Shoulder and Elbow

MSK Physiotherapy for people with shoulder & elbow problems is provided as part of the NHS Lothian Integrated Shoulder & Elbow Pathway.

The NHS Lothian integrated shoulder & elbow pathway is a multidisciplinary collaboration. The service is based on the principles of the right care, from the right person, at the right time in the right place. The service offers a single point of access for patients with routine shoulder and elbow problems who require referral for their problem following failure to improve with initial primary care management.

Once within the service patients will be able to access all the multidisciplinary services that are required for their problem including physiotherapy, upper limb advanced practice physiotherapy, investigation, orthopaedic opinion and pain clinic opinion. There will be no need for patients to return to their GP to seek additional referrals or investigations for the shoulder or elbow problem. The service is underpinned by agreed pathways, escalation criteria and multidisciplinary clinics.

For clinical support and referral guidance see Shoulder & Elbow pathways | Right Decisions (scot.nhs.uk) .
This tool is based upon the resource developed at The Oxford Shoulder Clinic at the Nuffield Orthopaedic Centre and has been modified to take account of specific service delivery within NHS Lothian. The tool was co-created with General Practitioner Services, Orthopaedic Services, MSK Physiotherapy Services and Radiology services as part of the NHS Lothian upper limb steering group.
For patients and professionals Integrated Shoulder and Elbow Service – NHS Lothian | Our Services

P.A & M.A – 16-7-26

Who can refer:

All primary care clinicians i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
Secondary care consultants and associated teams
MSK physiotherapists are able to escalate/refer to advanced practice physiotherapists underpinned by agreed pathways and processes NHS Lothian Integrated Shoulder & Elbow Service

Who to refer:

People with shoulder and elbow problems who have not responded to initial primary care management, do not have the presence of significant red flags or other exclusion criteria. Examples include undifferentiated/ non specific shoulder pain, other specific shoulder and elbow problems including frozen shoulder, calcific tendinopathy, rotator cuff related shoulder pain, early stage glenohumeral joint osteoarthritis, acromioclavicular joint disorders, tennis elbow, golfers elbow, biceps, triceps tendinopathy.

Who not to refer:

Patients who have the presence of significant red flags/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition – see serious shoulder & elbow conditions
Age <16

How to refer

Refer via SCI Gateway Referral “AHP-Physiotherapy” then choose local site.

Please provide as much detail as possible to help the triage process.

Important notes:

This single referral will gain access to the full multidisciplinary NHS Lothian Integrated Shoulder & Elbow service. Any consequent investigation/ surgical opinion/ pain service referral will be made within the service- the patient will not require to return to their GP. Please include relevant detail on your referral to allow the appropriate initial triage of the patient

Carefully consider red flags relating to the shoulder as the symptoms and signs associated with acute calcific tendinopathy often mimic malignant pain.

For all cases of routine low back pain / spine related leg pain – refer via SCI Gateway Referral “AHP-Physiotherapy” then choose local site.
This single referral will gain access to the full multidisciplinary NHS Lothian integrated back pain pathway. Any subsequent investigation/ surgical opinion/ pain service referral will be made within the service
Please include all relevant details on your referral to allow the appropriate initial triage of the patient. Initial triage will occur within MSK Physiotherapy and if appropriate will be passed to spinal advanced practice physiotherapy service.
Please signpost patients to Integrated Spinal Service Webpage for patient information.

Additional Information

This guidance can also be found on the Shoulder & Elbow pathways | Right Decisions (scot.nhs.uk)
Additional information regarding imaging available for xray and MRI found at radiology ref help spine Plain X-Rays – RefHelp

For further information see associated sections