GP triage – Shoulder Menu
Common Shoulder Conditions
- Explanation & advice on activity and ADL
- Regular simple analgesia
- Consider single intra-articular injection x1 (only if not considering surgery and in significant pain)
- 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.
- Education & advice – Some will be happy with watchful waiting for up to 18/12 -function returns in 80% of cases.
- Simple analgesics
- Physio referral
- Consider GHJ injection x1
- 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
- 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
- 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.