Knee
MSK Physiotherapy services across the four Health and Social Care Partnerships and the department at the Western General Hospital accept referrals from primary care clinicians for people with knee problems.
Orthopaedic Consultant and associated team referrals for people with knee problems are accepted by MSK Physiotherapy services across the four Health and Social Care Partnerships, the department at the Western General Hospital and The Royal Infirmary of Edinburgh.
Some lower complex Orthpaedic knee referrals may be re-routed to MSK Physiotherapy services at the point of initial triage by the Orthopaedic team. These referrals can be returned to Orthopaedics by MSK Physiotherapy if the person fails to make satisfactory progress or if at the point of triage or initial assessment within MSK Physiotherapy that the persons needs would be best served by an Orthopaedic opinion.
At the current time there is no direct pathway from MSK Physiotherapy Services in the community setting into Orthopaedics. For full information about the Orthopaedic Service see here https://apps.nhslothian.scot/refhelp/Orthopaedics/Knee
M.A & P.A. 15-09-23
| Who not to refer/red flag presentations: | Serious pathology as a cause of MSK conditions is considered rare, but needs to be managed either as emergency or urgent referral to relevant secondary care service. Consider below & also see relevant body area tab for further specific information and advice. Please make sure all red flag concerns have been managed prior to any MSK Physiotherapy referral |
| Emergency conditions | Symptoms & signs of acute infection Symptoms and signs of DVT Dislocated patella Trauma inc inability to weight bear, unusual deformity, abnormal patella position, sudden onset loss of movement, serious injury, inability to flex/extend the knee |
| Urgent conditions | Primary and secondary cancers- suspected New inflammatory arthritis- suspected Post arthroplasty |
| Consider serious pathology as a differential diagnosis if person presents with: | escalating pain and progressively worsening symptoms that do not respond to conservative management or medication as expected systemically unwell (fever, weight loss) night pain that prevents sleep due to escalating pain |
| What not to refer-other: | Presence of significant red flags as detailed above Age <16 Non MSK complaints Mod/severe osteoarthritis in individual who wishes to consider surgical opinion- refer direct orthopaedics Loose body with locking- refer directly orthopaedics Chronic pain with a significant psychological / psychiatric/ drug addiction element People not wishing to engage with Physiotherapy |
Who to refer:
People with musculoskeletal knee pain who have not responded to initial primary care management, do not have the presence of significant red flags and do not meet the criteria for referral to Orthopaedics.
Indications include;
- Undifferentiated MSK knee complaint
- Specific MSK conditions i.e. tendinopathies, osteoarthritis
- Soft tissue injuries
- Chronic MSK pain
- Post operative rehabilitation
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.
Knee pain is a common complaint that affects people of all ages for a variety of reasons. Many types of minor knee pain resolve by self-care measures. The majority of knee related MSK complaints should be managed initially in the primary/ community care setting supported with referral to MSK Physiotherapy as required. Where there are red flag signs or symptoms or indication for early opinion, an orthopaedic referral should be considered.
BMJ: MSK care pathway for adults with hip and knee pain referred for specialist opinion: a systematic review : https://pubmed.ncbi.nlm.nih.gov/31488471/
Nice Guideline Knee assessment: https://cks.nice.org.uk/topics/knee-pain-assessment/
Versus Arthritis : https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis-of-the-knee/
British Association for surgery of the knee: https://baskonline.com/
Chartered Society of Physiotherapy – managing your knee pain: https://www.csp.org.uk/conditions/managing-pain-home/managing-your-knee-pain
Osteoarthritis Guidebook : https://jigsaw-e.com/osteoarthritis-leaflet/
Patellar femoral pain : https://clairepatella.com/
