Referrals not suitable for the MSK Service

RefHelp - NHS Ayrshire and Arran
NHS Ayrshire and Arran

Important - Please do not submit referrals to the MSK service purely for imaging e.g. MRI, or specific treatments e.g. corticosteroid injection. These referrals will be rejected and returned to the referrer. Please see points 6. and 16. below for further information.

1. Red flags/suspicion of serious pathology Investigations within primary care or onwards referral to most appropriate service.
2. Suspicion of cauda equina syndrome See cauda equina referral information as per the MSK Ayrshire & Arran spinal pathway.
3. Duplicate referrals to both the MSK Services and other secondary care services  Prior to referral, please consider which speciality is most suited for the individual's needs at that time. In line with the clinical pathway's redirection of referral and/or removal of the duplicate referral may occur if deemed in best interests of patient care.
4. Rheumatology/inflammatory joint disease If suspicion of inflammatory joint disease please consider a referral to Rheumatology.
5. Patients who have made it known that they are not willing to engage in rehabilitation or self-management Shared decision making is required with patients regarding their willingness to engage in Rehab and expectations of MSK services.
6. Do not refer purely for MRI or other imaging  
7. Spinal pain with evidence of progressive/altered neurology This is defined as:
  • Myotomal weakness – Grade 0-2 on the Oxford scale
  • Multi-level dermatomal and non-dermatomal numbness

See Spinal section.
8. New onset undiagnosed foot drop should not be referred to the MSK service
  • Foot drop associated with trauma (knee, spine, pelvis) should be referred urgently to Orthopaedics, ED/on-call/Orthopaedic Assessment Unit.
  • Foot drop associated with radiculopathy – refer urgently to Orthopaedics via SCI gateway.

Painless foot drop

Patients with acute bilateral foot drop, one sided foot drop with fasciculations, or more widespread neuropathy should be referred urgently to Neurology via SCI gateway - see Drop foot
9. Advanced osteoarthritis where orthopaedic intervention maybe considered
  • If patient consents – refer to Orthopaedics for consideration of potential joint replacement surgery.
  • If the patient does not consent to an Orthopaedic referral then MSK or community/third sector services should be considered.
10. Presentation of osteoarthritis if there has been no x-ray performed within the last year  
11. Re-referral to MSK services for the same condition in the past year, when previous treatment has been completed
  • Consider other services for escalation or discharge to third sector services for self-management. See previous MSK discharge letter.
  • If you still feel a re-referral is required, please document a clear reason for this and the expectations of the service.
12. Significant mental health/psychosocial distress which needs to be treated as a priority before MSK referral being set in place
  • Current psychological or psychiatric problems which impacts on ability to engage with a rehabilitation approach on a regular basis.
  • Consider Mental Health Team Physiotherapy input if active within Mental Health Services.
13. Persistent pain where previous MSK Pain Management Intervention has been completed
  • Please refer to previous MSK discharge letter to confirm if appropriate pain management has been delivered.
  • If deemed appropriate as per the referral criteria, please consider referral to secondary care pain management service.
  • If re-referral to be considered please detail expectations of further intervention.
14. Pregnancy related spinal pain - antenatal Please refer to women’s health/maternity unit Physiotherapy team. Post-natal women can be referred to women’s health up to 6/52 post-natally.
15. Neurology conditions – CVA, MS and MND etc. Please consider referral to neurological outpatients through non MSK pathways unless specific isolated MSK condition indicated.
16. Do not refer for acupuncture or corticosteroid injections as sole treatment Following a full assessment and examination a comprehensive treatment plan will be considered based around the patients’ needs that may include these treatments but not in the first instance.
17. Do not refer patients that are housebound or
have the inability to attend the out-patient setting		 Refer to community/domiciliary Physiotherapy/Podiatry.
18. Children under secondary school age or are
currently involved with the Paediatric Service should not be referred to MSK Physiotherapy or Occupational Therapy		 Children under secondary school age should be referred to the Paediatric Service over MSK Physiotherapy or MSK Occupational therapy Referrals to MSK Podiatry for patients under secondary school age will be accepted.
19. Non MSK Related Podiatry issues Referral to general podiatry service for wound care, nail surgery etc.