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OA of Glenohumeral Joint


Referrals for USS guided steroid injections to RCHT Clinical Imaging have restarted.  Please note there is limited capacity so referrals should be reserved for patients with significant disabling and persistent symptoms.  Please click here for full details



Covid-19 Update: Corticosteroid Injections During The Coronavirus Pandemic  

Please ensure and document that a discussion has happened that the patient is aware corticosteroid injections pose a possible and quantifiably unknown increased risk of, and complications from, Covid and the possible risk of reduced Covid vaccine efficacy prior to performing.  Secondary care referrals for steroid injection, including image guided injections, require the patient to be counselled and risk assessed prior to referral and this documented in the referral.  Please see guidance available here for detailed information. 



Orthopaedic Referral

Moderate to severe osteoarthritis of the Glenohumeral Joint not responding to appropriate tailored analgesia

AND willing to consider surgical intervention

Please note an X ray within 6 months is required prior to referral

 

Primary Care Management

  • Appropriate tailored analgesia
  • X-ray to confirm diagnosis, rule out avascular necrosis and other pathology
  • Physiotherapy in mild osteoarthritis
  • Consider steroid injection into the Glenohumeral Joint or Subacromial space
  • Devices to support activities of daily living through Occupational Therapy or Cornwall Mobility

 

MSK Interface

Please note an X ray within 6 months is required prior to referral

  • Diagnostic uncertainty
  • Local physiotherapy should be tried first unless there is diagnostic uncertainty

Exclusion Criteria

  • Red flag pathology
  • Severe symptoms with functional limitations and willingness for surgery
  • Previous joint replacement or significant major surgery to the same joint
  • Patients under 16 years
  • Hand and foot problems
  • Multiple/inflammatory arthropathy
  • Lumps, bumps, ganglia

Patient Information Leaflets

Arthritis Research UK Shoulder Pain Leaflet http://www.arthritisresearchuk.org/arthritis-information/conditions/shoulder-pain.aspx

 

 

References

 

  1. BESS/BOA Patient Care Pathways Frozen Shoulder, Shoulder & Elbow 2015; 7(4) 299-307
  2. National Institute Of Clinical Excellence.  Clinical Knowledge Summaries Shoulder Pain, April 2017
  3. Cornwall Mobility.  How We Help At Home http://www.cornwallmobility.co.uk/how-we-help/at-home/

 

 

Contributors

 

Mr Jeremy Dainton, Consultant Orthopaedic Surgeon, Royal Cornwall Hospitals NHS Trust

 

Mr Sean Dixon, Consultant Orthopaedic Surgeon, Royal Cornwall Hospitals NHS Trust

 

Annie Rae, Specialist Extended Scope Physiotherapist, Royal Cornwall Hospitals NHS Trust

 

Deanne De Beer, Specialist Extended Scope Physiotherapist, Royal Cornwall Hospitals NHS Trust

 

Dr Katy Bray, GP with Specialist Interest Orthopaedics, Three Spires Medical Practice

 

Dr Rebecca Hopkins, GP and RMS Orthopaedic Guidelines Lead, Kernow Referral Management Service

 

 

Date reviewed                     11/03/2022

Next review due                  11/03/2023

Sifter name                          Dr Rebecca Hopkins