Acute knee & shoulder clinics

Acute knee clinic - NBT & UHBW (BRI)

Please see the Knee Pain page for advice on management of all types of knee pain.

Patients should only be referred to an acute knee clinic directly (not via MSK interface service) if referral criteria are met.

Referral Criteria

• Acute injury to the knee suspicious of traumatic cartilage, ligament or  meniscal pathology where a fracture is not suspected or has been excluded.
• Aged 16-60 years old (the upper age limit is to try and curb the high numbers of patients being referred with a flare of OA. Please contact the service to discuss if there are concerns about suitability for the clinic).

Exclusions

• Chronic knee problems
• Follow up of previous elective knee patients
• Degenerative knee pathology (more likely in older patients)
• Insidious onset knee problems.

These patients should be referred via the Musculoskeletal Interface (MSKI) Service.

Procedures Performed

Suitable patients will undergo assessment as appropriate which may include: investigation, diagnostic/ therapeutic injection, arthroscopic/ open surgery including repair and reconstruction for cartilage, ligament and meniscal knee injuries.

Imaging

If a fracture is suspected from history or examination the patient should be seen in UTC or ED and undergo x-ray. See the Ottawa Knee rules for guidance.

Otherwise, imaging is not required before referral. MRI scans are not required prior to referral but if performed, results should be included.

Referral

• NBT - NBT has an urgent, Acute Knee clinic is available via eRS referral (Urgent, Orthopaedics, Knee)
• UHBW (BRI) -  refer patients via the T & O Fracture Clinic RAS. 

Acute shoulder clinic - NBT

The acute shoulder clinic is an urgent service available at NBT to assess and manage acute soft tissue shoulder injuries.

This is not an emergency service and if the patient needs to be seen on the day or day after you should refer to the Emergency Department or discuss with Trauma and Orthopaedics on call, depending on the concern.

Conditions treated 

• Patients with suspected acute rotator cuff injury (30-75) – no concurrent bony injury
• Primary Traumatic Anterior Shoulder Dislocation - no fracture
• Primary Traumatic Posterior Shoulder Dislocation – no fracture 
• Acute Traumatic Pectoralis Major injury

Investigations

Patient must have a shoulder 3 view x-ray (AP/lateral and axilla) – this should not show any fractures

Soft tissue imaging (MRI & US) should NOT be requested prior to XR imaging and are not required prior to referral.

Criteria for referral: 

• Suspected traumatic acute rotator cuff injury
  • Recent trauma which has led to a previously functioning arm to become non-functioning
  • Age 30-75 - including those in this age range who have suffered a traumatic anterior GHJ dislocation (16-29 year olds are highly unlikely to present with an acute cuff tear)
• PrimaryTraumatic Anterior Shoulder Dislocation - no fracture
  • History of trauma – XR imaging of traumatic anterior shoulder dislocation which has been relocated in Urgent Care/ A&E/ MIU
• Primary Traumatic Posterior Shoulder Dislocation – no fracture 
  • History of trauma – XR imaging of traumatic posterior shoulder dislocation which has been relocated in Urgent Care/ A&E/ MIU 
• Suspected traumatic Pectoralis Major Injury
  • Recent trauma – evidence of injury to Pec Major

Exclusion Criteria:

• Recurrent dislocations anterior or posterior – with ongoing instability & no acute episode  
• Atraumatic GHJ instability  
• GHJ OA or rotator cuff tear arthropathy 
• Frozen Shoulder  
• Calcific tendinopathy  

These patients should be referred via the local MSKI service for further assessment.

Procedures Performed:

Clinical assessment/further investigation and treatment as appropriate

How to Refer

Sirona MSKI have advised that due to the acute nature of these clinics that referrals do not need to be submitted via the MSK Interface Service

Practices should submit these direct through e-Referral Service:  Acute Shoulder Service- Orthopaedics – Southmead RVJ

Note – all referrals to Acute Shoulder Clinic will be clinically triaged on ERS to assess referral criteria and appropriateness.

Fracture Clinics

See the Fracture Clinic section for details on referring to the individual fracture clinics at NBT and UHBW.

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