirm shoulder dislocation or shoulder arthritis
  • Ultrasound and MRI should only be ordered by MSK triage and are rarely indicated

If there is history of dislocation or subluxation of joint:

  • Give analgesia as required
  • Refer to physiotherapy

If there is no history of dislocation or subluxation of joint:

  • Initial self-management: analgesia and give exercise advice
  • If no improvement after 2-4 weeks, refer to physio and consider GP administered steroid injection (refer to MSK triage if unavailable in GP practice)
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