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|Combination of Trauma, Pain and Weakness should raise suspicion of Acute Cuff Tear||• Send to ED, or arrange same day X-ray.|
•If X-ray normal and can't achieve elevation above 90 degrees within 2 weeks, needs urgent assessment within 2-4 weeks with ESP or Ortho.
•If X-ray shows fracture, send to ED or MIU.
|Mass or swelling should raise suspicion of tumour||2WW|
|Erythema, Fever should raise suspicion of infection||Same Day Ortho Assessment|
|Trauma or seizure or electrocution in association with loss of function and change in shape should raise suspicion of dislocation||Send to ED|
|Unexplained wasting, significant sensory or motor deficit||Urgent referral|
|Acute onset of pain and severe tenderness over the cuff||Consider calcific tendinitis and seek early intervention by radiology|
Ultrasound guided injection is anatomically more accurate than landmark-guided injection. However, robustly blinded trials do not show significant improvements in pain relief compared to landmark-guided injection.
Community based injection will in most cases be possible in the GP practice , but at present is not a pre-referral criteria. Community physiotherapy services may have practitioners experienced in injection. If neither the GP or community physiotherapy services are able to provide an injection, we encourage referral to specialist services for this purpose
Where 'Specialist Referral' is indicated, the exact route of referral will vary depending on locality and may include the use of Intermediate Care services, Radiology services or Extended Scope Physiotherapy
Please see Red Flags for exceptions. Otherwise, numbered advice is intended to be followed in order.
This guideline has been signed off by the Planned Care Clinical Leads on behalf of NEW Devon CCG
Publication date: December 2017