GP triage – Shoulder Menu
Common Shoulder Conditions
OA Shoulder

Affected Area
- Gradual onset of stiffness and pain, worse with movement
- Morning Stiffness < 30 minutes
- Disturbed Sleep
- Crepitus
- Elderly population
- Explanation & advice on activity and ADL
- Regular simple analgesia
- Physiotherapy
- Consider single intra-articular injection x1 (only if not considering surgery and in significant pain)
- X-ray: AP/axillary view
- Not responding to treatment
- Functional disability significantly affecting work and ADL
- Patient would consider surgery and understands that surgery is mainly a pain relief measure.
Shoulder Impingement

Affected Area
- Painful arc mid-range
- Catches of pain
- Pain over deltoid
- Sleep disturbance (lying on
affected side) - Worse in elevation
- Affecting work or ADL
- Most commonly affects middle aged patients
- Education & advice
- Exercise
- Simple analgesics
- NSAIDS
- Physio referral for patients > 6/52
- Consider a single steroid injection
- X-ray: AP/axillary view
- Refer to Ortho
- Not responding to conservative treatment > 6 months duration (PT and steroid injection)
- Functional disability significantly affecting work and ADL
- Consideration of Arthroscopic SAD
- Refer to MSK service/ Physio
- Struggling with ADLs/ work/ conservative treatments.
Acromioclavicular joint

Affected Area
- Pain felt over the top of shoulder over ACJ
- Painful arc above 150°
- Painful cross body flexion & high flexion/abduction
- May have history of fall ,on to shoulder
- May have ACJ deformity
- Education & advice
- Exercise
- Simple analgesics
- NSAIDS
- Physio referral
- Consider a steroid injection to ACJ
- X-ray: AP/axillary view together with ACJ view
- Not responding to treatment including steroid injection after 2-3 months
Adhesive Capsulitis

Affected Area
- Global loss of movement actively and passively, especially external rotation and elevation
- Variable pain presentations depending on stage
- Sleep disturbance
- Usually age>40
- Education & advice – Some will be happy with watchful waiting for up to 18/12 -function returns in 80% of cases.
- Exercise
- Simple analgesics
- NSAIDS
- Physio referral
- Consider GHJ injection x1
- X-ray: AP/axillary view
- Not responding to treatment.
- If no response to injection – consider secondary care for hydrodilation or consideration of surgical intervention (MUA).
Shoulder Instability

Affected Area
- History of dislocation / subluxation
- May be traumatic or non-trauma (hyperlaxity)
- Education & advice
- Exercise
- Simple analgesics
- NSAIDS
- Physio referral for patients > 6/52
- Consider a single steroid injection
- X-ray: AP/axillary view
- Refer to MSK service – No response to conservative treatment.
- Apprehension or true instability affecting ADL, work, sport
- Refer to Ortho – If symptoms are the consequence of a trauma within past 3 months and patient not seen in fracture clinic
Degenerative Cuff Tear

Affected Area
- Usually age >40
- Inability to abduct shoulder (if large tear)
- Painful arc in abduction 50-130°
- Catches in certain positions
- May have crepitus
- May have drop arm weakness
- Upper arm pain
- Night pain
- May have impingement signs
- Education & advice
- Exercise
- Simple analgesics
- NSAIDS
- Physio referral
- Consider a single
- Sub-acromial steroid injection
- X-ray: AP/axillary view
- No response to treatment and 1 x steroid injection after 3-6 months
- If pain persistent and functionally limiting ?consideration for SAD/cuff repair
- Refer to secondary care if: Ultrasound scan confirms tear and not responding to injection or physiotherapy
- Ultrasound scan/MRI depending on surgeons preference.
Acute Cuff Tear

Affected Area
- Sudden inability to abduct arm
- History of trauma
- Sudden inability to abduct arm
- History of trauma
- X-ray: AP/axillary view
- Direct referral to secondary care
- Ultrasound/MRI depending on surgeons preference.
Inflammatory Shoulder Pain

Affected Area
- Painful swollen joint
- ESR>30 Mono or polyarthropathy
- Direct referral to rheumatology
- Analgesia/NSAID
- X-ray: AP/axillary view
- Inflammatory blood screen, urate
- Direct referral to rheumatology