MANAGEMENT CONSENSUS PROJECT

Patient presents to GP for clinical diagnosis and advice

Pain predominates

Patient decides pathway

Analgesia and nsaids and review

Optimal result achieved

Yes DC with advice

APPROXIMATE BORDER BETWEEN PRIMARY AND SECONDARY CARE

Pain not

resolving as expected

Further investigation including formal psycho-social assessment

Pain team input or address revealed pathology

Capsular release

Comprehensive follow up pain con- trol and physiotherapy package

Yes

Optimal result achieved

No No Stiffness predominates

Stiffness not resolving in usual timefframe AND

other pathology excluded AND HVDA failed

Surgical consultation MUA

HVDA (up to two times)

Optimal result achieved

No Yes No

Treatment package one

Treatment package two

Stiffness predominates

Patient decides pathway

exercise booklet +/- analgesia and review

No

Optimal result achieved

Yes DC with advice

TREATMENT PACKAGE ONE

Diagnostic second opinion from musculoskeletal specialist eg physiotherapist, GPwSi

Physiotherapy: to include simple exercises to maintain range such as pendular exercises; normal movement advice and train- ing such as scapula stability; treatment for associated cervical or thoracic components of the presentation

Home exercises to reinforce treatment Pain relieving treatments as indicated: eg ice, TENS

Steroid injection: preferably image-guided but shown to work well for pain especially if night pain is a prominent feature of the presentation.

www.sportex.net

TREATMENT PACKAGE TWO

Diagnostic second opinion from musculoskeletal specialist eg physiotherapist, GPwSi

Physiotherapy: to include simple exercises to include normal movement advice and training such as scapula stability; treat- ment for associated cervical or thoracic components of the pre- sentation; a vigorous stretching programme including posteri- or capsule and anterior-superior capsular stretches. a home exercise programme that focuses on range of motion for func- tional tasks (hand on head, reach, dressing)

Home exercises to reinforce treatment Pain relieving treatments as indicated: eg ice, TENS

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