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Acute knee & shoulder clinics

Checked: 12-03-2024 by Vicky Ryan Next Review: 12-03-2026

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

An urgent, Acute Shoulder clinic is available at NBT. This clinic deals with soft tissue injuries. Fractures are dealt with at the specific fracture clinic.

Conditions treated - Refer patients with suspected non-emergency Acute rotator cuff injury

Criteria for referral:

Suspected traumatic acute rotator cuff injury.
Age 30-70 (including those in this age range who have suffered a traumatic anterior GHJ dislocation).
Recent trauma, functioning arm to non-functioning arm

Procedures Performed - Clinical assessment/further investigation and treatment as appropriate

Suggested investigations - Must refer with Shoulder 3 view x-ray (AP, Lat. and axilla) - NO FRACTURE.

Service Note: assessment clinic for acute rotator injuries in age 30-70 (16-29 year olds are highly unlikely to present with an acute cuff tear)

Exclusions - Recurrent Dislocators, GHJ OA or rotator cuff tear arthropathy, Frozen shoulder. These patients should be referred via the local MSK services.

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

Refer

Practices should submit these direct through e-Referral to ‘Urgent, Orthopaedics, Shoulder/elbow’

Fracture Clinics

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

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