Shoulder Instability

Shoulder Instability

 

Traumatic Dislocation

Patients Presenting to RCHT ED

The majority of traumatic shoulder dislocations will present to ED for initial assessment and relocation. 

Fracture associated dislocation           Patient will be followed up in virtual fracture clinic

 

No fracture associated                     Patient will receive telephone triage from the Shoulder

                                                           Specialist Extended Scope Physiotherapist for onward

                                                           management and local physio if all stable

 

Late Presentation Of Traumatic Dislocation In Primary Care

If suspicion of fracture or significant neurovascular injury refer to ED

If suspicion of acute rotator cuff tear follow rotator cuff tear guidelines

Otherwise X Ray at Minor Injury Unit/ED to confirm correct relocation and to fully exclude fracture

Then early Physiotherapy

Each Physiotherapy department has a Shoulder Specialist Physio as part of their department who can link into the Shoulder Extended Scope Physiotherapists for advice

 

If suspected Axillary nerve injury (numbness over the deltoid with weakness and fatigue on flexion, abduction and external rotation) refer Physio

If not improving with Physio refer to MSK Interface or Orthopaedics depending upon Physio advice

 

 

 Atraumatic Dislocation

Suspected rotator cuff tear follow rotator cuff tear guidelines

If suspected Axillary nerve injury (numbness over the deltoid with weakness and fatigue on flexion, abduction and external rotation) refer Physio

Refer to the nominated Shoulder Specialist Physio in the local Physiotherapy department.  They are able to link into the Shoulder Extended Scope Physiotherapists for advice.

If not improving with physio refer to MSK Interface or Orthopaedics depending upon Physio advice

 

 

 

Date reviewed                     11/03/2022

Next review due                  11/03/2023

Sifter name                          Dr Rebecca Hopkins

Version No. 1.1