{"id":28933,"date":"2026-07-15T09:12:03","date_gmt":"2026-07-15T08:12:03","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=28933"},"modified":"2026-08-07T08:18:15","modified_gmt":"2026-08-07T07:18:15","slug":"serious-shoulder-and-elbow-conditions-red-flags","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/","title":{"rendered":"Serious shoulder and elbow conditions (Red Flags)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">These include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Suspected septic arthritis\/ septic bursitis<\/li>\n\n\n\n<li>Suspected facture or dislocation<\/li>\n\n\n\n<li>Suspected acute traumatic rotator cuff tear in the younger patient<\/li>\n\n\n\n<li>Suspected acute distal biceps rupture<\/li>\n\n\n\n<li>Suspected malignancy\/ tumor<\/li>\n\n\n\n<li>Suspected inflammatory condition<\/li>\n\n\n\n<li>Suspected neurological condition<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-fixed-layout\"><thead><tr><th>Condition<\/th><th>Presentation<\/th><th>Referral Type<\/th><th>Referral Process<\/th><\/tr><\/thead><tbody><tr><td><strong>Suspected septic arthritis\/ septic bursitis<\/strong><strong><\/strong> &nbsp;<\/td><td>Red skin, painful joint, fever, systemically unwell &nbsp;<\/td><td>Same day<strong><\/strong><\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected facture or dislocation<\/strong><strong><\/strong> <strong>&nbsp;<\/strong><\/td><td>Trauma, electric shock, seizure, deformity, pain, loss of rotation, abnormal shape<\/td><td>Same day<strong><\/strong><\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute distal biceps rupture<\/strong><strong><\/strong><\/td><td>sudden and forceful eccentic load to a flexed elbow, weakness in flexion \/ supination, positive &#8220;hook&#8221; test.<\/td><td>Same day<strong><\/strong><\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000 Also consider urgent referral to MSK Physiotherapy to commence rehabilitation<strong><\/strong><\/td><\/tr><tr><td><strong>Suspected acute traumatic rotator cuff tear in the younger patient<\/strong><strong><\/strong> <strong>&nbsp;<\/strong><\/td><td>patient &lt;65 years old, trauma, pain, significant weakness, sudden inability to raise arm<\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow and shoulder<\/td><\/tr><tr><td><strong>Suspected malignancy\/ tumour<\/strong><strong><\/strong> <strong>&nbsp;<\/strong><\/td><td>shoulder mass, swelling, unexplained deformity, history of cancer, signs or symptoms of lymphadenopathy<\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow and shoulder<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>P.A &amp; M.A- 15-7-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer: <\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners <\/li>\n\n\n\n<li>Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP <a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/where-to-find-us\/\" target=\"_blank\" rel=\"noreferrer noopener\">Where To Find Us \u2013 Musculoskeletal Physiotherapy<\/a>)<\/li>\n\n\n\n<li>Secondary care consultants and associated teams<\/li>\n\n\n\n<li>MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes <a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Integrated Shoulder &amp; Elbow Service<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who and How to refer:<\/h4>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-fixed-layout\"><thead><tr><th>Condition<\/th><th>Presentation<\/th><th>Referral Type<\/th><th>Referral Process<\/th><\/tr><\/thead><tbody><tr><td><strong>Suspected septic arthritis\/ septic bursitis<\/strong><strong><\/strong> &nbsp;<\/td><td>Red skin, painful joint, fever, systemically unwell &nbsp;<\/td><td>Same day<strong><\/strong><\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected facture or dislocation<\/strong><strong><\/strong> <strong>&nbsp;<\/strong><\/td><td>Trauma, electric shock, seizure, deformity, pain, loss of rotation, abnormal shape<\/td><td>Same day<strong><\/strong><\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute distal biceps rupture<\/strong><strong><\/strong><\/td><td>sudden and forceful eccentic load to a flexed elbow, weakness in flexion \/ supination, positive &#8220;hook&#8221; test.<\/td><td>Same day<strong><\/strong><\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000 Also consider urgent referral to MSK Physiotherapy to commence rehabilitation<strong><\/strong><\/td><\/tr><tr><td><strong>Suspected acute traumatic rotator cuff tear in the younger patient<\/strong><strong><\/strong> <strong>&nbsp;<\/strong><\/td><td>patient &lt;65 years old, trauma, pain, significant weakness, sudden inability to raise arm<\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow and shoulder<\/td><\/tr><tr><td><strong>Suspected malignancy\/ tumour<\/strong><strong><\/strong> <strong>&nbsp;<\/strong><\/td><td>shoulder mass, swelling, unexplained deformity, history of cancer, signs or symptoms of lymphadenopathy<\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow and shoulder<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients who have the presence of significant red flags\/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition &#8211; <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" target=\"_blank\" rel=\"noreferrer noopener\">see serious shoulder &amp; elbow conditions<\/a><\/li>\n\n\n\n<li>Age &lt;16<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Detail as per who to refer section,<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">For further information see associated sections<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>Link to NHS Lothian patient internet site including patient information resources \u2013&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/ises\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/ISES\/Pages\/default.aspxopens a new window<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page shoulder &nbsp;problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problemsopens a new window<\/a><\/li>\n\n\n\n<li>Link to NHS Inform shoulder problems- Patient self help guide&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-pain\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-painopens a new window<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page elbow problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problemsopens a new window<\/a><\/li>\n\n\n\n<li>Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service&nbsp;<a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>These include: Condition Presentation Referral Type Referral Process Suspected septic arthritis\/ septic bursitis &nbsp; Red skin, painful joint, fever, systemically unwell &nbsp; Same day Orthopaedic registrar via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000 Suspected facture or dislocation &nbsp; Trauma, electric shock, seizure, deformity, pain, loss of<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[422,1410],"class_list":["post-28933","page","type-page","status-publish","hentry","category-musculoskeletal-physiotherapy","category-https-apps-nhslothian-scot-refhelp-serious-shoulder-and-elbow-conditions-red-flags"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/\" rel=\"tag\">Musculoskeletal Physiotherapy<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/https-apps-nhslothian-scot-refhelp-serious-shoulder-and-elbow-conditions-red-flags\/\" rel=\"tag\">Serious Shoulder and Elbow conditions (red flags)<\/a>","rttpg_excerpt":"These include: Condition Presentation Referral Type Referral Process Suspected septic arthritis\/ septic bursitis &nbsp; Red skin, painful joint, fever, systemically unwell &nbsp; Same day Orthopaedic registrar via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000 Suspected facture or dislocation &nbsp; Trauma, electric shock, seizure, deformity, pain, loss of","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28933","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=28933"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28933\/revisions"}],"predecessor-version":[{"id":29414,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28933\/revisions\/29414"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=28933"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=28933"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}