MSK Physiotherapy Service

General

• Acute soft tissue/trauma injury rehabilitation
• Postural conditions
• Post orthopaedic elective/trauma surgery
• Post satisfactory united fractures

Spinal

• Non-specific mechanical spinal pain

Peripheral

• Patellofemoral Pain
• Shoulder rotator cuff (impingement) duration less than a year
• ‘Acute’ tendinopathy (less than approximately 6 months)
• Degenerative joint problems
• Musculoskeletal conditions are variable in ‘recovery’. Many ‘acute/mild’ sprains, strains and spinal conditions will improve naturally over a 4 to 6 week period with reassurance, pain control advice and simple guidance on a graduated return to normal activities

Spinal

• Spinal nerve root compromise
• Whiplash Associated Disorder
• Spinal stenosis

Peripheral

• Peripheral nerve injuries (Including carpal tunnel)
• Chronic tendinopathy (duration greater than 6 months)
• Adhesive capsulitis (depends on stage)
• Brachial plexus injuries
• Complex Regional Pain Syndrome- early management and advice
• Heel Pain Syndrome (Podiatry will also see this condition)
• Cervicogenic headaches
• Temporomandibular Joint problems
• Tenosynovitis (rest, splinting, injection may be appropriate)

General

• Widespread chronic pain with previous failed physiotherapy (Consider referral to pain services if appropriate or Pain Concern classes)
• Physiotherapy re-referral for same condition in past 12 months
• Previous attendance at pain management services for same condition (Consider re referral to pain management only if change in condition)
• Patients with suspected undiagnosed sinister or serious pathology (Consider investigation/onward referral to appropriate service)
• Domiciliary – housebound visits (refer to local rehab team)
• Fibromyalgia (Consider referral to local services e.g. third sector if available or to Centre for Integrated Care)
• Referrals for wheelchair (Refer to Westmarc)
• Recurrent shoulder dislocation more than 1 episode, especially in patients aged 20 years or less or involved in sports (Refer to orthopaedics)
• Systemic neurological disorders (refer to appropriate neuro service e.g. Neurology; stroke team; local rehab services etc)
• Hypermobility Joint syndrome/Ehlers Danlos (Consider referral to Rheumatology if diagnostic uncertainty or already under care of Rheumatology with follow up appointment)
• Post surgical complications (Consider referral to surgical service if appropriate)
• Diagnosed Complex Regional Pain Syndrome- Severe, not responding to first line management (Consider referral to Pain Services if appropriate)
• Facial Palsy (Consider provision of appropriate self management advice/steroids for recent onset/ Maxillofacial for chronic if appropriate)
• Referrals for GP specified interventions only (e.g. acupuncture, injection, braces; splints. Only Refer for MSK Physiotherapy Assessment)

Spinal

• Cauda Equina (for suspected CES refer to A&E via local pathway).
• Metastatic Spinal Cord Compression (refer to MSCC Pathway)
• Pain with neuropathic referred leg or arm pain, duration longer than 2 years (consider referral to pain services if appropriate)
• Back pain BMI>40 Kg/m2 (Consider referral to weight management if appropriate or to Live Active)
• Cervical myelopathy (Refer urgently to Neurosurgery)

• Rheumatological disorders – e.g. peripheral inflammatory Arthritis, spondyloarthropathy, crystal arthritis, connective tissue disease, Ankylosing spondylitis, PMR (Polymyalgia Rheumatica)
• Pelvic Floor Dysfunction (refer to Continence Service)
• Pregnant patients or patients less than 6 weeks post partum for pregnancy related problems e.g. lumbar/pelvic pain (refer to Maternity Services)
• Respiratory conditions
• Vestibular Problems, Undiagnosed dizziness, vertigo- specialist service
• Falls (unless under 65 and directly related to an MSK problem) e.g. rehabilitation and prevention, mobility (consider referral to Falls team or day hospital as appropriate)
• Cardiac conditions, systemic cardiovascular problems