{"id":4425,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/shoulderelbow\/"},"modified":"2026-07-16T09:52:40","modified_gmt":"2026-07-16T08:52:40","slug":"shoulderelbow","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/","title":{"rendered":"Shoulder and Elbow"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">MSK Physiotherapy for people with shoulder &amp; elbow problems is provided as part of the NHS Lothian Integrated Shoulder &amp; Elbow Pathway. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The NHS Lothian integrated shoulder &amp; elbow pathway is a&nbsp;<strong>multidisciplinary collaboration<\/strong>. The service is based on the principles of the&nbsp;<strong>right care, from the right person, at the right time in the right place<\/strong>. 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n<style>.kb-image4425_dbe5a6-e9 .kb-image-has-overlay:after{opacity:0.3;}<\/style>\n<div class=\"wp-block-kadence-image kb-image4425_dbe5a6-e9\"><figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"951\" height=\"821\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ShoulderElbowPathway.png\" alt=\"ShoulderElbowPathway\" class=\"kb-img wp-image-29000\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ShoulderElbowPathway.png 951w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ShoulderElbowPathway-300x259.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ShoulderElbowPathway-768x663.png 768w\" sizes=\"auto, (max-width: 951px) 100vw, 951px\" \/><figcaption>Right Decisions<\/figcaption><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For clinical support and referral guidance see <a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/msk-pathways\/shoulder-elbow-pathways\/?organization=nhs-lothian\" data-type=\"link\" data-id=\"https:\/\/www.rightdecisions.scot.nhs.uk\/msk-pathways\/shoulder-elbow-pathways\/?organization=nhs-lothian\" target=\"_blank\" rel=\"noreferrer noopener\">Shoulder &amp; Elbow pathways | Right Decisions (scot.nhs.uk)<\/a>&nbsp;.&nbsp;<\/li>\n\n\n\n<li>This tool is based upon the resource developed at The Oxford <a href=\"https:\/\/www.ouh.nhs.uk\/shoulderandelbow\/information\/documents\/JRFinal2010poster.pdf\" data-type=\"URL\" data-id=\"https:\/\/www.ouh.nhs.uk\/shoulderandelbow\/information\/documents\/JRFinal2010poster.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Shoulder <\/a>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&nbsp; with General Practitioner Services, Orthopaedic Services, MSK Physiotherapy Services and Radiology services as part of the NHS Lothian upper limb steering group.<\/li>\n\n\n\n<li>For patients and professionals <a href=\"https:\/\/services.nhslothian.scot\/ises\/\">Integrated Shoulder and Elbow Service \u2013 NHS Lothian | Our Services<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>P.A &amp; M.A &#8211; 16-7-26<\/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 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 are able to escalate\/refer to advanced practice physiotherapists underpinned by 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 to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">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. &nbsp;&nbsp;<\/p>\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; see <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\">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\"><strong>Refer via&nbsp;SCI Gateway&nbsp;Referral \u201cAHP-Physiotherapy\u201d then choose local site.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please provide as much detail as possible to help the triage process.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Important notes:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>This single referral will gain access to the full multidisciplinary NHS Lothian Integrated Shoulder &amp; 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<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Carefully consider red flags relating to the shoulder as the symptoms and signs associated with acute calcific tendinopathy often mimic malignant pain.&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For all cases of routine low back pain \/ spine related leg pain &#8211; refer via&nbsp;<strong>SCI Gateway Referral \u201cAHP-Physiotherapy\u201d then choose local site.<\/strong><\/li>\n\n\n\n<li>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<\/li>\n\n\n\n<li>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.<\/li>\n\n\n\n<li>Please signpost patients to&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/ibps\/\" target=\"_blank\" rel=\"noreferrer noopener\">Integrated Spinal Service Webpage<\/a>&nbsp;for patient information.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Additional Information<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>This guidance can also be found on the <a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/msk-pathways\/shoulder-elbow-pathways\/?organization=nhs-lothian\" target=\"_blank\" rel=\"noreferrer noopener\">Shoulder &amp; Elbow pathways | Right Decisions (scot.nhs.uk)<\/a><\/li>\n\n\n\n<li>Additional information regarding imaging available for xray and MRI found at radiology ref help spine <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/radiology\/plain-x-rays\/\" target=\"_blank\" rel=\"noreferrer noopener\">Plain X-Rays \u2013 RefHelp<\/a><\/li>\n<\/ul>\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.aspx<\/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-problems<\/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-pain<\/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-problems<\/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>MSK Physiotherapy for people with shoulder &amp; elbow problems is provided as part of the NHS Lothian Integrated Shoulder &amp; Elbow Pathway. The NHS Lothian integrated shoulder &amp; elbow pathway is a&nbsp;multidisciplinary collaboration. The service is based on the principles of the&nbsp;right care, from the right person, at the right time in the right place.<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4160,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[422,427],"class_list":["post-4425","page","type-page","status-publish","hentry","category-musculoskeletal-physiotherapy","category-shoulder-elbow"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"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\/shoulder-elbow\/\" rel=\"tag\">Shoulder \uff06 Elbow<\/a>","rttpg_excerpt":"MSK Physiotherapy for people with shoulder &amp; elbow problems is provided as part of the NHS Lothian Integrated Shoulder &amp; Elbow Pathway. The NHS Lothian integrated shoulder &amp; elbow pathway is a&nbsp;multidisciplinary collaboration. The service is based on the principles of the&nbsp;right care, from the right person, at the right time in the right place.","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4425","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\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4425"}],"version-history":[{"count":28,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4425\/revisions"}],"predecessor-version":[{"id":29005,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4425\/revisions\/29005"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4160"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4425"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4425"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}