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Rotator Cuff Tear

Rotator Cuff Tear

Acute Traumatic Rotator Cuff Tear

Degenerative Rotator Cuff Tears

Referral Criteria

Red Flags

 

Acute Traumatic Rotator Cuff Tear

Trauma associated Shoulder pain with:

Symptoms and signs suggestive of a complete rotator cuff tear

These may include:

Significant loss of overhead function and/or weakness of external rotation, however some patients may still maintain overhead function

Arrange an urgent USS and urgent orthopaedic referral

 

Degenerative Rotator Cuff Tears

Symptoms and signs suggestive of a rotator cuff tear with/without pain

May settle with conservative measures:

NB. Partial thickness tears can be found incidentally on MRI scanning and may not be the source of pain, however tears causing pain and disability require treatment

Degenerative Rotator Cuff Tear Referral Criteria

Symptoms and signs suggestive of a rotator cuff tear without history of trauma with

Significant pain and disability with significant impact on activities of daily living or employment

OR

Infraspinatus tears (Identified by a loss of active external rotation) Requires urgent referral

AND the patient is willing to consider surgery

Shoulder X ray within 6 months is required for the referral

Discussion Points

Repair of the rotator cuff is not always appropriate in older patients and each patient must be considered individually. Without careful management however, untreated tears can progress to leave the patient with no useful function or painful erosion of the shoulder.

Patients over 65 with a tear who are pain free and function normally above shoulder height need no further intervention. Other patients need careful counselling as to their options.

Red Flags

Same day referral

Unreduced dislocation  Refer to ED

Septic joint                         Discuss with on call orthopaedics

 

Urgent referral

Acute traumatic rotator cuff tear

 

Cancer

Suspected primary bone/soft tissue tumour                                       2WW

Metastasis of suspected primary site but not confirmed                2WW

Metastasis of unknown primary site, active treatment                   Cancer MDT Co-ordinator

Metastasis of unknown primary site                                                       Urgent oncology

 

Suspected inflammatory oligo/polyarthritis

Rheumatology http://rms.kernowccg.nhs.uk/primary_care_clinical_referral_criteria/primary_care_clinical_referral_criteria/rheumatology/inflammatory_arthritis

 

Martin SD, Martin TL.  Management of Rotator Cuff Tears. Up to Date October 2017

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

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