Upper limb (UL) and especially shoulder injuries are a fairly common presentation within the ED, but in the acute phase can be difficult to give a definitive diagnosis and an appropriate treatment / referral plan.

With this in mind we now have a new referral pathway for UL injuries. This is for the secondary assessment of acute presentations, rather than chronic conditions needing extended or intensive physiotherapy.

Most presentations will now go through the ED physio service for either definitive treatment, further investigation (eg MRI), or  referral as appropriate.

Some caveats:

• Nothing below the elbow. Wrist and hand physio is a specialist discipline and not one we can accommodate at present.
• Upper arm and elbow trauma is fine for clinic (bicep/tricep) but no fracture or dislocations – these need ortho input. No chronic or non-acute presentations (eg tennis elbow) these can go back to GP
• Shoulder Dislocations. If they are  new and simple, easily reduced – physio, if they are chronic / recurrent – physio, if they are complex, hard to reduce, have fractures associated – ortho’s.
• No Paediatric Referrals. Patients under 16 who require follow up should be referred to the ED clinic or fracture clinic.

Don’t forget we have a separate pathway for paediatric clavicle fractures and there is a useful leaflet for early shoulder exercises in minor trauma or chronic conditions.