NHS AYRSHIRE AND ARRAN

MUSCULOSKELETAL HIP PAIN PATHWAY

For further information please contact:Judith Reid, Consultant Physiotherapist in MSK, Crosshouse Hospital.

Email; judith.reid.aapct.scot.nhs.uk

STAGE ONE Patient presents with Hip disorder

Red Flags, Known/ Suspected fracture, AVN

STAGE FOUR

MSK TRIAGE AND TREATMENT

Orthopaedics Rheumatology

Other Acute Services

Working Health Service/ Local Gym Programmes

Pain Services

STAGE THREEReferral process

DISCHARGED

IMMEDIATE OR URGENT ORTHOPAEDIC REFERRAL/ A & E

STAGE TWOGP managementSelf management,

Summary of Pathway

STAGE ONE

Initial presentation of hip pain disorder:

RED FLAGS for possible serious Hip pathology:

Suspected/ Known Hip FractureViolent Trauma eg RTA/ Fall from height

Avascular NecrosisConstant, Progressive, Non Mechanical Pain

Severe unremitting night painPMH Carcinoma

Systemically unwellStructural deformity

Gross loss of movement/ mobility with severe painWidespread neurological signs and symptoms

Urgent referral to Orthopaedics/ A & E

STAGE TWO GP Management

In absence of need for immediate referral

Explain and reassureAdvise to stay active and workingControl symptomsEnable self-help / management Consider Pelvic X-ray for Osteo-ArthritisWeight ManagementProvision of walking aidsSteroid injection for Trochanteric BursitisConsider local gym programmes ( Please find OA Booklet attached)

Drug Therapy

AnalgesicsParacetamolNSAIDsWeak Opioids

STAGE THREEREFERRAL

RECHECK FOR RED FLAGS/ POTENTIAL FRACTURES

IMMEDIATE OR URGENT ORTHOPAEDIC REFERRAL/ A & E

In the Absence of Hip OA and spinal involvement consider MSK hip Pathway

CONSIDER REFERRAL TO MSK SERVICE FOR

Anterior Groin Pain with or without anterior thigh pain Pain on weight bearing/ walking distance reducedLoss of movement of hipSleep disturbed

Lateral Thigh PainPain on palpation over Greater Trochanter and resisted hip abduction

Soft Tissue InjuryFracture excluded on plain x-ray if indicated e.g. groin strain

Consider Orthopaedic referral ifAdvanced OA confirmed on X-ray

Early/ moderate OA confirmed on X-ray and no change within 3 months with conservative treatment

PROCESS FOR REFERRALS TO MSK SERVICEElectronic referral via SCI gateway

Musculoskeletal Triage and Treatment Hip Pathway.

Please note: Referrals directed to Orthopaedics considered to be more suitable for MSK will be redirected

CCONSIDER WORKING HEALTH SERVICE www.healthyworkinglives.comwww.salus.co.ukSelf refer: 0800 019 2211

Lateral Thigh pain Soft Tissue Injury

If failing to progress after 4 sessions - senior clinician support

ESP / Combined ClinicImaging if required

Orthopaedics Other acute services

Pain services

Re-evaluate for worrying pathology, disorder not originating from hip

Communication with GP, referral returned or redirected appropriately

Discharged

Anterior Groin pain with or without anterior thigh pain

Self management/ Discharged

Physiotherapy appointment (2 weeks)

Routine Physiotherapy appointment (4-6 weeks)

Self management/ Discharged

STAGE FOURAHP MSK SERVICE

APPENDIX 1

Hip OA information

hip