Borders Ref Help Toolkit
Who not to refer
Red flag presentations
Serious pathology as a cause of MSK conditions is considered rare but needs to be managed either as referral to relevant emergency or urgent referral for secondary care service. Consider below & also see relevant body area tab for further specific information and advice.
Please make sure all red flag concerns have been managed prior to any MSK Physiotherapy referral
Emergency Conditions
- Cauda equina syndrome- suspected
- Metastatic spinal cord compression (MSCC) – suspected
- Spinal infection- suspected
- Acute foot drop
- Septic arthritis- suspected
- Deep vein thrombosis- suspected
- Suspected acute achilles/patellar/quads/distal biceps/ pec major tendon rupture
- Suspected discitis,
- Suspected slipped upper femoral epiphysis
Urgent Conditions
- Cervical myelopathy- suspected
- Major spinal related neurological deficit/ worsening neurological deficit- suspected
- Insufficiency fracture
- Primary and secondary cancers- suspected
- New inflammatory arthritis/ myositis- suspected
- Inflammatory spinal pain – suspected
- Avascular necrosis
- Suspected slipped upper femoral epiphysis
Consider serious pathology as a differential diagnosis if person presents with:
- Escalating pain and progressively worsening symptoms that do not respond to conservative management or medication as expected
- Systemically unwell (fever, weight loss)
- Night pain that prevents sleep due to escalating pain and/or difficulty lying flat
Other exclusions- housebound patients, duptyrens and trigger finger, non MSK physio conditions-long COVID, neurological conditions, respiratory conditions, facial palsy,etc, foot and toe conditions- podiatry, previous attendance at pain clinic for same condition, referral for stand alone treatment- injection, acupuncture, continence problems, Chronic MSK pain disorders with significant psychological/ psychiatric/ drug addiction element, paediatric referrals with non MSK conditions, Referrals for orthotic devices
Who to refer - Routine
Specific MSK conditions such as tendinopathies, mild to moderate osteoarthritis, post orthopaedic surgery that requires extra support, Post fracture/dislocation as deemed suitable from orthopaedics
Soft tissue injuries, strains and sprains, spinal pain +/-referred symptoms
Chronic MSK pain disorders without significant psychological/ psychiatric/ drug addiction element
Antenatal and postnatal conditions such as pelvic girdle pain, abdominal diastasis
Paediatric age 12 and above with MSK conditions.
Who to refer - Urgent
- Post operative (less than 3 months) rehabilitation
- Post fracture (less than 3 months) rehabilitation
- Persistent, deteriorating nerve root pain and/or confirmed progressive neurological deficit
- Cases where a delay would have an adverse impact on outcome, for example antenatal obstetrics where there is a “window of opportunity” to impact on clinical effectiveness of an intervention.
Should a GP/FCP/ANP have a concern about the urgency which does not fit within the criteria, the physiotherapy service would be happy to consider individual cases on discussion. Expediting individual cases will be considered if alerted by phoning 01896 827427 or by email bor.physiotherapyadmin@nhs.scot
Note: Please provide as much detail as possible to help the triage process
How to refer:
SCI Gateway – see below for detail
Please consider the detail provided within the specific body region to help support initial primary care management and referral process. Clinicians are
asked to follow the Primary Care Management guidance on RefHelp whenever possible prior to making any referral.